Handbook of Parenting: Volume I: Children and Parenting, Third Edition [3 ed.] 1138228664, 9781138228665

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HANDBOOK OF PARENTING

This highly anticipated third edition of the Handbook of Parenting brings together an array of field-leading experts who have worked in different ways toward understanding the many diverse aspects of parenting. Contributors to the Handbook look to the most recent research and thinking to shed light on topics every parent, professional, and policymaker wonders about. Parenting is a perennially “hot” topic. After all, everyone who has ever lived has been parented, and the vast majority of people become parents themselves. No wonder bookstores house shelves of “how-to” parenting books, and magazine racks in pharmacies and airports overflow with periodicals that feature parenting advice. However, almost none of these is evidence-based.The Handbook of Parenting is. Period. Each chapter has been written to be read and absorbed in a single sitting, and includes historical considerations of the topic, a discussion of central issues and theory, a review of classical and modern research, and forecasts of future directions of theory and research. Together, the five volumes in the Handbook cover Children and Parenting, the Biology and Ecology of Parenting, Being and Becoming a Parent, Social Conditions and Applied Parenting, and the Practice of Parenting. Volume 1, Children and Parenting, considers parenthood as a functional status in the life cycle: Parents protect, nurture, and teach their progeny, even if human development is more dynamic than can be determined by parental caregiving alone.Volume 1 of the Handbook of Parenting begins with chapters concerned with how children influence parenting. Notable are their more obvious characteristics, like child age or developmental stage; but subtler ones, like child gender, physical state, temperament, mental ability, and other individual differences factors, are also instrumental. The chapters in Part I, on Parenting Across the Lifespan, discuss the unique rewards and special demands of parenting children of different ages and stages—infants, toddlers, youngsters in middle childhood, and adolescents—as well as the modern notion of parent–child relationships in emerging adulthood, adulthood, and old age. The chapters in Part II, on Parenting Children of Varying Status, discuss common issues associated with parenting children of different genders and temperaments as well as unique situations of parenting adopted and foster children and children with a variety of special needs, such as those with extreme talent, born preterm, who are socially withdrawn or aggressive, or who fall on the autistic spectrum, manifest intellectual disabilities, or suffer a chronic health condition. Marc H. Bornstein holds a BA from Columbia College, MS and PhD degrees from Yale University, and honorary doctorates from the University of Padua and University of Trento. Bornstein is President of the Society for Research in Child Development and has held faculty positions at Princeton University and New York University as well as academic appointments in Munich, London, Paris, New York, Tokyo, Bamenda, Seoul,Trento, Santiago, Bristol, and Oxford. Bornstein is author of several children’s books, videos, and puzzles in The Child’s World and Baby Explorer series, Editor Emeritus of Child Development and founding Editor of Parenting: Science and Practice, and consultant for governments, foundations, universities, publishers, scientific journals, the media, and UNICEF. He has published widely in experimental, methodological, comparative, developmental, and cultural science as well as neuroscience, pediatrics, and aesthetics.

HANDBOOK OF PARENTING Volume 1: Children and Parenting Third Edition

Edited by Marc H. Bornstein

Third edition published 2019 by Routledge 52 Vanderbilt Avenue, New York, NY 10017 and by Routledge 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business © 2019 Taylor & Francis The right of Marc H. Bornstein to be identified as the author of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. First edition published by Laurence Erlbaum Associates 1995 Second edition published by Taylor and Francis 2002 Library of Congress Cataloging-in-Publication Data A catalog record has been requested for this book ISBN: 978-1-138-22865-8 (hbk) ISBN: 978-1-138-22866-5 (pbk) ISBN: 978-0-429-44084-7 (ebk) Typeset in Bembo by Apex CoVantage, LLC

For Marian and Harold Sackrowitz

CONTENTS

Preface to the Third Edition About the Editor About the Contributors

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PART I

Parenting Across the Lifespan

1

  1 Parenting Infants Marc H. Bornstein

3

  2 Parenting Toddlers Marjolein Verhoeven, Anneloes L. van Baar, and Maja Deković

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  3 Parenting During Middle Childhood W. Andrew Collins and Stephanie D. Madsen

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  4 Parenting Adolescents Bart Soenens, Maarten Vansteenkiste, and Wim Beyers

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  5 Parenting Emerging Adults Laura M. Padilla-Walker and Larry J. Nelson

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  6 Parent–Child Relationships in Adulthood and Old Age Karen L. Fingerman, Steven H. Zarit, and Kira S. Birditt

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Contents PART II

Parenting Children of Varying Status

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  7 Parenting Siblings Mark E. Feinberg, Susan M. McHale, and Shawn D.Whiteman

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  8 Parenting Girls and Boys Christia Spears Brown and Michelle Tam

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  9 Parenting and Temperament John E. Bates, Maureen E. McQuillan, and Caroline P. Hoyniak

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10 Parenting in Adoptive Families Ellen E. Pinderhughes and David M. Brodzinsky

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11 Foster Parenting Kristin Bernard, Allison Frost, Sierra Kuzava, and Laura Perrone

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12 Parenting Talented Children David Henry Feldman and Mel Andrews

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13 Parenting Children Born Preterm Merideth Gattis

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14 Parenting Behaviorally Inhibited and Socially Withdrawn Children Paul D. Hastings, Kenneth H. Rubin, Kelly A. Smith, and Nicholas J.Wagner

467

15 Parenting Aggressive Children Tina Malti, Ju-Hyun Song,Tyler Colasante, and Sebastian P. Dys

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16 Parenting and Autism Spectrum Disorder James B. McCauley, Peter Mundy, and Marjorie Solomon

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17 Parenting Children With Intellectual Disabilities Robert M. Hodapp, Ellen G. Casale, and Kelli A. Sanderson

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18 Parenting Children With a Chronic Health Condition Thomas G. Power, Lynnda M. Dahlquist, and Wendy Pinder

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Index625

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PREFACE TO THE THIRD EDITION

Previous editions of the Handbook of Parenting have been called the “who’s who of the what’s what.” This third edition of the Handbook appears at a time that is momentous in the history of parenting. The family generally, and parenting specifically, are today in a greater state of flux, question, and redefinition than perhaps ever before. We are witnessing the emergence of striking permutations on the theme of parenting: blended families, lesbian and gay parents, teen versus fifties first-time moms and dads, genetic versus social parents. One cannot but be awed on the biological front by technology that now renders postmenopausal women capable of childbearing and with the possibility of parents designing their babies. Similarly, on the sociological front, single parenthood is a modern-day fact of life, adult child dependency is on the rise, and even in the face of rising institutional demands to take increasing responsibility for their offspring, parents are ever less certain of their roles and responsibilities.The Handbook of Parenting is concerned with all these facets of parenting . . . and more. Most people become parents, and everyone who ever lived has had parents, still parenting remains a mystifying subject. Who is ultimately responsible for parenting? Does parenting come naturally, or must parenting be learned? How do parents conceive of parenting? of childhood? What does it mean to parent a preterm baby, twins, or a child on the autistic spectrum? to be an older parent, or one who is divorced, disabled, or drug abusing? What do theories (psychoanalysis, personality theory, attachment, and behavior genetics, for example) contribute to our understanding of parenting? What are the goals parents have for themselves? for their children? What functions do parents’ cognitions serve? What are the aims of parents’ practices? What accounts for parents believing or behaving in similar ways? Why do so many attitudes and actions of parents differ so? How do children influence their parents? How do personality, knowledge, and worldview affect parenting? How do social class, culture, environment, and history shape parenthood? How can parents effectively relate to childcare, schools, and their children’s pediatricians? These are many of the questions addressed in this third edition of the Handbook of Parenting . . . for this is an evidenced-based volume set on how to parent as much as it is one on what being a parent is all about. Put succinctly, parents create people. They are entrusted with preparing their offspring for the physical, psychosocial, and economic conditions in which their children eventually will fare and hopefully will flourish. Amidst the many influences on each next generation, parents are the “final common pathway” to children’s development and stature, adjustment and success. Human social inquiry—antedating even Athenian interest in Spartan childrearing practices—has always, as a matter of course, included reports of parenting. Freud opined that childrearing is one of three “impossible ix

Preface to the Third Edition

professions”—the other two being governing nations and psychoanalysis. One encounters as many views as the number of people one asks about the relative merits of being an at-home or a working mother, about what mix of daycare, family care, or parent care is best for a child, about whether good parenting reflects intuition or experience. The Handbook of Parenting concerns itself with different types of parents—mothers and fathers, single, adolescent, and adoptive parents; with basic characteristics of parenting knowledge, beliefs, and expectations about parenting—as well as the practice of parenting; with forces that shape parenting—employment, social class, culture, environment, and history; with problems faced by parents—handicap, marital difficulties, drug addiction; and with practical concerns of parenting— how to promote children’s health, foster social adjustment and cognitive competence, and interact with educational, legal, and religious institutions. Contributors to the Handbook of Parenting have worked in different ways toward understanding all these diverse aspects of parenting, and all look to the most recent research and thinking in the field to shed light on many topics every parent, professional, and policymaker wonders about. Parenthood is a job whose primary object of attention and action is the child. But parenting also has consequences for parents. Parenthood is giving and responsibility, and parenting has its own intrinsic pleasures, privileges, and profits as well as frustrations, fears, and failures. Parenthood can enhance psychological development, self-confidence, and sense of well-being, and parenthood also affords opportunities to confront new challenges and to test and display diverse competencies. Parents can derive considerable and continuing pleasure in their relationships and activities with their children. But parenting is also fraught with small and large stresses and disappointments. The transition to parenthood is daunting, and the onrush of new stages of parenthood is relentless. In the final analysis, however, parents receive a great deal “in kind” for the hard work of parenting—they can be recipients of unconditional love, they can gain skills, and they can even pretend to immortality. This third edition of the Handbook of Parenting reveals the many positives that accompany parenting and offers resolutions for its many challenges. The Handbook of Parenting encompasses the broad themes of who are parents, whom parents parent, the scope of parenting and its many effects, the determinants of parenting, and the nature, structure, and meaning of parenthood for parents. The third edition of the Handbook of Parenting is divided into five volumes, each with two parts: CHILDREN AND PARENTING is Volume 1 of the Handbook. Parenthood is, perhaps first and foremost, a functional status in the life cycle: Parents issue as well as protect, nurture, and teach their progeny even if human development is too subtle and dynamic to admit that parental caregiving alone determines the developmental course and outcome of ontogeny. Volume 1 of the Handbook of Parenting begins with chapters concerned with how children influence parenting. Notable are their more obvious characteristics, like child age or developmental stage; but more subtle ones, like child gender, physical state, temperament, mental ability, and other individual differences factors, are also instrumental. The chapters in Part I, on Parenting Across the Lifespan, discuss the unique rewards and special demands of parenting children of different ages and stages—infants, toddlers, youngsters in middle childhood, and adolescents— as well as the modern notion of parent–child relationships in emerging adulthood and adulthood and old age. The chapters in Part II, on Parenting Children of Varying Status, discuss common issues associated with parenting children of different genders and temperaments as well as unique situations of parenting adopted and foster children and children with a variety of special needs, such as those with extreme talent, born preterm, who are socially withdrawn or aggressive, or who fall on the autistic spectrum, manifest intellectual disabilities, or suffer a chronic health condition.

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Preface to the Third Edition

BIOLOGY AND ECOLOGY OF PARENTING is Volume 2 of the Handbook. For parenting to be understood as a whole, biological and ecological determinants of parenting need to be brought into the picture.Volume 2 of the Handbook relates parenting to its biological roots and sets parenting in its ecological framework. Some aspects of parenting are influenced by the organic make-up of human beings, and the chapters in Part I, on the Biology of Parenting, examine the evolution of parenting, the psychobiological determinants of parenting in nonhumans, and primate parenting and then the genetic, prenatal, neuroendocrinological, and neurobiological bases of human parenting. A deep understanding of what it means to parent also depends on the ecologies in which parenting takes place. Beyond the nuclear family, parents are embedded in, influence, and are themselves affected by larger social systems. The chapters in Part II, on the Ecology of Parenting, examine the ancient and modern histories of parenting as well as epidemiology, neighborhoods, educational attainment, socioeconomic status, culture, and environment to provide an overarching relational developmental contextual systems perspective on parenting. BEING AND BECOMING A PARENT is Volume 3 of the Handbook. A large cast of characters is responsible for parenting, each has her or his own customs and agenda, and the psychological characteristics and social interests of those individuals are revealing of what parenting is. Chapters in Part I, on The Parent, show just how rich and multifaceted is the constellation of children’s caregivers. Considered first are family systems and then successively mothers and fathers, coparenting and gatekeeping between parents, adolescent parenting, grandparenting, and single parenthood, divorced and remarried parenting, lesbian and gay parents, and finally sibling caregivers and nonparental caregiving. Parenting also draws on transient and enduring physical, personality, and intellectual characteristics of the individual.The chapters in Part II, on Becoming and Being a Parent, consider the intergenerational transmission of parenting, parenting and contemporary reproductive technologies, the transition to parenthood, and stages of parental development, and then chapters turn to parents’ well-being, emotions, self-efficacy, cognitions, attributions, as well as socialization, personality in parenting, and psychoanalytic theory. These features of parents serve many functions: They generate and shape parental practices, mediate the effectiveness of parenting, and help to organize parenting. SOCIAL CONDITIONS AND APPLIED PARENTING is Volume 4 of the Handbook. Parenting is not uniform across communities, groups, or cultures; rather parenting is subject to wide variation.Volume 4 of the Handbook describes socially defined groups of parents and social conditions that promote variation in parenting. The chapters in Part I, on Social and Cultural Conditions of Parenting, start with a relational developmental systems perspective on parenting and move to considerations of ethnic and minority parenting among Latino and Latin Americans, African Americans, Asians and Asian Americans, Indigenous parents, and immigrant parents. The section concludes with the roles of employment and of poverty on parenting. Parents are ordinarily the most consistent and caring people in children’s lives. However, parenting does not always go right or well. Information, education, and support programs can remedy potential ills. The chapters in Part II, on Applied Issues in Parenting, begin with how parenting is measured and follow with examinations of maternal deprivation, attachment, and acceptance/rejection in parenting. Serious challenges to parenting—some common, such as stress, depression, and disability, and some less common, such as substance abuse, psychopathology, maltreatment, and incarceration—are addressed, as are parenting interventions intended to redress these trials. THE PRACTICE OF PARENTING is Volume 5 of the Handbook. Parents meet the biological, physical, and health requirements of children. Parents interact with children socially. Parents stimulate children to engage and understand the environment and to enter the world

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of learning. Parents provision, organize, and arrange their children’s home and local environments and the media to which children are exposed. Parents also manage child development vis-à-vis childcare, school, the circles of medicine and law, as well as other social institutions through their active citizenship. Volume 5 of the Handbook addresses the nuts-and-bolts of parenting as well as the promotion of positive parenting practices. The chapters in Part I, on Practical Parenting, review the ethics of parenting, parenting and the development of children’s self-regulation, discipline, prosocial and moral development, and resilience as well as children’s language, play, cognitive, and academic achievement and children’s peer relationships. Many caregiving principles and practices have direct effects on children. Parents indirectly influence children as well, for example, through relations they have with their local or larger communities. The chapters in Part II, on Parents and Social Institutions, explore parents and their children’s childcare, activities, media, schools, and health care and examine relations between parenthood and the law, public policy, and religion and spirituality. Each chapter in the third edition of the Handbook of Parenting addresses a different but central topic in parenting; each is rooted in current thinking and theory as well as classical and modern research on a topic; each is written to be read and absorbed in a single sitting. Each chapter in this new Handbook adheres to a standard organization, including an introduction to the chapter as a whole, followed by historical considerations of the topic, a discussion of central issues and theory, a review of classical and modern research, forecasts of future directions of theory and research, and a set of evidence-based conclusions. Of course, each chapter considers contributors’ own convictions and findings, but contributions to this third edition of the Handbook of Parenting attempt to present all major points of view and central lines of inquiry and interpret them broadly.The Handbook of Parenting is intended to be both comprehensive and state-of-the-art. To assert that parenting is complex is to understate the obvious. As the expanded scope of this third edition of the Handbook of Parenting also amply attests, parenting is naturally and intensely interdisciplinary. The Handbook of Parenting is concerned principally with the nature and scope of parenting per se and secondarily with child outcomes of parenting. Beyond an impressive range of information, readers will find passim typologies of parenting (e.g., authoritarian-autocratic, indulgent-permissive, indifferent-uninvolved, authoritative-reciprocal), theories of parenting (e.g., ecological, psychoanalytic, behavior genetic, ethological, behavioral, sociobiological), conditions of parenting (e.g., gender, culture, content), recurrent themes in parenting studies (e.g., attachment, transaction, systems), and even aphorisms (e.g., “A child should have strict discipline in order to develop a fine, strong character,” “The child is father to the man”). Each chapter in the Handbook of Parenting lays out the meanings and implications of a contribution and a perspective on parenting. Once upon a time, parenting was a seemingly simple thing: Mothers mothered. Fathers fathered. Today, parenting has many motives, many meanings, and many manifestations. Contemporary parenting is viewed as immensely time consuming and effortful. The perfect mother or father or family is a figment of false cultural memory. Modern society recognizes “subdivisions” of the call: genetic mother, gestational mother, biological mother, birth mother, social mother. For some, the individual sacrifices that mark parenting arise for the sole and selfish purpose of passing one’s genes on to succeeding generations. For others, a second child may be conceived to save the life of a first child. A multitude of factors influences the unrelenting advance of events and decisions that surround parenting—biopsychosocial, dyadic, contextual, historical. Recognizing this complexity is important to informing people’s thinking about parenting, especially informationhungry parents themselves. This third edition of the Handbook of Parenting explores all these motives, meanings, and manifestations of parenting.

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Preface to the Third Edition

Each day, more than three-quarters of a million adults around the world experience the rewards and challenges, as well as the joys and heartaches, of becoming parents. The human race succeeds because of parenting. From the start, parenting is a “24/7” job. Parenting formally begins before pregnancy and can continue throughout the life-span: Practically speaking for most, once a parent, always a parent. Parenting is a subject about which people hold strong opinions and about which too little solid information or considered reflection exists. Parenting has never come with a Handbook . . . until now. —Marc H. Bornstein

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ABOUT THE EDITOR

Marc H. Bornstein holds a BA from Columbia College, MS and PhD degrees from Yale University, and honorary doctorates from the University of Padua and University of Trento. Bornstein was a J. S. Guggenheim Foundation Fellow, and he received a Research Career Development Award from the National Institute of Child Health and Human Development. He also received the C. S. Ford Cross-Cultural Research Award from the Human Relations Area Files, the B. R. McCandless Young Scientist Award and the G. Stanley Hall Award from the American Psychological Association, a United States PHS Superior Service Award and an Award of Merit from the National Institutes of Health, two Japan Society for the Promotion of Science Fellowships, four Awards for Excellence from the American Mensa Education & Research Foundation, the Arnold Gesell Prize from the Theodor Hellbrügge Foundation, the Distinguished Scientist Award from the International Society for the Study of Behavioral Development, and both the Distinguished International Contributions to Child Development Award and the Distinguished Scientific Contributions to Child Development Award from the Society for Research in Child Development. Bornstein is President of the Society for Research in Child Development and a past member of the SRCD Governing Council and Executive Committee of the International Congress of Infancy Studies. Bornstein has held faculty positions at Princeton University and New York University as well as academic appointments as Visiting Scientist at the Max-Planck-Institut für Psychiatrie in Munich; Visiting Fellow at University College London; Professeur Invité at the Laboratoire de Psychologie Expérimentale in the Université René Descartes in Paris; Child Clinical Fellow at the Institute for Behavior Therapy in New York; Visiting Professor at the University of Tokyo; Professeur Invité at the Laboratoire de Psychologie du Développement et de l’Éducation de l’Enfant in the Sorbonne in Paris;Visiting Fellow of the British Psychological Society;Visiting Scientist at the Human Development Resource Centre in Bamenda, Cameroon; Visiting Scholar at the Institute of Psychology in Seoul National University in Seoul, South Korea; Visiting Professor at the Faculty of Cognitive Science in the University of Trento, Italy; Profesor Visitante at the Pontificia Universidad Católica de Chile in Santiago, Chile; Institute for Advanced Studies Benjamin Meaker Visiting Professor, University of Bristol; Jacobs Foundation Scholar-in-Residence, Marbach, Germany; Honorary Fellow, Department of Psychiatry, Oxford University; Adjunct Academic Member of the Council of the Department of Cognitive Sciences, University of Trento, Italy; and International Research Fellow at the Institute for Fiscal Studies, London.

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About the Editor

Bornstein is coauthor of The Architecture of the Child Mind: g, Fs, and the Hierarchical Model of Intelligence, Gender in Low- and Middle-Income Countries, Development in Infancy (5 editions), Development: Infancy through Adolescence, Lifespan Development, Genitorialità: Fattori Biologici E Culturali Dell’essere Genitori, and Perceiving Similarity and Comprehending Metaphor. He is General Editor of The Crosscurrents in Contemporary Psychology Series, including Psychological Development from Infancy, Comparative Methods in Psychology, Psychology and Its Allied Disciplines (Vols. I–III), Sensitive Periods in Development, Interaction in Human Development, Cultural Approaches to Parenting, Child Development and Behavioral Pediatrics, and Well-Being: Positive Development Across the Life Course, and general editor of the Monographs in Parenting series, including his own Socioeconomic Status, Parenting, and Child Development and Acculturation and Parent–Child Relationships. He edited Maternal Responsiveness: Characteristics and Consequences, the Handbook of Parenting (Vols. I–V, 3 editions), and the Handbook of Cultural Developmental Science (Parts 1 and 2), and is Editor-in-Chief of the SAGE Encyclopedia of Lifespan Human Development. He also coedited Developmental Science: An Advanced Textbook (7 editions), Stability and Continuity in Mental Development, Contemporary Constructions of the Child, Early Child Development in the French Tradition, The Role of Play in the Development of Thought, Acculturation and Parent–Child Relationships, Immigrant Families in Contemporary Society, The Developing Infant Mind: Origins of the Social Brain, and Ecological Settings and Processes in Developmental Systems (Volume 4 of the Handbook of Child Psychology and Developmental Science). He is author of several children’s books, videos, and puzzles in The Child’s World and Baby Explorer series. Bornstein is Editor Emeritus of Child Development and founding Editor of Parenting: Science and Practice. He has administered both federal and foundation grants, sits on the editorial boards of several professional journals, is a member of scholarly societies in a variety of disciplines, and consults for governments, foundations, universities, publishers, scientific journals, the media, and UNICEF. He has published widely in experimental, methodological, comparative, developmental, and cultural science as well as neuroscience, pediatrics, and aesthetics. Bornstein was named to the Top 20 Authors for Productivity in Developmental Science by the American Educational Research Association.

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ABOUT THE CONTRIBUTORS

Mel Andrews is at Tufts University studying theories of cognition, evolution, and development. Andrews hopes to contribute to a scholarly understanding of human mentality, agency, consciousness, and cultural reality in relation to our status as evolved organisms. She has presented her work at conferences organized by the Society for the Study of Human Development and The Generalized Theory of Evolution. As a visiting fellow at Binghamton University, Andrews taught evolutionary biology with a focus on implications for the philosophy of science. Andrews has a background in both qualitative and experimental approaches to the ontogeny of the human mind, having served as a cognitive developmental researcher at both Tufts University and Harvard University. John E. Bates is Professor in the Department of Psychological and Brain Sciences at Indiana University, Bloomington. He received his BS in Psychology from the University of Washington, where he first became interested in the question of how individual differences develop. He received his PhD from UCLA in Clinical Psychology with minors in Developmental Psychology and Social Psychology. His research has emphasized the longitudinal study of additive and interactive roles of biological and social processes in development of behavioral adjustment. In the Indiana University Psychological Clinic, he has led a clinic for families of children with oppositional problems. Kristin Bernard is Assistant Professor of Psychology at Stony Brook University. Bernard received her PhD from the Department of Psychology at the University of Delaware and completed her clinical internship at the University of Illinois at Chicago. Bernard was named a Rising Star by the Association for Psychological Science. Bernard takes a translational approach to research about childhood maltreatment by integrating methods across fields of developmental science, neuroscience, and prevention science. Wim Beyers is Professor at the Department of Developmental, Personality and Social Psychology at Ghent University, Belgium. He received his PhD from the Catholic University of Leuven. His major research interests include the development of autonomy, identity, and sexuality in adolescence. He is assistant editor of the Journal of Adolescence. Kira S. Birditt is Associate Research Professor in the Life Course Development Program at the Institute for Social Research, University of Michigan. She received her PhD in Human Development and Family Studies from the Pennsylvania State University. She is Principal Investigator on xvi

About the Contributors

a study of racial health disparities in hypertension, which incorporates short-term stress reactivity studies into a larger longitudinal study of social relationships and health. She is also a co-investigator on the Family Exchanges Study, a longitudinal study of three-generation families; the Daily Experience in Late Life Study, an in-depth study of social engagement among older adults; and the Social Relations and Health study, a longitudinal study of social relationships. She has published widely on the topic of negative aspects of relationships and their implications for biological systems and health. Marc H. Bornstein is President of the Society for Research in Child Development. He holds a BA from Columbia College, MS and PhD degrees from Yale University, and honorary doctorates from the University of Padua and University of Trento. He has held faculty positions at Princeton University and New York University as well as visiting academic appointments in Munich, London, Paris, New York, Tokyo, Bamenda (Cameroon), Seoul, Trento, Santiago (Chile), Bristol, Oxford, and the Institute for Fiscal Studies (London). He is Editor Emeritus of Child Development and founding Editor of Parenting: Science and Practice. He has administered both Federal and Foundation grants, sits on the editorial boards of several professional journals, is a member of scholarly societies in a variety of disciplines, and consults for governments, foundations, universities, publishers, the media, and UNICEF. Bornstein has published widely in experimental, methodological, comparative, developmental, and cultural science as well as neuroscience, pediatrics, and aesthetics. David M. Brodzinsky is Professor Emeritus of Clinical and Developmental Psychology at Rutgers University and Research Director at the National Center on Adoption and Permanency. Brodzinsky was educated at the State University of New York at Buffalo and was previously affiliated with the Donaldson Adoption Institute. His research has focused primarily on developmental and family issues in the adjustment of adopted children and their families, including families headed by sexual minority parents. He received the Adoption Excellence Award from the U.S. Department of Health and Human Services, Children’s Bureau, for his contributions to the field. Brodzinsky is co-author of Children’s Adjustment to Adoption: Developmental and Clinical Issues and co-editor of Adoption by Lesbians and Gay Men: A New Dimension in Family Diversity. Christia Spears Brown is Professor of Developmental Psychology at the University of Kentucky. She earned her PhD in Psychology at the University of Texas at Austin. She was previously at the University of California, Los Angeles. Her research focuses on children’s perceptions of gender and ethnic discrimination, the development of stereotypes and group identity, and the impact of discrimination and stereotypes on academic, psychological, and social outcomes funded by the Foundation for Child Development. She has written two books, one for an academic audience, Discrimination in Childhood and Adolescence, and one for parents, Parenting Beyond Pink and Blue, and co-edited the Wiley Handbook of Group Processes in Children and Adolescents. She is Associate Editor of the Journal of Adolescent Research. Ellen G. Casale is a doctoral student in the Special Education-Low Incidence Disabilities program at Vanderbilt University. She received her Education Specialist degree in autism spectrum disorders from the University of Alabama at Birmingham and her master’s degree in Special Education from Vanderbilt University. Casale has worked as a special education teacher, in-home interventionist, autism specialist and diagnostician, and district special educational specialist. She co-authored a chapter for the Oxford Handbook of Down Syndrome. Casale’s research interests include improving educational, behavioral, and functional outcomes for individuals with severe disabilities. Tyler Colasante is a postdoctoral fellow from the Laboratory for Social-Emotional Development and Intervention in the Department of Psychology at the University of Toronto. He completed his PhD at the University of Toronto where he focused on the psychophysiological correlates of guilt xvii

About the Contributors

and aggressive behavior in childhood and adolescence. Ultimately, he aims to understand how children with different regulatory and socioemotional capacities navigate social conflicts across development and to generate practical implications to reduce aggression and related problem behaviors. Colasante is co-author of a chapter on aggression, and morality in the Handbook of Child and Adolescent Aggression. W. Andrew Collins is Morse-Alumni Distinguished Teaching Professor Emeritus at the Institute of Child Development, University of Minnesota. He received his PhD from Stanford University. Collins served as Director of the Institute of Child Development, Secretary of the Society for Research in Child Development, and President of the Society for Research on Adolescence. Collins specialized in the study of social processes and relationships in middle childhood and adolescence and has investigated developmental aspects of children’s and adolescents’ responses to television and parent–child relationships during the transitions to adolescence and young adulthood. He served as Chair of the National Research Council’s Panel on the Status of Basic Research on Middle Childhood (age 6–12 years) and is co-author of The Development of the Person:The Minnesota Study of Risk and Adaptation from Birth to Adulthood. Collins edited or coedited multiple volumes, including Relationships as Developmental Contexts and Relationships Pathways: From Adolescence to Young Adulthood. Lynnda M. Dahlquist is Professor of Psychology at the University of Maryland, Baltimore County. Dahlquist completed her graduate training in clinical psychology at Purdue University, where she specialized in child health psychology, and her internship training in Pediatric Psychology at the Oklahoma Health Sciences Center. Formerly a member of the Baylor College of Medicine faculty at Texas Children’s Hospital, she has extensive clinical experience consulting with pediatricians and working with children with acute and chronic health conditions and their families. Dahlquist’s research focuses primarily on child and family adjustment to chronic pediatric health conditions, such as food allergy, arthritis, and cancer, and on nonpharmacological pain management strategies for children experiencing acute pain. She is the author of Pediatric Pain Management. Maja Deković is Professor of Clinical Child and Family Studies and leader of the Utrecht Centre for Child and Adolescent Studies, an interdisciplinary research program that aims to explain how individual characteristics, proximal social relationships, and the wider social and cultural context shape developmental trajectories, with the ultimate aim to improve preventive and/or interventions to help children and families optimally develop. She received her PhD at Radboud University, Nijmegen, and previously was affiliated with the University of Amsterdam. Her research interests include children and adolescent normative and deviant development, parent–child relationships, family interaction, and effects of family-based interventions. She was project leader of several effectiveness studies (Home-Start, Multisystemic Therapy, Intensive Home Visiting Program, Family Conferencing, Rock and Water). In addition, she is a member of several (inter)national research committees and editorial boards on (inter)national journals. Sebastian P. Dys is a PhD candidate in the Developmental Sciences Program at the University of Toronto. His research focuses on the cognitive and affective mechanisms that promote children’s and adolescents’ moral, emotional, and social development. This research employs a multimethod approach using eye tracking, facial expression analyses, behavioral observations, and interviews. His overarching goal is to provide direction to parents, educators, and program developers interested in specific strategies and practices for promoting socioemotional development and behavioral health. Dys is a coauthor of a chapter on emotions and morality in New Perspectives in Moral Development.

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About the Contributors

Mark E. Feinberg is Research Professor at the Pennsylvania State University. Feinberg was educated at Harvard College and George Washington University. He has developed and tested several prevention programs, including Family Foundations, a transition-to-parenthood program designed to enhance coparenting among first-time parents. Feinberg has also co-developed prevention programs addressing sibling relationship conflict, adverse birth outcomes, and childhood obesity and has been involved in the long-term evaluation of large-scale community prevention systems, including Communities That Care, PROSPER, and Evidence2Success. He has written about and examined the community epidemiology of adolescent problem behaviors, and the ways in which risk factors are linked to behavior problems within and between communities. David Henry Feldman is Professor at the Eliot-Pearson Department of Child Development, Tufts University, and President of the Society for the Study of Human Development. Prior faculty appointments include the University of Minnesota and Yale University and visiting appointments at Harvard University, Tel Aviv University, and the University of California, San Diego. Feldman holds degrees from the University of Rochester, Harvard University, and Stanford University. His research interests involve developmental theory, transitions between levels of expertise in cognitive development, extremes in intellectual development, creativity, and the development of cultural knowledge domains. Feldman is the recipient of a Fulbright Fellowship to Israel and the Distinguished Scholar of the Year Award of the National (U.S.) Association for Gifted Children. His books include Beyond Universals in Cognitive Development, Nature’s Gambit: Child Prodigies and the Development of Human Potential, and Changing the World: A Framework for the Study of Creativity. Karen L. Fingerman is Professor of Human Development and Family Sciences at the University of Texas at Austin. She received her PhD in Psychology from the University of Michigan and has served on the faculty at the University of San Francisco, Pennsylvania State University, and Purdue University. She is currently Principal Investigator on the Family Exchanges Study, a longitudinal study of three-generation families. She also directs the Daily Experience in Late Life Study, an indepth study tracking social engagement, daily activities, and well-being among over 300 older adults. She is the author or coeditor of Aging Mothers and Their Adult Daughters: A Study in Mixed Emotions, Growing Together: Personal Relationships across the Life Span, and Handbook of Lifespan Development. She was an associate editor on the Encyclopedia of Mental Health and the SAGE Encyclopedia of Lifespan Human Development. Allison Frost is a graduate student in the Clinical Psychology program at Stony Brook University. Frost obtained her BS in Education from Northwestern University. She is the recipient of a National Science Foundation Graduate Research Fellowship. Frost is interested in how early adversity can impact children’s neurobiological and socioemotional functioning, and how these effects may confer risk for later psychopathology. Merideth Gattis is Professor of Psychology at Cardiff University and a Fellow of the Learned Society of Wales. Gattis was educated at Gordon College, Massachusetts, and the University of California, Los Angeles, and previously was affiliated with the Max Planck Institute and the University of Sheffield. She is on the editorial boards of Parenting: Science and Practice and Psychological Science. Gattis is editor of Spatial Schemas and Abstract Thought. Paul D. Hastings is Professor of Psychology at the University of California Davis, where he directs the Healthy Emotions, Relationships and Development Lab at the Center for Mind and Brain. Hastings was educated at McGill University and the University of Toronto before completing postdoctoral

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About the Contributors

training at the University of Waterloo, Ontario, and the National Institute of Mental Health. Hastings was Chair of Psychology and Interim Dean of the School of Education at the University of California Davis and at Concordia University in Montreal. His research is focused on social relationships, neurobiological regulation, and social-emotional development of children and youth. Robert M. Hodapp is Professor of Special Education at Peabody College of Vanderbilt University. He is also the Director of Research for Vanderbilt Kennedy Center’s University Center for Excellence in Developmental Disabilities. Hodapp received his PhD from Boston University, was a postdoctoral fellow with Edward Zigler at the Yale Child Study Center, and was a professor at UCLA’s Graduate School of Education and Information Studies. The author of Development and Disabilities and co-author of Genetics and Mental Retardation Syndromes, Hodapp is also the series co-editor of the International Review of Research in Developmental Disabilities. Caroline P. Hoyniak is a PhD candidate in the Clinical Science program in the Department of Psychological and Brain Sciences at Indiana University, Bloomington. She received her BA in Psychology from the Saint Louis University. Her research focuses on the development of self-regulation during early childhood, with a particular emphasis on examining its neural correlates. Sierra Kuzava is a graduate student in the Clinical Psychology program at Stony Brook University. Kuzava obtained her BA in Psychology from Columbia. She is the recipient of a National Science Foundation Graduate Research Fellowship. Kuzava is interested in the mechanisms through which early life stress may impact children’s development as well as the psychobiology of responsive parenting. Stephanie D. Madsen is Associate Dean for Sophomore Students and Professor of Psychology at McDaniel College,Westminster, Maryland. She received her PhD in Child Psychology with a minor in Interpersonal Relationships Research from the Institute of Child Development, University of Minnesota. She has focused her research on the role of relationships in development. She currently serves on the Teaching Committee for the Society of Research on Child Development and is a recipient of the Ira G. Zepp Distinguished Teaching Award. Tina Malti is Professor of Psychology and the Director of the Laboratory for Social-Emotional Development and Intervention at the University of Toronto. Malti was educated at the Max Planck Institute for Human Development, Harvard Medical School, and the Jacobs Center for Productive Youth Development. She is a fellow of the Association for Psychological Science and the American Psychological Association (Division 7, Developmental Psychology). Her research focuses on why certain children become aggressive, whereas others show high levels of concern from a very young age. She is Associate Editor of Child Development and a co-editor of the Handbook of Child and Adolescent Aggression. Malti also serves as the Membership Secretary of the International Society for the Study of Behavioural Development. James B. McCauley is currently a PhD candidate in the Department of Human Development and a graduate student researcher at the MIND Institute and the Department of Psychiatry at the University of California, Davis. He has previously researched processes such as self-esteem, memory, and academic achievement in youth with autism spectrum disorders and has extensive experience working with families of children with ASD. His dissertation is exploring the role of parent–adolescent and parent–adult interactions in families of children with ASD and their effects on social and adaptive behaviors.

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About the Contributors

Susan M. McHale is Distinguished Professor of Human Development and Professor of Demography at Pennsylvania State University. Her research examines children’s and adolescents’ family roles, daily activities, and relationships, particularly sibling relationships, and their links with individual development and adjustment as well as the development of sibling differences. Highlighted are family gender dynamics, including connections between the work and family roles of mothers and fathers and girls’ and boys’ development. She also has investigated family sociocultural contexts and dynamics, including the implications of parents’ and youth cultural values and practices for family life and youth development and adjustment in African American and Mexican American families. Maureen E. McQuillan is a PhD candidate in the Clinical Science program in the Department of Psychological and Brain Sciences at Indiana University, Bloomington. She received her BA in Psychology from the University of Notre Dame. She studies parental stress, sleep deficits, and parent–child interactions to advance understanding of the development and treatment of oppositional problems in young children. Peter Mundy is the Lisa Capps Professor of Neurodevelopmental Disorders and Education in the Department of Psychiatry and the MIND Institute and Distinguished Professor in the School of Education at the University of California at Davis. Mundy is also Associate Editor for Autism Research and the Associate Dean for Academic Personnel and Research in the University of California Davis School of Education. A developmental and clinical psychologist, Mundy works on identifying the role that joint-attention plays in the problems with learning, language, and social-cognition that affect individuals with autism spectrum disorders. Mundy authored Autism and Joint Attention: Developmental, Neuroscience and Clinic Foundations. Larry J. Nelson is a Professor in the School of Family Life at Brigham Young University. Nelson earned his PhD from the University of Maryland, College Park. He examines factors that contribute to flourishing or floundering during emerging adulthood. He has served on the Founding Board and Governing Council of the Society for the Study of Emerging Adulthood. He is the editor of a book series on emerging adulthood and co-editor of Flourishing in Emerging Adulthood: Positive Development during the Third Decade of Life. Laura M. Padilla-Walker is a Professor in the School of Family life at Brigham Young University. Padilla-Walker received her PhD at the University of Nebraska, Lincoln. Her research focuses primarily on parenting, media, and adolescents’ and emerging adults’ moral and prosocial development. Padilla-Walker is former Associate Editor of the journal Emerging Adulthood and has co-edited Prosocial Development: A Multidimensional Approach, Flourishing in Emerging Adulthood: Positive Development During the Third Decade of Life, and The Oxford Handbook of Parenting and Moral Development. Laura Perrone is a graduate student in the Clinical Psychology program at Stony Brook University. Perrone obtained her BA in Psychology from Pomona College. She is the recipient of a National Science Foundation Graduate Research Fellowship. Perrone is interested in the effects of early adversity on children’s development and psychobiology as well as the role of parenting as a protective factor. Wendy Pinder, MA, is a clinical psychology doctoral student at the University of Maryland, Baltimore County. Her research interests include pediatric pain management as well as interventions that promote adherence to medical regimens for children with chronic illnesses and their families.

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Ellen E. Pinderhughes is Professor in the Eliot-Pearson Department of Child Study and Human Development, Tufts University, and Senior Fellow with the National Center for Adoption and Permanency. Pinderhughes was educated at Yale University and previously was affiliated with Vanderbilt University and Cleveland State University. A developmental and clinical psychologist, she studies contextual influences on and cultural processes in parenting among families facing different challenges, including adoption, living in high-risk, low-resource communities, and rearing children as a sexual minority parent. Her research addresses adoption professionals’ practices and adoptive parents’ experiences concerning intercountry adoption and adoption socialization, cultural socialization, and preparation-for-bias among adoptive parents. She has received funding from the William T. Grant Foundation. Thomas G. Power is Emeritus Professor of Human Development at Washington State University. He received his PhD in Developmental Psychology at the University of Illinois. He was a member of the psychology faculty at the University of Houston and the Human Development faculty at Washington State University. Power led the development of the nation’s first PhD program in Prevention Science and served as its first director. He conducts research on parent–child relationships, with a particular emphasis on stress, coping, and health behaviors. He is author of Play and Exploration in Children and Animals. Kenneth H. Rubin is Professor of Human Development and Quantitative Methodology and Founding Director of the Center for Children, Relationships, and Culture at the University of Maryland, College Park. Previously, he was Professor at the University of Waterloo and held visiting appointments at Stanford, Washington, Melbourne, and Munich. He holds a BA from McGill and a PhD from Pennsylvania State University. His research interests include the study of child and adolescent social development, especially peer and parent–child relationships; social and emotional adjustment and maladjustment in childhood and adolescence; and the origins and developmental course of social competence, social withdrawal, and aggression. Kelli A. Sanderson earned her PhD in Special Education from Peabody College at Vanderbilt University. She is Assistant Professor of Special Education at California State University at Long Beach. Sanderson worked as a special education teacher in Los Angeles. Sanderson’s research interests include family-practitioner collaboration, transition services for students with severe disabilities, postsecondary education, and disability advocacy. Kelly A. Smith is a doctoral student at the University of Maryland, College Park, in the Department of Human Development and Quantitative Methodology. She received her BA in psychology from Georgetown University before beginning graduate training at the Center for Children, Relationships, and Culture at the University of Maryland. Bart Soenens is Professor at the Department of Developmental, Personality, and Social Psychology at Ghent University, Belgium. He received his PhD in Developmental Psychology from the Catholic University of Leuven, Belgium. His research interests include self-determination, autonomy, parent– adolescent relationships, parental psychological control, and identity development. He is co-author of Vitamins for Psychological Growth and co-editor of Autonomy in Adolescent Development. Marjorie Solomon is the Oates Family Endowed Chair in Lifespan Development in Autism at University of California, Davis, School of Medicine, where she is also Professor in the Department of Psychiatry and Behavioral Sciences, the Interim Director of the Imaging Research Center, and

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About the Contributors

a faculty member of the MIND Institute. Solomon received her BA from Harvard College and her PhD from the University of California, Berkeley. Her laboratory examines cognitive development in individuals with autism spectrum disorder through the lifespan using cognitive neuroscience methods, including functional magnetic resonance imaging. She is Director of the MIND Institute Social Skills Training Group Program. Ju-Hyun Song is an assistant professor in the Department of Child Development at California State University Dominguez Hills. Song completed her PhD at the University of Michigan and her postdoctoral training at the University of   Toronto. Her research focuses on the joint contributions of affective and social-cognitive processes and parental socialization to aggressive and prosocial behaviors in children and adolescents. She is co-author of a chapter on social-emotional development and aggression in the Handbook of Child and Adolescent Aggression. Michelle Tam is a PhD graduate student in Developmental Psychology at the University of Kentucky. She earned her MA in Developmental Psychology at the University of Kentucky. Her research focuses on children’s gender identity and the development and maintenance of gender and ethnic stereotypes. Anneloes L. van Baar is Professor in Diagnostics and Treatment at the Department of Development and Treatment of Psychosocial Problems, part of the research group on Child and Adolescent Studies at the faculty of Social and Behavioural Sciences of Utrecht University,The Netherlands.Van Baar was educated at the University of Amsterdam and the Emma Children’s Hospital of the Academic Medical Center in Amsterdam. She worked as a health psychologist at the St. Joseph Hospital in Veldhoven, worked in the Adhesie mental health institution in Deventer as a research manager, and previously was Professor in Pediatric Psychology at Tilburg University in The Netherlands. Her research focuses on development of children with perinatal risk factors, such as prematurity, and diagnostic assessment instruments. Maarten Vansteenkiste is Professor at the Department of Developmental, Personality and Social Psychology at Ghent University, Belgium. He received his PhD from the Catholic University of Leuven. His major research interests include the study of motivation and autonomy in diverse life domains, including parenting, and in different developmental periods, including adolescence. He is co-author of Vitamins for Psychological Growth and co-editor of Autonomy in Adolescent Development. Marjolein Verhoeven is Assistant Professor of Clinical Child and Family Studies, part of the Utrecht Centre for Child and Adolescent Studies, at Utrecht University in The Netherlands. She received her PhD at the University of Amsterdam and worked at the Research and Evaluation Unit of the Women’s and Children’s Hospital in Adelaide, Australia. Her research concerns parenting and child development, with a specific focus on early childhood. Nicholas J. Wagner is Assistant Research Professor at the University of Maryland in the Human Development and Quantitative Methodologies Department.Wagner received his PhD in the Department of Psychology and Neuroscience at the University of North Carolina, where he was supported by a National Institute of Child Health and Development pre-doctoral fellowship at the Center for Developmental Science, before completing his postdoctoral training at the Center for Children, Relationships, and Culture at the University of Maryland. Shawn D. Whiteman is Associate Professor of Family, Consumer, and Human Development at Utah State University. Whiteman received his PhD in Human Development and Family Studies

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About the Contributors

from the Pennsylvania State University and was previously affiliated with Purdue University. His research focuses on the connections between family socialization processes and youth adjustment. Whiteman serves on editorial boards for Adolescent Research Review, Family Relations, Journal of Marriage and Family, Journal of Research on Adolescence, and Journal of Youth and Adolescence. Steven H. Zarit is Distinguished Professor Emeritus in Human Development and Family Studies at the Pennsylvania State University and Adjunct Professor at the Institute for Gerontology, Jönköping University, Jönköping, Sweden. He received his PhD from the Committee on Human Development at the University of Chicago. He has studied family caregiving and conducted research on intergenerational relationships and on health and functioning in very late life. Along with his co-authors, he was an investigator on the Family Exchanges Study. He is the co-author of Mental Disorders in Later Life.

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PART I

Parenting Across the Lifespan

1 PARENTING INFANTS Marc H. Bornstein

Introduction When infants first begin to speak, their articulations are limited to a set of sounds that follow a universal pattern of development based on the anatomical structure of the oral cavity and vocal tract and on ease of motor control (Jakobson, 1969; Kent, 1984). Thus, certain sound combinations— consonants articulated at the front of the oral cavity at the lips (/m/ and /p/) or teeth (/d/), and vowels articulated at the back of the oral cavity (/a/)—have primacy because their voicing maximizes contrasts. In consequence, infants’ earliest sound combinations consist of front consonants with back vowels. Significantly, of four logically possible combinations, the front-consonant—back-vowel pairs of /pa/, /da/, and /ma/ are used as parental kin terms in nearly 60% of more than 1,000 of the world’s languages, many more than would be expected by chance (Murdock, 1959). It seems that parents of infants have adopted as generic labels for themselves their infants’ earliest vocal productions.

Nothing stirs the emotions or rivets the attention of adults more than the birth of a child. By their very coming into existence, infants forever alter the sleeping, eating, and working habits of their parents; they change who parents are and how parents define themselves. Infants keep parents up late into the night or cause them to abandon late nights to accommodate dawn wakings; they require parents to give up a rewarding career to care for them or to take a second job to support them; they lead parents to make new friends with others in similar situations and sometimes cause parents to lose old friends who are not parents.Yes, parents may even take for themselves the names that infants uncannily bestow. Parenting an infant is a “24/7” job, whether by a parent or by a surrogate caregiver who is on call. That is because the altricial human infant is totally dependent on parents for survival. Unlike the newborn foal that will stand in the hour after delivery and soon canter, or the newborn chick that pipes on its shell to hatch, feeds itself on the internal yolk sac, and forages on its own soon after hatching, the newborn human cannot walk, talk, thermoregulate, or even nourish without the aid of a competent caregiver. Terrestrial infant mammals are either cached (left in secluded locales with only intermittent mother–infant contact) or carried (in regular and extensive maternal contact); human infants are the carrying kind (Lozoff and Brittenham, 1979). As the analyst Winnicott (1965, p. 39) enigmatically mused, “There is no such thing as an infant.” Infants only exist in a system with a caregiver.

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Most adults become parents (86% of U.S. American adult women and 84% of men ages 45 and older; Child Trends, 2002). Worldwide each day approximately three-quarters of a million people experience the joys and heartaches as well as the challenges and rewards, of becoming new parents (Worldometers.info). In a given year, approximately 4 million new babies are born in the United States.The wonder is that for the 11,000 babies born every day (National Center for Health Statistics, 2017), a number equivalent to the population of a small town, each one is unique and special. Infancy defines the period of life between birth and the emergence of language approximately 1½ to 2 years into childhood. Our generic terms “infant” and “baby” both have origins in languagerelated concepts.The word infant derives from the Latin in + fans, translated literally as “nonspeaker,” and the word baby shares a Middle English root with “babble” (another front-consonant–back-vowel combination). Our newborn and infant are for the Chagga of Tanganyika mnangu (the “incomplete one”) and mkoku (“one who fills lap”). For Westerners, children are infants until they talk, and become toddlers when they walk; but for the Alor of the Lesser Sundra Islands, the first stage of infancy lasts from birth to an initial smile, and the second stage from the smile to the time when the child can sit alone or begins to crawl (Mead and Newton, 1967, in Fogel, 1984). Infancy encompasses only a small fraction of the average person’s life expectancy, but it is a period highly attended to and invested in by parents all over the world. According to a nationwide survey conducted by the National Center for Children, Toddlers, and Families, more than 90% of U.S. parents said that, when they had their first child, they not only felt “in love” with their baby but were personally happier than ever before in their lives (Civitas Initiative, Zero to Three, and Brio Corporation, 2000). Parenting responsibilities are also greatest during infancy, when the child is most dependent on caregiving and the child’s ability to cope alone is almost nonexistent. Not by chance, infants’ physiognomy is especially attractive to adults (Kringelbach, Stark, Alexander, Bornstein, and Stein, 2016); infants engender feelings of responsibility and solicitude. Infants are fun to observe, to talk to, and to play with; they smell good; and infants do not know how to be agonistic, deceiving, or malicious. But infants make undeniable demands. Furthermore, infancy is a period of rapid development in practically all spheres of expression and function, and people are perennially fascinated by

Figure 1.1 

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the dramatic ways in which the helpless and disorganized human newborn transforms into the competent and curious, frustrating and frustrated, child. Even though the absolute frequency of “daily hassles” reported by parents of infants is approximately the same as for children of other ages, parents of infants do not rate their intensity or salience as high. Infancy seems to represent a “honeymoon period” in which parents acknowledge the difficultness of parenting chores but choose not to make stressful attributions about them. Parents also perceive greater willfulness in children’s behavior once their offspring transition out of infancy. Infancy is the phase of the life cycle when adult caregiving is not only at its most intense but is thought to exert its most significant influences. Infants may profit most from parental care in that infants are believed to be particularly susceptible and responsive to their experiences. From a very early age, infants recognize and prefer the sights, sounds, and smells of their caregivers (Bornstein, Arterberry, and Mash, 2015) and over the course of the first year develop deep and lifelong attachments to them (Cummings and Warmuth, 2019; Sroufe, Egeland, Carlson, and Collins, 2009). Adults in the United States (Aguiar and Hurst, 2007; Sayer, Bianchi, and Robinson, 2004), as elsewhere in the world (Sayer, Gauthier, and Furstenberg Jr., 2004), spend more time with their children today than in the past. However, the sheer amount of interaction between parent and child is greatest in infancy; parents of younger children (0–6 years) spend twice as much time in childcare activities than do parents of older children (6–17 years; United States Bureau of Labor Statistics, 2013), and children’s exposure to their parents’ cognitions and practices diminishes markedly after infancy (Bradley, Corwyn, McAdoo, and García Coll, 2001). In effect, parents and caregivers are responsible for determining most, if not all, of infants’ earliest experiences. It is the evolutionary destiny and continuing task of parents to prepare their children for the physical, economic, and psychosocial situations in which their children are to develop (Bornstein, 2015). Parents everywhere appear highly motivated to carry out this task (Nelson-Coffey and Stewart, 2019). At their best, parent and infant activities are characterized by intricate patterns of attuned and synchronous interactions and sensitive mutual understandings (Bornstein, 2013a). One study submitted 2- to 4-month-old infants’ sensitivities when interacting to test (Murray and Trevarthen, 1985). Infants first viewed real-time images of their mothers interacting with them by means of closedcircuit television, and during this period infants were seen to engage and react with normal interest and pleasure. Immediately afterward, the same infants watched a recording of the same interaction; this time the infants exhibited signs of distress. Infants’ negative reactions were considered to arise out of the lack of synchrony with their mothers that the babies suddenly experienced. Only months-old infants are sensitive to the presence or the absence of appropriate parenting. This chapter overviews the salient features of parenting infants. First, a brief history of interest in parenting infants is provided, followed by a discussion of the theoretical significance attached to parenting infants. Next, the cast of characters who parent infants—mothers, fathers, and nonparental (sibling, familial, and nonfamilial) infant caregivers—is introduced. The chapter then turns to review principles of parenting infants, including the instantiation of parenting infants in cognitions and practices, followed by successive examinations of psychometrics, direct and indirect effects, models of parenting effects, and mechanisms of action of parenting effects. Afterward, forces that shape parenting during infancy are outlined, including biological and psychological characteristics of parents, characteristics of infants and infant development, and various contextual social, socioeconomic, and cultural determinants.

A Brief History of Parenting Infants Infancy is an easily definable stage of life, based on biological and mental data as well as on social convention. Infants do not speak, whereas youngsters and adults do; infants creep and crawl, whereas youngsters and adults walk and run. Harkness and Super (1983, p. 223) suggested that “a primary 5

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function of culture in shaping human experience is the division of the continuum of human development into meaningful segments, or ‘stages. . .’ All cultures . . . recognize infancy as a stage of human development.” Infancy already achieved recognition in Classical times; when the Romans depicted periods in the life cycle of a typical man on “biographical” sarcophagi, they included infancy. Indeed, artists everywhere and throughout the ages have represented infancy as typically a first age or early stage in the lifespan. Iconographically, infants symbolize origins and beginnings. Informal interest and concerns for parenting infants are motivated in large measure by perennial questions about the roles of heredity and experience in human development. Speculation on the subject dates to ancient Egypt, the Code of Hammurabi, and the pre-Socratic philosophers. Plato (ca. 355 BC) theorized about the significance of infancy; Henri IV of France had the physician Jean Héroard carefully document experiences of the Dauphin Louis from the time of his birth in 1601; and Charles Darwin (1877) and Sigmund Freud (1949) initiated scientific observations of infants and theoretical speculations about the role of infancy in development and in culture. The formal study of parenting infants had its beginnings in attempts by philosopher, educator, or scientist parents to do systematically what parents around the world do naturally everyday—observe their babies in wonder. The first-ever written accounts of children were diary descriptions of infants in their natural settings set down by parents—“baby biographies” (Darwin, 1877; Hall, 1891; Jaeger, 1985; Lamott, 2013; Mendelson, 1993; Preyer, 1882; Prochner and Doyon, 1997; Rousseau, 1762; Stern, 1990;Taine, 1877;Tiedemann, 1787;Wallace, Franklin, and Keegan, 1994). Darwin, who introduced evolutionary theory in 1859 with the Origin of Species, published observations he had made in the early 1840s on the first months of life of his firstborn son,William Erasmus, nicknamed “Doddy.” Darwin’s (1877) “Biographical Sketch of an Infant” gave great impetus to infancy studies (Lerner, Hershberg, Hilliard, and Johnson, 2015). In succeeding years, baby biographies grew in popularity around the world—whether they were scientific documents, parents’ personal records, or illustrations of educational practices—and they still appear today. Perhaps the most influential of the modern baby biographers was Piaget (1952), whose writings and theorizing refer chiefly to observations of his own three very young children (Jacqueline, Laurent, and Lucienne). These systematic historical observations of infancy had many salutary effects, heightening awareness in parents and provoking formal studies of how to guide infant development. Historians and sociologists of family life documented evolving patterns of primary infant care (Colón with Colón, 1999). Because of high rates of infant mortality historically, parents in early times may have cared for but resisted emotional investment in the very young (Dye and Smith, 1986; Slater, 1977–1978), a point of view that sometimes persists where especially dire circumstances reign (Scheper-Hughes, 1989). One historian theorized that parents have generally improved in their orientation to and treatment of infants because parents have, through successive generations, improved in their ability to identify and empathize with the special qualities of early childhood (deMause, 1975). Today, advice on parenting infants begins well before the birth of a child in so-called “preconception care” whose goal is to reduce the risk of adverse effects for women, fetuses, and neonates by optimizing women’s health and knowledge in planning and conceiving a pregnancy (American College of Obstetricians and Gynecologists, 2005; Centers for Disease Control and Prevention, 2017). Such advice can be found in professional compendia that provide comprehensive medical treatises of prenatal, perinatal, and postnatal development, such as the Guide to Effective Care in Pregnancy and Childbirth (Enkin et al., 2013) and The A to Z of Children’s Health: A Parent’s Guide From Birth to 10 Years (Friedman, Saunders, and Saunders, 2013); in now-classic how-to books, such as Dr. Spock’s Baby and Child Care (Spock and Needlman, 2011), Your Baby and Child: From Birth to Age Five (Leach, 2010), and What to Expect When You’re Expecting (Murkoff and Mazel, 2016); in practical guides, such as Baby Care Basics (Friedman and Saunders, 2015) and Teach Your Children Well (Levine, 2016); as well as in innumerable popular periodicals that overflow magazine racks in supermarkets, airports, and bookstores. 6

Parenting Infants

The Theoretical Significance Attached to Parenting During Infancy From the perspective of formal studies of parenting, infancy attracts attention in part because a provocative debate yet rages around the significance of events occurring in infancy for later development (Bornstein, 2014). Proponents from one viewpoint contend that the infancy period is not particularly influential because the experiences and the habits of infants have little (if any) long-term significance on the balance of the life course. Others argue contrariwise that experiences and habits developed in infancy are of crucial, and perhaps lifelong, significance; that is, the social orientations, personality styles, and intellectual predilections established at the start fix or, at least, contribute to enduring patterns. Either the invisible first foundation and frame of the edifice are always and forever critical to the structure, or, once erected, what really matters to a building is continuing upkeep and renovation. Theoreticians and researchers alike have been surprisingly hard-pressed to confirm or to refute the significance of the child’s earliest experiences to the course and the eventual outcome of development. The answer (if there is one) certainly depends on what is investigated in whom and when, as well as the judgment of long-term longitudinal data (Bornstein, 2015). Prominently, psychoanalysis propounded the significance of early experience. Freud (1949) theorized that child development is characterized by critical phases during which certain experiences assume unusual significance. Infancy defines the “oral phase,” when experiences and activities centered on the mouth, notably feeding, are imbued with salience for personality in terms of oral fixations. According to Freud, if the baby’s needs for oral gratification are overindulged or underindulged, the baby will grow into an adult who continually seeks oral gratification. Overlapping the end of infancy, according to Freud, the oral phase is succeeded by an “anal phase.” During this period, parent–infant interactions center on toilet training, with long-term personality consequences likely involving stubbornness and obsessiveness. Erikson (1950) portrayed infant experiences as provided by parents somewhat differently, but also asserted that experiences in infancy can exert telling longterm influences. From oral sensory experiences, Erikson suggested, infants develop basic trust or mistrust in others, and whether infants develop trust has implications for the way they negotiate the next muscular anal stage, in which the key issue is establishing autonomy or shame. More modern proponents of psychodynamic and similar schools of thinking continue to see infancy as critical to the basic differentiation of self (Ainsworth, Blehar, Waters, and Wall, 1978; Bowlby, 1969; Greenspan and Greenspan, 1985; Mahler, Pine, and Bergman, 1975; Stern, 1985). For example, the notion of sensitivity to infants’ needs was seized on by Bowlby (1969), who contended that their state of immaturity renders infants dependent on the care and protection of parents and that infancy is an evolutionarily conditioned period for the development of long-lasting attachments to primary caregivers. Indeed, the internal working models of caregiver-infant relationships, established in infancy, generalize to other later social relationships (Cummings and Warmuth, 2019). Like psychoanalysts, behaviorists and learning theorists also stressed the significance of infant experiences for the rest of the life course (Dollard and Miller, 1950; Watson, 1924/1970). Behaviorists eschew the idea that infancy per se should be set apart; but for them as well, an organism’s earliest experiences are crucial because they are first, have no competing propensities to replace, and thus yield easy and rapid learning. Moreover, early behavior patterns lay the foundation for later ones. Students of the constructivist school of developments, beginning with Piaget (1952), likewise theorized that capacities of later life build on development early in life and that infants actively participate in their own development. Pride of place for infancy has also been emphasized by embryologists and ethologists (Lorenz, 1935/1970; Spemann, 1938;Tinbergen, 1951). In the view of those who study developmental physiology and animal behavior, the immature nervous system is in an especially plastic state, and during “sensitive periods” structural developments and behavioral tendencies are maximally susceptible to influences by specific types of experience (Bornstein, 1989b). The sensitive period concept typically 7

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assigns great weight to infant experiences because it holds that experiences that occur within its boundaries are likely to have enduring influences and that, once that period had passed, even the same experiences no longer exert the same formative influences. Demonstrations of sensitive periods in lower animals (imprinting, as in the “ugly duckling”) award biological and scientific credibility to the potency of experiences in infancy in general, and this feature has been painted into many portraits of human infant growth and development. Thus, neoteny (the prolongation of infancy), which is especially characteristic of human beings, is thought to have special adaptive significance (Gould, 1985) insofar as it allows for enhanced parental influence and prolonged learning (Bjorklund and Myers, 2019). Not all developmental theoreticians espouse the view that infancy or experiences in infancy are formative, however. Some have, in equally compelling arguments, maintained that experiences in infancy are peripheral or ephemeral, in the sense that they exert little or no enduring effect on development afterward. These individuals attribute the engine and controls of development instead to emerging biology and unfolding maturation and to influential later experiences.The embryologist Waddington (1962) theorized that, based on principles of growth such as “canalization,” early experiences, if influential, are not determinative (McCall, 1981). Infancy may be a period of plasticity and adaptability to transient conditions, but those effects may not persist, or they may be altered or supplanted by subsequent conditions that are more consequential (Kagan, 2000; Lewis, 1997). Infancy is the first phase of extrauterine life, and the characteristics we develop and acquire then may be formative and fundamental in the sense that they endure or (at least) constitute building blocks that later developments or experiences use or modify. Infancy is only one phase in the lifespan, however, and so development is also shaped by biological emergence and acquired experiences after infancy. Parenting the infant does not fix the route or the terminus of development, but it makes sense that effects have causes and that the start exerts an impact on the end. Parenting is therefore central to infancy and to the long-term development of children. In consequence, we are motivated to know the meaning and the importance of parenting infants for later life out of the desire to improve the lives of infants and for what infancy tells us about parents. Indeed, cultural inquiry has almost always included reports of infant life and adults’ first efforts at parenting (Bornstein, 1991). Parents are fundamentally invested in infants: their survival, their socialization, and their education. Parents in the United States spend an average of $12,680 a year on their infant (and $233,610 from birth through age 17; Lino, Kuczynski, Rodriguez, and Schap, 2017).

Who Parents Infants? Mothers normally play the principal part in infant childrearing, even if historically fathers’ social and legal claims and responsibilities on children were pre-eminent (French, 2019). Cross-cultural surveys attest to the primacy of biological mothers’ caregiving (Leiderman, Tulkin, and Rosenfeld, 1977; Lozoff and Brittenham, 1979), and theorists, researchers, and clinicians all have largely focused on mothering in recognition of this fact. Mothers are primarily responsible for home and family, and they are believed to bear the heaviest psychic burden in parenting (Calzada, Eyberg, Rich, and Querido, 2004; Metsäpelto and Pulkkinen, 2003; Verhoeven, Junger, Van Aken, Deković, and Van Aken, 2007). According to regular reports from the American Time Youth Survey, conducted by the U.S. Bureau of Labor Statistics, mothers (even those who work full-time) spend about twice as much time as do fathers in child caregiving of all sorts (Guryan, Hurst, and Kearney, 2008). Fathers may withdraw from their infants when they are unhappily married; mothers almost never do (Kerig, Cowan, and Cowan, 1993). Despite lower quantities of interaction and divergent styles, however, infants can become attached to their fathers as they do to their mothers. Western industrialized nations have witnessed increases in the amounts of time fathers spend with their children; however, fathers still assume little responsibility for infant care and rearing (Lareau 8

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and Weininger, 2008; Pleck, 2012), and fathers are primarily helpers who defer to mothers (Cabrera, Tamis-LeMonda, Bradley, Hofferth, and Lamb, 2000; Pleck, 2012). Of course, fathers are neither inept nor uninterested in infant caregiving. When feeding infants, for example, fathers and mothers alike respond to infants’ cues by adjusting the pace of their feeding (Parke and Cookston, 2019). Both mothers and fathers touch and look more closely at an infant after the infant has vocalized, and both equally increase their rates of speech to baby following baby vocalization (Parke and Cookston, 2019). Mothers and fathers hold some similar and some different ideas about parenting and appear to interact with and care for children in some convergent and some complementary ways; that is, they tend to divide some of the labor of caregiving and engage children by modeling different orientations and emphasizing different types of interactions. Boivin and colleagues (2005) analyzed the factor structure of a self-administered questionnaire designed to assess 2,122 mothers’ and 1,829 fathers’ self-efficacy, perceived impact, hostile-reactive behaviors, and overprotection of their young infants. The two parents did not differ with respect to perceived parental impact, but gender differences emerged in other parenting self-perceptions. Mothers worried more about the health and safety of their infants than fathers, and fathers were more prone to hostile-reactive behaviors than mothers. When in face-to-face play with their ½- to 6-month-olds, mothers tend to be rhythmic and containing, whereas fathers tend toward staccato bursts of physical and social stimulation (Yogman, 1982). Mothers are more likely to hold their infants while caregiving, whereas fathers are more likely to do so when playing or in response to infants’ bids to be held. Fathers spend proportionally more time in teaching and play than mothers (Craig, 2006; Guryan et al., 2008; Ho, Chen, Tran, and Ko, 2010; Pleck, 2012). Mothers and fathers are both sensitive to infant language status, but here too they appear to complement one another regarding the quality and the quantity of speech they direct to infants (Rondal, 1980). On the one hand, maternal and paternal infant-directed speech displays the same well-known simplifications. On the other, mothers are more “in tune” with their infants’ linguistic abilities: Maternal utterance length relates to child utterance length; paternal utterance length does not. Fathers’ speech to infants is lexically more diverse than mothers’ speech, and it is also shorter, corrects children’s speech less often, and places more verbal demands on the child; it thereby “pulls” for higher levels of performance. When mother–infant and father-infant play were contrasted, both mothers and fathers followed interactional rules of sharing attentional focus on a toy with baby; however, mothers tended to follow the baby’s focus of interest, whereas fathers tended to establish attentional focus themselves (Power, 1985). In research involving both traditional U.S. American families (Belsky, Gilstrap, and Rovine, 1984) and traditional and nontraditional (father as primary caregiver) Swedish families (Lamb, Frodi, Frodi, and Hwang, 1982), parental gender was determined to exert a greater influence in caregiving than, say, parental role or employment status: Mothers are more likely to kiss, hug, talk to, smile at, tend, and hold infants than fathers are, regardless of relative professed degree of involvement in caregiving. Indeed, mothers and fathers make some independent contributions to children’s development (Martin, Ryan, and Brooks-Gunn, 2007; Ryan, Martin, and Brooks-Gunn, 2006). Infant care by biological parents is often supplemented. Siblings or other youngsters care for infants, and in different cultures now and historically infants have been tended by nonparental care providers—aunts and grandmothers, nurses and slaves, daycare workers and metaplot1—whether in family daycare at home, daycare facilities, village centers, or fields. In short, many individuals “socially” parent infants (Leon, 2002). Indeed, human cultures distribute the tasks of childcare in different ways (Leinaweaver, 2014). In some places, infants are reared in extended families in which care is provided by many adults; in others, mothers and babies are isolated from almost all social contexts. In some groups, fathers are treated as irrelevant social objects; in others, fathers assume complex responsibilities for infants. In many non-Western non-industrialized cultures, infants can be found in the care of an older (more usually) sister or (less usually) brother (Weisner, 1987). In such situations, siblings typically spend 9

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most of their infant-tending time involved in unskilled nurturant caregiving, thereby freeing adults for more remunerative economic activities. In Western and industrialized societies, by contrast, siblings are seldom entrusted with much responsibility for “parenting” infants. That said, mothers in singleparent households are known to recruit older siblings to care for younger ones (Roy and Smith, 2013). Sibling care toward infants tends to display features of both adult-infant and peer-infant systems. On the one hand, older siblings and infants (especially ones close in age) share common interests and have more similar behavioral repertoires. On the other, sibling pairs resemble adult-infant pairs to the extent that siblings differ in experience and levels of both cognitive and social ability. Older siblings tend to “lead” interactions and engage in more dominant, assertive, and directing behaviors, and they create more “social” (game) and “intellectual” (language) experiences for their infant siblings (Volling, 2017) and so may influence social and cognitive skills of infants through teaching and modeling (Zajonc, 1983). Reciprocally, infants often take special note of what their older siblings do; they follow, imitate, and explore toys recently abandoned by older children. This strategy maximizes infant learning from older children. Older siblings spend at least some time teaching object-related and social skills to their younger siblings (including infants), and the amount of teaching increases with the age of the older child (Minnett,Vandell, and Santrock, 1983; Stewart, 1983). Peer interaction and play in infancy are not solely “parallel” in nature. Toward the end of the first year, children watch and imitate peers’ actions with toys (Singer, 1995). One study revealed that 17to 20-month-olds engage in more creative or unusual uses of objects during play with peers than during play with mothers (Rubenstein and Howes, 1976). Still, older siblings or peers are less likely to respond contingently to 6- and 9-month infants than are mothers (Vandell and Wilson, 1987). Infants also commonly encounter a social world that extends beyond the immediate family. In some societies, multiple-infant caregiving is natural. Today, most infants in the United States are cared for on a regular basis by someone in addition to a parent (Bornstein, Putnick, and Suwalsky, 2016). One common form of nonparental familial care involves relatives such as grandparents (Smith and Wild, 2019). Grandparental care of infants may be indirect or direct. Increased life expectancy, decreased family size, more maternal employment, and the rise of single-parent families have conspired to increase the potential for grandparents to play greater parts in the lives of their grandchildren (Arber and Timonen, 2012; Dunifon, 2012; Kornhaber, 2002; Tanskanen and Rotkirch, 2014; Witkin, 2012). Approximately 43% of grandparents provide some childcare on a regular basis (Lou and Chi, 2012; Stelle, Fruhauf, Orel, and Landry-Meyer, 2010), and in custodial grandparent families children are reared solely by grandparents (as the result, e.g., of maternal incarceration or other parental problems; Dallaire, 2019; Poehlmann et al., 2008). Nonfamilial daycare providers constitute the other common infant caregiver lot (Raikes et al., 2019). Most provide infants with care in daycare centers; the next most provide infants with care in their own homes; and the fewest care for infants in the baby’s home. In their first year, 46% of infants in the United States experience at least one weekly nonparental childcare arrangement (Institute for Educational Sciences, National Center for Educational Statistics, 2018. https://nces.ed.gov). It was once believed that only full-time mothers could provide infants with the care they needed to thrive: These beliefs were fostered by literature on the adverse effects of maternal deprivation (Bowlby, 1951; Rutter and Woodhouse, 2019). Attachment theory maintained that infants become attached to those persons who are associated over time with consistent, predictable, and appropriate responses to infants’ signals as well as to their needs, and that attachment was critical to the development of a healthy and normal personality (Cummings and Warmuth, 2019). However, some social critics argue that high-quality nonparental infant childcare is possible and that the normalcy of infants’ emotional attachments depends not on the quantity of time that carers spend with infants, but on the quality of carers’ interactions with them (Howes and Oldman, 2001; Howes and Spieker, 2008). So, social relationship theory posits that multiple associations are important to children because each meets a different developmental need (Vandell, 2000). 10

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Coparenting is often thought to apply to mother and father; marital relationships and father involvement affect the quality of mother–child and father-child relationships and child outcomes. Coparenting comprises multiple interrelated components: agreement or disagreement on childrearing issues, support or undermining of the parental role, and joint management of family interactions (Feinberg, 2003; Feinberg, McHale, and Sirotkin, 2019). However, coparenting in principle applies to any constellation of infant carers, and how “parents” work together as a coparenting team may have far-reaching consequences for infants. A coparent who has a positive and supportive relationship with a child tends to diminish the likelihood that the second parent will behave in a hostile manner toward the child (Conger, Schofield, and Neppl, 2012). Mothers in supportive coparenting relationships are less harried and less overwhelmed, have fewer competing demands on their time, and consequently are more available to their children and are more competent and sensitively responsive to their young children than are mothers lacking such relationships (Crnic and Greenberg, 1990; Grych, 2002). In the Civitas Initiative et al. (2000) national survey, 70% of mothers of children under 3 reported that they relied on their spouse and 66% on their mothers, for support, information, and advice; 54% reported that they relied on their child’s doctor/pediatrician, 25% on nurses, and 20% on childcare providers.

Parenting Infants Human infants do not and cannot grow up as solitary individuals; parenting constitutes the initial and all-encompassing ecology of infant development. Parenting is instantiated in parents’ cognitions and practices, and mothers, fathers, and others guide the development of infants according to several principles of direct and indirect effects that follow different possible models utilizing different mechanisms.

Parenting Cognitions When their infants are only 1 month of age, 99% of mothers believe that babies can express interest, 95% joy, 84% anger, 75% surprise, 58% fear, and 34% sadness (Johnson, Emde, Pennbrook, Stenberg, and Davis, 1982). These judgments may reflect infants’ expressive capacities or contextual cues or mothers’ subjective inferences. In response to specific questions, mothers describe their infants’ vocal and facial expressions, along with their gestures and movements, as the bases of these judgments. Because mothers commonly respond differently to different emotional messages they perceive in their infants, they have frequent opportunities to have their inferences fine-tuned or corrected, depending on how their babies respond in turn. There is therefore good reason to invest confidence and meaningfulness in many parental cognitions about infants. Parents’ cognitions—their ideas, knowledge, values, goals, expectations, and attitudes—have held a consistently popular place in the study of parent–infant relationships (Holden and Smith, 2019). Parental beliefs are conceived to serve many functions; in the so-called “standard model” of parenting (Bornstein, Putnick, and Suwalsky, 2018b), cognitions are thought to generate and shape parental behaviors, and they may mediate the effectiveness of parenting or help to organize parenting. Thus, how parents see themselves vis-à-vis infants generally can lead to their expressing one or another kind of affect, thinking, or behavior in childrearing: Mothers who feel efficacious and competent in their role as parents are more responsive (Schuengel and Oosterman, 2019) and more empathic, less punitive, and more appropriate in their developmental expectations (East and Felice, 1996). How parents construe infancy in general functions in the same way: Mothers who believe that they can or cannot affect infant personality or intelligence appear to modify their parenting accordingly. Mothers who feel effective vis-à-vis infants are motivated to engage in further interactions that in turn provide infants with additional opportunities to understand and interact positively and appropriately 11

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with their infants (Teti, O’Connell, and Reiner, 1996). How parents see their own infants has its specific consequences too: Mothers who regard their infants as being difficult are less likely to pay attention or respond to their infants’ overtures, and their inattentiveness and nonresponsiveness can then foster temperamental difficulties and cognitive shortcomings (Bates, McQuillan, and Hoyniak, 2019). Are parents’ beliefs about their own behaviors with infants accurate, consistent, and valid? Some maternal behaviors correspond to maternal beliefs: for example, mothers’ behaviors toward their infants and their beliefs about childrearing practices (Wachs and Camli, 1991) and mothers’ infant caregiving competence and beliefs about their parenting effectiveness (Teti and Gelfand, 1991). European American mothers underscore the importance of certain values, such as independence, assertiveness, and creativity, when asked to describe an ideal child, whereas Puerto Rican mothers underscore the importance of obedience and respect for others. In line with these values, U.S. mothers have been observed to foster independence in infants; for example, in naturalistic mother–infant interactions during feeding, U.S. mothers encourage their infants to feed themselves at 8 months of age. In contrast, Puerto Rican mothers hold their infants closely on their laps during mealtimes and take control of feeding them meals from start to finish (Harwood, Miller, and Irizarry, 1995). However, coordinate relations between parents’ beliefs and behaviors have often proven elusive, with many researchers finding only irregular relations between mothers’ professed parenting attitudes and their activities with their infants (Cote and Bornstein, 2000). Likely, the conceptual match between cognition and practice is all-important (Bornstein, Putnick, and Suwalsky, 2018b). Siddiqui and Hägglöf (2000) found that mothers’ antenatal attachment expectancy toward their unborn child predicted mothers’ sensitivity at 3 months postpartum. Dayton, Levendosky, Davidson, and Bogat (2010) learned that mothers who professed affectively disengaged prenatal representations of their children were at 1 year more behaviorally controlling; mothers whose representations were affectively distorted were hostile; and mothers with balanced representations demonstrated positive parenting. Using an equivalent longitudinal design, Haltigan and colleagues (2014) determined that mothers’ attachment representations assessed prenatally predicted observed maternal sensitivity at 6 months postnatally. In probing infantrearing cognitions, we may come to better understand how and why parents behave in the ways they do. For example, parents might believe a child is misbehaving purposefully, when the child’s behavior may in fact be developmentally typical. Higher levels of internal attributions of child misbehaviors are more prevalent among neglectful, abusive, and authoritarian mothers (Wang, Deater-Deckard, and Bell, 2013). Ethnographic interviews of mothers with infants between the ages of 2 and 18 months revealed that some avoid using physical punishment with infants because they believe that infants are not able to clearly understand right and wrong, whereas others believe that infants can misbehave intentionally and need to be punished to stop their bad behavior and learn to respect mothers’ authority. Subsequent quantitative analyses revealed that mothers who expressed concerns about bad behavior and spoiling interacted less positively with their infants (Burchinal, Skinner, and Reznick, 2010). Parenting knowledge of childrearing and child development draws on the science base as well as social construction and is thought to be valid and reliable by clinical and research communities alike (Bornstein, Cote, Haynes, Hahn, and Park, 2010). Parenting knowledge encompasses many domains, including fulfilling the biological and physical as well as socioemotional and cognitive needs of children as they develop, understanding normative child development, and awareness of practices and strategies for maintaining and promoting children’s health and coping effectively with children’s illness. Parenting knowledge is associated with enhanced parental self-perceptions of competence, satisfaction, and investment in parenting (Bornstein, Hendricks, Hahn, Haynes, Painter, and TamisLeMonda, 2003), and mothers’ knowledge explains variations in their emotional relationships with children (Bornstein, Putnick, and Suwalsky, 2012). Are parents’ beliefs about infants accurate? From their long-term, intimate experience with their infants, parents surely know their own infants better than anyone else does. For that reason, parents (or 12

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other close caregivers) have long been thought to provide valid reports about their infants (Thomas, Chess, Birch, Hertzig, and Korn, 1963). However, parental report also invites bias owing, for example, to parents’ subjective viewpoint, personality disposition, unique experiences, social desirability, and other factors (Bornstein, Putnick, Lansford, Pastorelli, et al., 2015). One study compared maternal and observer ratings of manifest infant activity (reaching, kicking, and other explicit motor behaviors) when infants were by themselves, when with mother, and when with an observer (Bornstein, Gaughran, and Seguí, 1991). Mother–observer assessments agreed, but only moderately. Different observers have different amounts of information about a baby, and they also carry with them unique perspectives that have been shaped by their idiosyncratic personology and different prior experiences; both information level and perspective influence cognitions about infants. Significantly, parents in different cultures harbor different beliefs about their own parenting as well as about their infants (Bornstein and Lansford, 2010). Parents may then act on culturally defined beliefs as much or more than on what their senses tell them about their babies. Parents in Samoa think of young children as having an angry and willful character, and, independent of what children might actually say, parents consensually report that their children’s first word is tae—Samoan for “shit” (Ochs, 1988). Parents in Mexico promote play in infants as a forum for the expression of interpersonal sensitivity, whereas parents in the United States are prone to attach greater cognitive value to play (Bornstein, 2007).The ways in which parents (choose to) interact with their infants may relate to parents’ general or specific belief systems.

Parenting Practices More salient in the phenomenology of the infant are actual experiences that parents provide; behaviors are direct expressions of parenting. Before children are old enough to enter formal or even informal social situations, like play groups and pre-school, most of their worldly experience stems directly from interactions they have within the family. In that context (at least in Western cultures), two adult caregiving figures are (usually) responsible for determining those experiences. A small number of domains of parenting interactions have been identified as common “cores” of parental care (Bornstein, 1989a, 2015), and they have been studied for their variation, stability, continuity, and covariation, as well as for their correspondences with and prediction of infant development. In infrahuman primates, maternal behaviors consist largely of biologically requisite feeding, grooming, protection, and the like (Bard, 2019).The contents of parent–infant interactions are much more dynamic, varied, and discretionary in human beings. Moreover, there is initially asymmetry in parent and child contributions to interactions and control: Post-infancy, children play increasingly active and anticipatory roles in interactions, whereas initial responsibility for wholesome infant development lies unambiguously with the parent (Kochanska and Aksan, 2004; Maccoby, 1992). Four superordinate categories of human parental caregiving (and reciprocally for the infant, experiences) have been identified: They are nurturant, social, didactic, and material (Bornstein, Putnick, Park, Suwalsky, and Haynes, 2017). These categories apply to the infancy period and to normal caregiving. Not all forms of parenting, or parenting domains appropriate for older children (for example, discipline), are accounted for in this taxonomy. Although these modes of caregiving are conceptually and operationally distinct, in practice caregiver-infant interaction is intricate and multidimensional, and infant caregivers regularly engage in combinations of them. Together, however, these modes are perhaps universal, even if their instantiations (forms) or emphases (frequency or duration) vary across social groups. For their part, human infants are reared in, influenced by, and adapt to a social and physical ecology commonly characterized by this taxonomy and its elements (Bornstein, Putnick, Lansford, Deater-Deckard, and Bradley, 2015; Bornstein, Putnick, Park, et al., 2017). Nurturant caregiving meets the physical requirements of the infant. Infant mortality is a perennial parenting concern, and parents centrally are responsible for promoting infants’ wellness and 13

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preventing their illness from the moment of conception—or even earlier. Parents in virtually all higher species nurture their very young, providing sustenance, protection, supervision, grooming, and the like. Parents shield infants from risks and stressors. Nurturance is prerequisite to infants’ survival and well-being; reciprocally, seeing a child to reproductive age enhances parents’ fitness, the probability of passing on their genetic characteristics. Social caregiving includes the variety of visual, verbal, affective, and physical behaviors parents use in engaging infants in interpersonal exchanges (kissing, tactile comforting, smiling, vocalizing, and playful contact). Parental displays of warmth and physical expressions of affection toward their offspring peak in infancy. Social caregiving includes the regulation of infant affect as well as the management and monitoring of infant social and emotional relationships with others, including relatives, nonfamilial caregivers, and peers. Didactic caregiving consists of the variety of strategies parents use in stimulating infants to engage and understand the environment outside the dyad. Didactics include focusing the infant’s attention on properties, objects, or events in the surround; introducing, mediating, and interpreting the external world; describing and demonstrating; as well as provoking or providing opportunities to observe, to imitate, and to learn. Normally, didactics increase over the course of infancy. Material caregiving includes those ways in which parents provision and organize the infant’s physical world. Adults are responsible for the number and variety of inanimate objects (toys, books) available to the infant, level of ambient stimulation, limits on physical freedom, safety, and overall physical dimensions of babies’ experiences.

Principles of Parenting Infants Certain principles pervade parenting; some are general, others come into play specifically with infants. Three significant psychometric characteristics of variation, consistency, and independence distinguish parenting cognitions and practices. In addition, effects of parenting may be direct or indirect; follow diverse models of early, contemporaneous, or cumulative experience; and operate according to specificity, transaction, and coregulation mechanisms of action.

Psychometrics Variation in parenting cognitions and practices. Adults can, and often do, differ considerably in their caregiving beliefs and behaviors, even when they come from otherwise homogeneous social groups. For example, the amount of language that parents use to address their infants varies enormously. One study reported that, even when from a relatively homogeneous group in terms of education and socioeconomic status (SES), some mothers talked to their 4-month-old infants during as little as 3%, and some during as much as 97%, of an hour-long home observation (Bornstein and Ruddy, 1984). Thus, the range in amount of language that washes over babies is virtually as large as it can be. This is not to say that there are not also systematic differences by social group; there are (see below). Consistency in parenting cognitions and practices. There are two forms of consistency: Stability connotes consistency in the relative ranks of individuals in a group, and continuity consistency in the mean level of a group, over time; the two are independent, and both are meaningful (Bornstein, Putnick, and Esposito, 2017). Short-term reliabilities of cognitions and practices in parents tend to be high as documented in meta-analysis (Holden and Miller, 1999), although rank and level both are moderated by parenting construct, interassessment duration, context, child age, and methodological approach (Bornstein, Putnick, Suwalsky, and Gini, 2006; Dallaire and Weinraub, 2005; Haltigan, Roisman, and Fraley, 2013; Maas,Vreeswijk, and van Bakel, 2013; Porter and Hsu, 2003). The extant literature also supports stability of relationship measures in parent–infant dyads (Bornstein, Gini, Putnick, et al., 2006; Bornstein, Gini, Suwalsky, Putnick, and Haynes, 2006). Individual parents do 14

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not vary much in their activities from day to day, but parenting activities change over longer periods and in response to children’s development. Unsurprisingly, the time devoted to caregiving activities decreases (Fleming, Ruble, Flett, and Van Wagner, 1990). Sensitive parents also tailor their behaviors to match their infants’ developmental progress (Bornstein, 2013a), for example by speaking more and providing more didactic experiences as infants age (Bornstein, Tal, et al., 1992; Bornstein and Tamis-LeMonda, 1990; Klein, 1988). Indeed, parents are sensitive to infant age and to increasing infant capacity or performance (Bellinger, 1980): The mean length of mothers’ utterances tends to match the mean length of utterances of their 1½- to 3½-year-olds (McLaughlin, White, McDevitt, and Raskin, 1983). One study examined activities of mothers toward their firstborn infants between the time babies were 2 and 5 months of age (Bornstein and Tamis-LeMonda, 1990). Two kinds of mothers’ encouraging attention, two kinds of speech, and maternal bids to social play in relation to infants’ exploration and vocalization were recorded. Table 1.1 provides a conceptual summary of some pertinent findings, distinguishing activities that are stable and unstable as well as those that are continuous and discontinuous over time. Notable is the fact that every cell in the table is represented with a significant parenting activity. Some activities are stable and continuous as infants age (e.g., total maternal speech to baby). Others are stable and discontinuous, showing either a general developmental increase (e.g., didactic stimulation) or a decrease (e.g., infant-directed speech). Some are unstable and continuous (e.g., social play), whereas others are unstable and discontinuous, showing either a general developmental increase (e.g., adult-directed speech) or a decrease (e.g., social stimulation). Independence of parenting cognitions and practices. Classical authorities, including notably psychoanalysts and ethologists, once conceptualized maternal beliefs and behaviors as a more or less unitary— variously denoted as “good,” “sensitive,” “warm,” or “adequate” (Ainsworth et al., 1978; Mahler et al., 1975; Rohner, 1985; Winnicott, 1957)—despite the wide range of attitudes and activities mothers naturally hold and engage in with infants. The thinking was that parents behave in consistent ways or adhere to a single “style” across domains of interaction, time, and context (Baumrind, 1967). Alternatively, domains of parenting infants might constitute internally coherent, but relatively distinctive, constructs (Bornstein, 1989a, 2015; Bornstein, Putnick, Park, et al., 2017).That is, mothers who engage in more face-to-face play with their infants are not necessarily or automatically those who read to their infants more. Independence turns out to be a general characteristic of mothers in a wide variety of different countries (Bornstein, Putnick, Park, et al., 2017; Bornstein, Azuma, Tamis-LeMonda, and Ogino, 1990; Bornstein and Tamis-LeMonda, 1990; Bornstein, Tamis-LeMonda, Pêcheux, and Rahn, 1991; Bornstein,Toda, Azuma,Tamis-LeMonda, and Ogino, 1990). In other words, individual mothers tend to emphasize particular attitudes and activities with their infants.

Table 1.1  Developmental stability and continuity in maternal activities in infancy Developmental Continuity Continuous

Discontinuous

Developmental Stability

Increase

Decrease

Didactic stimulation Adult-directed speech

Infant-directed speech Social stimulation

Stable Unstable

Speecha Social play

a For example, across early infancy, mothers speak to their infants approximately the same amount in total (continuity), and those mothers who speak more when their infants are younger speak more when their infants are older, just as those mothers who speak less when their infants are younger speak less when their infants are older (stability).

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Direct and Indirect Effects Mothers and fathers contribute directly to the nature and the development of their infants by passing on their biological characteristics. Modern behavior genetics argues that a host of different characteristics of offspring—height and weight, intelligence and personality—reflects genetic inheritance in some degree (Kong et al., 2018; Knopik, Neiderhiser, DeFries, and Plomin, 2017). At the same time, all prominent theories of development put experience in the world as either the principal source of individual growth or as a major contributing component (Lerner et al., 2015; Wachs, 2000). Studies of children with genetic backgrounds that differ from those of their nurturing families provide one means of evaluating the impacts of heredity and experience on infant development. In (ideal) natural experiments of adoption, the child shares genes but not environment with biological parents, and the child shares environment but not genes with adoptive parents. Studies of l-year-old infants, their biological parents, and their adoptive parents in this design reveal that development of communicative competence and cognitive abilities relates to the general intelligence (IQ) of biological mothers and to the behaviors of adoptive mothers (imitating and responding contingently to infant vocalization). These results point to direct roles for both genetics and experience in parenting infants (Hardy-Brown, 1983; Hardy-Brown and Plomin, 1985).Thus, evidence for heritability effects neither negates nor diminishes equally compelling evidence for the direct effects of parenting cognitions and practices (Collins, Maccoby, Steinberg, Hetherington, and Bornstein, 2000).To cite an obvious example, genes contribute to making siblings alike, but (as we all recognize) siblings normally also differ from one another, and it is widely held that siblings’ different experiences (the nonshared environment) in growing up contribute to making them distinctive individuals (Bornstein, Putnick, and Suwalsky, 2018a). Even within the same family and home setting, therefore, parents help to create distinctive and effective environments for their different children (Turkheimer and Waldron, 2000). Empirical research attests to the short- and the long-term influences of parent- or caregiverprovided experiences over infant development. Mothers who speak more, prompt more, and respond more during the first year of their infants’ lives have 6-month-old infants to 4-year-old children who score higher in standardized evaluations of language and cognition (Bornstein, 1985; Bornstein, Tamis-LeMonda, and Haynes, 1999; Nicely, Tamis-LeMonda, and Bornstein, 1999). Even features of the parent-outfitted material environment appear to influence infant development directly (Wachs and Chan, 1986): New toys and changing room decorations promote child language acquisition in and of themselves and separate and apart from parental language. Indirect effects of parenting are subtler and less noticeable than direct effects, but likely no less meaningful. One primary type of indirect effect on infants is support and communication in the parents’ marriage. Conflicts and disagreements between parental partners increase with the birth of a baby, marital satisfaction decreases from pregnancy to early childhood, and parents’ attitudes about themselves and their marriages during this transition influence the quality of their interactions with their infants and, in turn, their infants’ development (Cowan and Cowan, 1992). Effective coparenting bodes well for infant development, and mothers (as indicated) who report supportive relationships even with “secondary parents” (lovers or grandparents) are more competent and sensitively responsive to their infants than are mothers deprived of such relationships. In the extreme, conflict between spouses may reduce the availability of an important source of support in infantrearing, namely one’s partner. Short of that, parents embroiled in marital conflict may have difficulty attending to the sometimes-subtle signals infants use to communicate their needs. Infants in these homes may learn that their caregivers are unreliable sources of information or assistance in stressful situations. For example, year-old infants are less likely to look to their maritally dissatisfied fathers for information or clarification in the face of stress or ambiguity than are infants of maritally satisfied fathers (Parke and Cookston, 2019). In one study, the influence of the 16

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husband-wife relationship on mother–infant interaction in a feeding context was assessed (Pedersen, 1975). Ratings were made of the quality of mother–infant interaction during home observations when infants were 4 weeks of age. Feeding competence referred to the appropriateness of the mother in managing and pacing feeding without disrupting the baby and to her displays of sensitivity to the baby’s needs for either stimulation of feeding or brief rest periods during feeding. In addition, the husband-wife relationship was evaluated, and neonatal assessments (Brazelton, 1973) were made.When fathers were more supportive of mothers, esteeming maternal skills, mothers were more competent in feeding babies. (Of course, competent mothers could elicit more positive evaluations from their husbands.) The reverse held for marital discord:Tension and conflict in the marriage were associated with more inept feeding on the part of the mother.The marital relationship also predicted the status and the well-being of the infant as assessed by Brazelton scores. With an alert baby, the father evaluated the mother more positively; with a motorically mature baby, the marriage was characterized by less tension and conflict. In brief, research supports both direct and indirect effects of parenting on infant development.

Models of Parenting Effects Parenting cognitions and practices shape development in infancy by means of different temporal pathways. A parent-provided experience might influence the infant at a particular time point in a particular way, and the consequence for the infant endures, independent of later parenting and any contribution of the infant. Theoreticians and researchers have long supposed that the child’s earliest experiences herald later development (Plato, ca. 355 BC), and data derived from ethology, psychoanalysis, behaviorism, and neuropsychology support this first early experience model. Empirically, mothers encouraging their 2-month-olds to attend to properties, objects, and events in the environment uniquely predicts infants’ tactual exploration of objects at 5 months over and above 2- to 5-month stability in infant tactual exploration and any contemporaneous 5-month maternal stimulation (Bornstein and Tamis-LeMonda, 1990). In a second contemporary experience model, parents exert unique influences over their infants at only a given point in development, overriding the effects of earlier experiences and independent of whatever individual differences infants carry forward. Empirical support for this model typically consists of failures of early intervention studies to show enduring effects and of recovery of functioning from early deprivation (Clarke and Clarke, 1976; Lewis, 1997; Rutter and the English and Romanian Adoptees Study Team, 1998). Empirically, mothers’ didactic encouragement of 5-month-olds is uniquely associated with infants’ visual exploration of the environment at 5 months, independent of stability in infant exploration to that point and mothers’ didactic encouragement 3 months earlier (Bornstein and Tamis-LeMonda, 1990). The first two models are consonant with a sensitive period interpretation of parenting effects (Bornstein, 1989b). A third cumulative/additive/stable environment model combines the two. That is, a parent-provided experience at any one time does not necessarily exceed a meaningful threshold to affect the infant, but effective longitudinal relations are structured by parenting that repeats and aggregates through time (Abelson, 1985; Olson, Bates, and Bayles, 1984). Empirically, maternal didactic stimulation when the infant is 2 and 5 months old cumulates to predict unique variance (above stability) in infant nondistress vocalization when the infant is 5 months old (Bornstein and Tamis-LeMonda, 1990). Although longitudinal data in the first 6 months provide evidence for unique early, unique contemporary, and cumulative experiential effects between mothers and infants, for the most part children are typically reared in relatively stable parenting environments (Holden and Miller, 1999), so that cumulative experience is likely. Of course, there is nothing to prevent different models of parenting influence from operating simultaneously in different spheres of infant development (as we have seen). 17

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It would be equally shortsighted to assume that different kinds of parenting exert only independent and linear effects over infant development; such a stance fails to consider complex, conditional, and nonlinear effects of caregiving. Parenting of specific sorts might affect development monistically, but different practices certainly also often combine in conditional ways; some parenting effects may be direct, others indirect; some may be immediate, others may need to aggregate to be more effective. In brief, parenting effects may follow any of three different temporal models.

Mechanisms of Parenting Effects Parents’ cognitions and practices influence infants and infant development by different paths. A common assumption in parenting is that the overall level of parental involvement or stimulation affects the infant’s overall level of development (Maccoby and Martin, 1983). An illustration of this simple main effects model asserts that the amount of language infants command is determined (at least to some degree) by the amount of language infants hear (Hart and Risley, 1995, 1999). Increasing evidence suggests that complex and more nuanced mechanisms need to be brought to bear to explain parenting effects. First, specific (rather than general) parenting cognitions and practices appear to relate concurrently and predictively to specific (rather than general) aspects of infant competence or performance; second, parent and infant transact to mutually influence one another through time; and, third, parent–infant coregulation appears optimal for development. The specificity principle states that specific parent-provided experiences at specific times exert specific effects over specific aspects of infant development in specific ways (Bornstein, 1989a, 2015). For example, mothers’ single-word utterances are just those that appear earliest in their children’s vocabularies (Chapman, 1981). Several such specificities were observed in the longitudinal study of relationships between mothers and their 2- to 5-month-old infants referred to earlier (Bornstein and Tamis-LeMonda, 1990), and they generalize across cultures (Bornstein Putnick, Park, et al., 2017). For instance, mothers who encourage their infants to attend to the mothers themselves have infants who later look more at their mothers, whereas mothers who encourage their infants’ attention to the environment have infants who explore surrounding properties, objects, and events more. Mothers’ responses to their infants’ communicative overtures are central to children’s early acquisition of language but exert less influence over the growth of motor abilities or play (Tamis-LeMonda and Bornstein, 1994). (The point here is not to deduce causation; correlation cannot support such an interpretation. Rather, the point here is to support specificity and coregulation.) The transaction principle in development recognizes that the characteristics of individuals shape their experiences and, reciprocally, that experiences shape the characteristics of individuals through time (Bornstein, 2009). Endowment and experience mutually influence development from birth onward, and each life force affects the other as development unfolds (Lerner et al., 2015). Infant caregiving is differentiated by responsibility and lead. In Western industrialized cultures, parents are generally acknowledged to take principal responsibility for structuring their exchanges with babies: They engage infants in turn taking in verbal interchange (Bornstein, Putnick, Cote, Haynes, and Suwalsky, 2015). Frequently, then, thinking about parent–infant relationships highlights parents as agents of infant socialization with infants conceived of as passive recipients.To a considerable degree, however, parenting infants is a two-way street. Infants cry to be fed and changed, and when awake they are ready to play. Parents’ initiatives are proactive; often, however, they are reactive and thence interactive. Infants appear to be sensitive to contingencies between their own actions and the reactions of others, and such contingencies are a hallmark of parent–infant responsive exchanges. By virtue of their unique characteristics and propensities—state of arousal, perceptual awareness, cognitive ability, emotional expressiveness, and individuality of temperament—infants actively contribute, through their interactions with their parents, to their own development. Infants influence which experiences they will be exposed to, and they filter (“interpret”) those experiences and so in 18

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some degree determine how those experiences will affect them. Infants deliberately search for and use others’ (parents’) emotional (facial, vocal, gestural) expressions to help clarify and evaluate uncertain and novel events, termed social referencing (Kim and Kwak, 2011; Murray et al., 2008). Between 9 and 12 months of age, infants look to mothers and fathers for emotional cues and are influenced by both positive and negative adult expressions (Dickstein and Parke, 1988; Hirshberg and Svejda, 1990). Indeed, in uncertain situations infants may position themselves so they can keep their mother’s face in view (Sorce and Emde, 1981). That negative qualities of caregivers’ emotional expressions— distress, disgust, fear, anger—influence infant behavior seems sensible, given that the overriding message in a parent’s emotional expressions is that an event is or is not dangerous or threatening to the baby. Infants not only play less with unusual toys when their mothers display disgust, instead of pleasure, about the toys, but when the same toys are presented later infants show the same responses, even though their mothers no longer pose emotional expressions but are instead silent and neutral (Hornik, Risenhoover, and Gunnar, 1987). Infants are negatively affected immediately and long-term by mothers’ lapsing into a “still face,” and infants of depressed mothers show inferior social referencing skills, perhaps because their mothers provide less frequent or less certain facial and vocal cues and fewer modeling responses (Manian and Bornstein, 2009). Infant and parent bring distinctive characteristics to, and each changes as a result of, every interaction; both then enter the next round of interaction as changed individuals.Thus, infant temperament and maternal sensitivity, for example, operate in tandem to affect one another and eventually the attachment status of the child (Bates et al., 2019). Vygotsky (1978) theorized that, as a central feature of this transactional perspective, the more advanced or expert partner (usually the mother) will elevate the level of performance or competence of the less advanced or expert partner (the infant), and the dynamic systems perspective posits that reciprocity between parent and infant facilitates higher-order forms of interaction. Responsiveness is on these grounds a key component of parenting infants (Ainsworth et al., 1978; Bornstein, 1989c). Although responsiveness takes many guises, parents who respond promptly, reliably, and appropriately to their babies’ signals give babies good messages from the start.They tell their children that they can trust their parents to be there for them. They give their children a sense of control and of self. A baby cries, a mother comes—the baby already feels she or he has an effect on the world. Responsiveness has been observed as a typical characteristic of parenting in mothers in different regions of the world (Bornstein, Putnick, Cote, et al., 2015; Bornstein, Putnick, Rigo, et al., 2017; Bornstein,Tamis-LeMonda, et al., 1992). Mesman et al. (2016) sampled 751 mothers in 26 cultural groups from 15 countries around the globe and found strong pervasive convergence between attachment theory’s description of the sensitive responsive mother and maternal beliefs about the ideal mother. Some types of responsiveness are similar, but some vary relative to divergent cultural goals of parenting. Mothers in different cultures respond to infant vocal distress and nondistress but vary in when and how they do so (Bornstein, Putnick, Cote, et al., 2015). Responsiveness to infant distress is thought to have evolved an adaptive significance for eliciting and maintaining proximity and care (Bowlby, 1969). However, mothers respond variously in more discretionary interactions, as in determining which infant attentional behaviors to respond to and how to respond to them. In line with cultural expectations, for example, Japanese mothers emphasize emotional exchange within the dyad in responsive interactions with their babies, whereas U.S. American mothers promote language and emphasize the material world outside the dyad (Bornstein, Tamis-LeMonda, et al., 1992).Transactional goodness-of-fit models explain much in infant development.Thus Lea, who is an alert and responsive baby, invites her parents’ stimulation; Lea’s enthusiastic responses are rewarding to her parents, who engage her more, which in turn further enriches her life. By contrast, a baby whose parent has been unresponsive is frequently upset because the parent’s inaccessibility may be painful and frustrating; furthermore, because of uncertainty about the parent’s responsiveness, the infant may grow apprehensive and protest stressful situations. 19

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Figure 1.2 

Coregulation is a third principle of optimizing infant development. Well-functioning parent– infant relationships are characterized by coordination, harmony, mutuality, reciprocity, and synchrony (Bornstein, 2013a). Coregulation is the adaptive unfolding of individual action that is continuously modified by changing actions of the partner. Parent–infant coregulation operates at biological (hormonal and nervous system) and behavioral (affective and cognitive) levels and consists of transacting contributions of partners. Like a Gestalt, however, coregulation transcends actors and is a property of the dyad; coregulation is dyadic, dynamic, and wholistic. Furthermore, early biological and behavioral coregulation facilitate infant development of secure attachment which then promotes self-regulation and fosters other domains of development. For examples, infant and maternal cortisol levels tend to 20

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be synchronous (Spangler, 1991; Sethre-Hofstad, Stansbury, and Rice, 2002; Stenius et al., 2008) as infant and mother levels of the enzyme alpha-amylase tend to correlate (Davis and Granger, 2009); infant affect becomes more positive when mutual mother–infant gaze had occurred in the previous moment, suggesting that the experience of synchronicity is associated with observable shifts in affect (MacLean et al., 2014); mothers vocalize contingently in response to their infants’ vocalizations, and infants vocalize in response to their mothers, and the two are correlated (Bornstein, Putnick, Cote, Haynes, and Suwalsky, 2015); infant and mother emotional availability intercorrelate as well (Bornstein, Putnick, et al., 2012; Bornstein, Putnick, and Suwalsky, 2012; Bornstein, Suwalsky, et al., 2010). Beeghly, Perry, and Tronick (2016) and Hofer (2006) have argued that the emergence of self-regulation occurs primarily in a relational context: Affective behavioral matching during faceto-face interaction fosters the transition from mutual regulation to self-regulation in infants (Noe, Schluckwerder, and Reck, 2015). Coregulation facilitates the growth of a sturdy sense of self (Stern, 1985) and has been linked to a broad spectrum of positive outcomes in child social development, cognitive maturation, intellectual achievement, and behavioral adjustment (van IJzendoorn, Dijkstra, and Bus, 1995; van IJzendoorn, Juffer, and Poelhuis, 2005). More specifically, mother-infant coregulation is associated with attachment security (De Wolff and van IJzendoorn, 1997), positive mood in the child (Lay,Waters, and Park, 1989), child compliance (Rescorla and Fechnay, 1996), delay of gratification and self-control (Feldman, Greenbaum, and Yirmiya, 1999; Raver, 1996), social attentiveness, social problem solving skills, and nonaggression (Lindsey, Mize, and Pettit, 1997; Mize and Pettit, 1997; Pettit and Mize, 1993), and cooperation, emotional reciprocity, maternal responsiveness, and child responsiveness (Deater-Deckard and O’Connor, 2000). In brief, parenting effects operate according to several different principles.

Summary Out of the dynamic range and complexity of caregiving infants, diverse domains of parenting cognitions and practices have been distinguished: Parenting cognitions and practices are conceptually separable but fundamentally integral, and each is developmentally significant. The attitudes parents hold about their infants, and the activities they engage them in, are each meaningful to infant development. Parenting infants follows multiple principles: Parents’ beliefs and behaviors affect infant development directly as well as indirectly by means of parents’ influences on one another and the multiple contexts in which they rear infants; parent-provided experiences affect infants following different temporal models and follow different mechanisms of action according to principles of specificity, transaction, and coregulation.The working model of parenting infants and infant development is that specific parent-provided experiences at specific times affect specific aspects of infant development in specific ways and that specific infant abilities and proclivities evoke specific interactions that inflect specific trajectories of infant development. Before leaving this omnibus if nuanced consideration of how parents think about and behave toward infants, some reality testing is in order. In everyday life, parenting infants does not always go well and right. Infanticide was practiced historically, but thankfully it is very rare (although not unknown) today (Piers, 1978; Saavedra and de Oliveira, 2017). Nonetheless, the local 10 o’clock news too often leads with some tragic account of infant neglect or abuse (Sturge-Apple, Toth, Suor, and Adams, 2019). Short of outright pathology, numerous other risks alter postnatal parenting and compromise the innocent infant: In 2016, 40% of births in the United States were to unmarried women (www.cdc.gov/nchs/fastats/unmarried-childbearing.htm); in 2015, more than 1 in 3 singlemother families lived in poverty (https://nwlc.org/resources/national-snapshot-poverty-amongwomen-families-2015/); in 2016, 50% of child fatalities involved infants under 1 year of age (Child Welfare Information Gateway, 2017); in 2011, 4.4% of pregnant women used illicit drugs, 10.8% used alcohol, 3.7% engaged in binge drinking, and 16.3% smoked cigarettes (Behnke, Smith, Committee 21

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on Substance Abuse, and Committee on Fetus and Newborn, 2013); and in 2013, more than 20% of children under 2 were not fully immunized against preventable disease (Child Trends, 2015). Some parents are simply distressed and so supervise their infants less attentively, and consequently know their infants less well. Transient situations as well as ongoing pathology affect parenting. As many as 25% of new mothers are depressed (Cates et al., 2019) and sometimes demonstrate a style of interaction marked by intrusiveness, anger, irritation, and rough handling of their infants, a style to which infants respond with gaze aversion and avoidance (Esposito, Manian, Truzzi, and Bornstein, 2017; Manian and Bornstein, 2009). Mothers who have abused drugs often fail simply to attend to elementary parenting responsibilities (Chassin, Hussong, Rothenberg, and Sternberg, 2019; Mayes and Bornstein, 1995). No matter that they are kissed publicly and often before every election as an ultimate demonstration of political caring (Dickens, 1867), infants have always and in every society suffered physical and psychological neglect and abuse.

Forces That Shape Parenting Infants A critical step on the path to fully understanding parenting infants is to evaluate the many forces that shape it. The origins of infant caregiving—cognitions or practices—are extremely complex, but certain factors seem to be of paramount importance: (1) biological and psychological determinants in parents, (2) actual or perceived characteristics of infants, and (3) contextual influences (Bornstein, 2016). That is, the ways parents think about and interact with their babies vary depending on a variety of factors, including parents’ and infants’ characteristics as well as social and economic circumstances, ideology, and culture.

Parent Biological and Psychological Determinants of Parenting Diverse forces operating within the parent shape parenting. Because securing the survival of offspring is fundamental to evolutionary pressure, it is likely that specific biological and psychological characteristics evolved in the service of parenting. Basic physiology is mobilized to support parenting, and some parenting cognitions and practices normally first arise around biological processes associated with pregnancy and parturition. However, prenatal biological characteristics and events—parental age, diet, and stress, as well as other factors such as contraction of disease, exposure to environmental toxins, and even birthing anesthetics—also affect postnatal parenting. Genetic endowment, neurohormonal activity, and central nervous system structure and function constitute some central biological characteristics that condition parenting. Prospective and new parents are showing increased interest in genetics: New companies will utilize computational methods to combine and analyze the couple’s DNA (based on saliva samples) and deliver predictions of more than 20 possible traits (ancestry, physical appearance) of a future child to parents via a mobile phone app. Behavior genetics (BG) seeks to understand biological sources of variation in human characteristics (Knopik et al., 2017). By studying individuals of varying genetic relatedness (identical and fraternal twins, biological and adopted siblings who share or do not share the same experiences), behavior geneticists attempt to estimate the amount of variation (heritability) in characteristics that can be explained by genetic endowment. From a BG perspective, parenting is (just) another phenotype that reflects nature and nurture (Broderick and Neiderhiser, 2019; McGuire, 2003). Expressions of caregiving have been linked to hormones that are sometimes homologous in females and males (Bales, 2014; Feldman, 2019). Hormonal events involved in parturition prime the brain to be sensitive to new and unique stimuli (Lambert and Kinsley, 2012). Oxytocin (OT) promotes prosocial behavior (Galbally, Lewis, van IJzendoorn, and Permezel, 2011) and is known to support the parent–infant bond in mammals (MacDonald and MacDonald, 2010).Variation in the OT receptor gene is associated with maternal sensitivity (Bakermans-Kranenburg and van IJzendoorn, 22

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2008). Baseline OT levels in mothers and fathers are associated with different gender-typed parenting. Mothers’ OT levels are positively correlated with affectionate but not stimulatory infant contact, whereas fathers’ OT levels are positively correlated with stimulatory but not affectionate infant contact (Feldman, Gordon, Schneiderman, Weisman, and Zagoory-Sharon, 2010; Feldman, Gordon, and Zagoory-Sharon, 2011). Utilizing a double-blind, placebo-controlled, crossover design, Weisman, Zagoory-Sharon, and Feldman (2012) observed fathers and their 5-month-old infants twice in a face-to-face still-face paradigm following administration of OT or placebo to the father. OT administration increased fathers’ salivary OT and key parenting behaviors that support parent–infant bonding. Moreover, parallel increases were found in infant salivary OT and engagement, including social gaze, exploration, and social reciprocity. In other words, OT administration had parallel effects on the treated parent and untreated infant. Other neurohormones show associations with parenting cognitions and practices. Cortisol is a steroid hormone released in response to stress. It functions to increase blood sugar, to suppress the immune system, and to aid in the metabolism of fat, protein, and carbohydrates. Mothers with lower cortisol levels are less withdrawn and more interactive with infants (Flinn et al., 2012).Testosterone is the primary male sex hormone and an anabolic steroid. Testosterone plays a key role in the development of male reproductive tissues and promotes secondary sexual characteristics such as increased muscle and bone mass, the growth of body hair, and aggressiveness. Fathers with lower testosterone levels engage in more infant caregiving (Alvergne, Faurie, and Raymond, 2009; Kuzawa, Gettler, Muller, McDade, and Feranil, 2009). Just as genes and hormones are wrapped up in parenting, so are the structure and function of the autonomic and central nervous systems (Bridges, 2008; Brunton and Russell, 2008; Stark, Stein,Young, Parsons, and Kringelbach et al., 2019; Numan and Insel, 2003). Esposito and his colleagues (2014) measured autonomic physiological arousal using infrared thermography while Italian and Japanese adults viewed unfamiliar ingroup versus outgroup infant and adult faces. Both Italians and Japanese showed selective and specific physiological activation (increased facial temperature) for both ingroup and outgroup infant faces. Arousal responses to infants are mediated by the autonomic nervous system. Parenthood also alters the adult brain (Barrett and Fleming, 2011; Bornstein, 2013a; Kim et al., 2010; Leuner, Glasper, and Gould, 2010; Rilling, 2013). For example, Bornstein, Arterberry, and Mash (2013) found that just 3 months of exposure to their own infant’s face shaped particular frontal and occipital cortex evoked response potentials (ERP) in new mothers. Programmatic research with own versus other baby photographs and videos (Bornstein et al., 2013; Leibenluft, Gobbini, Harrison, and Haxby, 2004; Noriuchi, Kikuchi, and Senoo, 2008; Ranote et al., 2004; Strathearn, Li, Fonagy, and Montague, 2008; Swain, Leckman, Mayes, Feldman, and Schultz, 2006) and with cries of own infant versus standard cries versus control noises (De Pisapia et al., 2013; Ranote et al., 2004;Venuti et al., 2012) has revealed enhanced activations in regions of mothers’ and fathers’ brains associated with movement, speech, empathy, and emotion recognition and evaluation of own infants. Papoušek and Papoušek (2002) developed the notion that some infant caregiving practices are biologically “wired” into human beings, termed intuitive parenting. Such caregiving is developmentally suited to the age and the abilities of the infant and has the overall goal of enhancing infant adaptation and development. Parents regularly enact intuitive parenting programs in an unconscious fashion—such programs do not require the time or the effort typical of conscious decision-making, and, being more rapid and efficient, they utilize less attentional and cognitive reserve. An example of intuitive parenting is the use of infant-directed speech. Parents and others habitually and unconsciously modulate myriad aspects of their communication with infants to match infants’ presumed or evaluated competencies. Special characteristics of infant-directed speech include prosodic features (higher pitch, greater range of frequencies, more varied and exaggerated intonation); simplicity features (shorter utterances, slower tempo, longer pauses between phrases, fewer embedded clauses, fewer auxiliaries); redundancy features (more repetition over shorter amounts of 23

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time, more immediate repetition); lexical features (special forms like “mama”); and content features (restriction of topics to the child’s world). Cross-cultural developmental study attests that infantdirected speech is widespread (Soderstrom, 2007). Indeed, parents find it difficult to resist or modify such intuitive behaviors, even when asked to do so (Trevarthen, 1979). Additional support for the premise that some interactions with infants are intuitive comes from observations that nonparents (males and females) who have little prior experience with infants also modify their speech as the infants’ own parents do when an infant is actually present and even when asked to imagine speaking to an infant (Jacobson, Boersma, Fields, and Olson, 1983). Children from 2 to 3 years of age also engage in such systematic language adjustments when speaking to their year-old siblings as opposed to their mothers (Dunn and Kendrick, 1982), and when communicating with their infants mothers with hearing loss modify their sign language the way hearing mothers use infant-directed speech (Erting, Prezioso, and Hynes, 1994). Parenting derives in part from biology but also reflects psychological characteristics of an individual. Parent age and (as we have seen) gender are perennially important parenting topics (Bornstein, 2013b) as are parents’ attentiveness, intelligence, and cognitive preparedness as well as their transient feelings, enduring personality traits, and developmental history. The average age for first birth in the United States is about 26.0 years. However, the contemporary demographics of parturition indicate that the rate of teenage (15–19 years) motherhood is epidemic (204,043 live births in the United States in 2015; CDC/National Center for Health Statistics, 2017), as approximately 1 in 3 adolescent women becomes pregnant by the end of her 19th year. Having a baby is a major transition in a person’s life, marked by dramatic changes in information seeking, self-definition, and role responsibility (Bornstein, 2015). Teenage mothers are thought to have lower levels of ego strength, to be less mature emotionally and socially, and to lack a well-formed maternal self-definition, perhaps because they themselves are negotiating their own developmental issues and are unskilled because of a still-developing brain and dearth of life experience (Easterbrooks, Katz, and Menon, 2019).Younger European American mothers are less sensitive and optimally structuring, and their infants and toddlers are less responsive and involving (Bornstein, Putnick, and Suwalsky, 2012). Lewin, Mitchell, and Ronzio (2013) used the nationally representative Early Childhood Longitudinal Study-Birth cohort data set to compare parenting practices of adolescent mothers (25 years) when their children were 2 years of age. Controlling for socioeconomic differences, adolescent mothers exhibited less supportiveness, sensitivity, and positive regard than emerging-adult mothers, who exhibited less than adults. Adolescent and emerging-adult mothers reported equivalent frequencies of spanking and use of time-out, significantly more than adult mothers. The sociodemographic situations in which new mothers find themselves exert specific influences over parenting as well. Many new mothers appear to start their career as parents by being disadvantaged in some way. Large numbers of them in the United States have not finished high school and are not married when their baby is born, for example. Parents’ attentiveness, intelligence, mental functioning, and (as we see later) even memories of their own childhood help to create “strategy frames” or “affective lenses” that color their parenting. Attention at neurobiological levels is heightened in new mothers (Purhonen, Valkonen-Korhonen, and Lehtonen, 2008); policewomen report enhanced vigilance following the birth of their first child (Fullgrabe, 2002); and women’s improved attentional processing of infant emotions during pregnancy relates to their later relationships with their infant (Pearson, Lightman, and Evans, 2011). Analyzing data from the Massachusetts site of the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development, Mulvaney, McCartney, Bub, and Marshall (2006) learned that mothers’ verbal intelligence predicted the effectiveness of their scaffolding collaborations with their children (which in turn uniquely predicted later cognitive capabilities of the children). Even “cognitive readiness” to parent predicts parenting, at least during 24

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infancy (Borkowski et al., 2002), and accounts for relations between early maternal interactions and 1-year attachment status (Lounds, Borkowski, Whitman, Maxwell, and Weed, 2005). Furthermore, mothers’ knowledge of child development and parenting predicts positive emotional mother-infant relationships (Bornstein, Putnick, et al., 2012). Personality also plays a significant part in parenting: “One cannot take the ‘person’ out of the parent” (Vondra, Sysko, and Belsky, 2005, p. 2). A burgeoning literature explores relations between one or more of the Big Five personality factors and parenting (Bornstein, Hahn, and Haynes, 2011; Prinzie, Stams, Dekovic, Reijntjes, and Belsky, 2009). The five personality factors (as variables and in patterns as clusters) relate differently to diverse parenting cognitions and practices (Prinzie, de Hahn, and Belsky, 2019). Other features of personality favorable to good parenting of infants might include empathic awareness, predictability, nonintrusiveness, and emotional availability. Perceived self-efficacy likely affects parenting because parents who feel competent are reinforced and thus motivated to engage in further interactions with their infants, which in turn provides them with additional opportunities to read their infants’ signals, interpret them more accurately, and respond appropriately; the more rewarding the interaction, the more motivated are parents to seek “quality” interactions again. Adult adaptability may be especially vital in the first few months when infants’ activities appear unpredictable and disorganized, and their cues less distinct and differentiated. Negative characteristics of personality, whether transient or permanent, affect parenting infants adversely. The upbringing of children is highly emotional for both parents and children (Leerkes and Augustine, 2019). Self-centeredness likely leads to difficulties when adults fail to put infants’ needs before their own (Dix, 1991). Women who are more preoccupied with themselves, as measured by physical and sexual concerns, show less effective parenting in the postpartum year (Grossman, Eichler, and Winikoff, 1980). Self-absorbed, these mothers may not be adequately sensitive to their infants’ needs, a situation that also seems prevalent among adolescent mothers. Depression might be an enduring psychological characteristic, or it might be fleeting, as in response to economic circumstances or even the birth of the baby. Depressed mothers fail to experience— and convey to their infants—much happiness with life. Depression’s associated mood disturbance, worry, and rumination compromise mothers’ ability to attend, diminish their responsiveness, and discoordinate their interactions with infants and children (Dix and Meunier, 2009; Manian and Bornstein, 2009; Murray, Halligan, and Cooper, 2010; Stein et al., 2012). Mothers who present with depression show increased negative affect and cognitions, apathy and lack of energy, and decreased engagement with children (Dix and Moed, 2019). Psychopathology, such as mental illness, phobias, substance abuse, and antisociality, seriously impairs thinking, affect, and behavior, and consequently parenting cognitions and practices (Suchman and DeCoste, 2019).Vesga-López et al. (2008) estimated the prevalence of postpartum psychopathologies in mothers to range from 12% for substance use to 15% for mood disorders. In short, many positive and negative aspects of adult personality help to shape parenting and so may have short- as well as long-term consequences for infants. Furthermore, through intergenerational transmission (Kerr and Capaldi, 2019), by means of genetic and experiential pathways, purposefully or unintentionally, one generation (G1) appears to influence the parenting beliefs and behaviors of the second generation (G2) and thus the experiences and even childrearing of the third infant generation (G3). Fraiberg, Adelson, and Shapiro (2003) once referred to these inspirations as “ghosts in the nursery.” Mothers who report having had secure and realistic perceptions of their attachments to their own mothers are themselves more likely to have securely attached infants (Main, 1991). Kovan, Chung, and Sroufe (2009) provided a “longitudinal” illustration of such intergenerational transmission when they recorded interactions of parents (G1) and their 2-year-olds (G2) and then waited and recorded interactions of those 2-year-olds as parents (G2) with their own 2-year-olds (G3). Even accounting for confounds, a relatively strong correspondence emerged in parenting between generations. 25

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Infant Effects on Parenting Thinking about parent–infant relationships naturally highlights parents as agents of infant development, and there is ample evidence that, between parents and infants, infants have less agency and parents exert more sway (Kochanska and Aksan, 2004; Maccoby, 1992). Even if there is initially asymmetry between parent and infant contributions to parenting, infants affect parents. For parents (and professionals alike), the pervasiveness, rapidity, and clarity of changes in infancy engender fascination and motivate action. The most remarkable domains of change in infancy involve the growing complexity of the nervous system; alterations in the anatomy and capacity of the body; sharpening sensory and perceptual capacities; increasing abilities to make sense of, understand, and master objects in the world; acquiring communication; the emergence of characteristic personal and social styles; and forming specific social bonds. Parenting is also affected by developmental dynamics. During infancy, children transform from immature beings unable to move their limbs in a coordinated manner to people who control complicated sequences of muscle contractions and flections to reach or grasp or walk, and from children who can only cry or babble to people who make needs and desires abundantly clear in emotional displays and language. During infancy, children first make sense of and understand the material world, first express and read basic human emotions, first develop individual personalities and social styles, and form their first social bonds. Parents escort their infants through all these dramatic “firsts.” Not surprisingly, each of these developmental dynamics is closely tracked by parents, all shape parenting, and each in turn is shaped by parents (and so, on the transaction principle, infant development itself). So-called “infant effects” take many forms. Some are universal and common to all infants; others are unique to a particular infant. Here they are examined in some detail.

Structural Characteristics Some physical features of infancy probably affect parents everywhere in similar ways. By the conclusion of the first trimester, fetuses are felt to move in utero (“quickening”), and soon after (with support) fetuses may survive outside the womb (“viability”). These are significant markers in the life of the child and in the lives and psyches of the child’s parents (and society). After birth, the infant’s nature as well as certain infant actions likely influence parenting. The newborn has a large head dominated by a disproportionately large forehead, widely spaced sizeable eyes, a small and snub nose, an exaggeratedly round face, and a small chin. The ethologist Lorenz (1935/1970) argued that these physiognomic features of “babyishness” provoke adults to express reflexively nurturant reactions toward babies—even across different species (Kringelbach et al., 2016). As noted earlier, viewing a picture of one’s own infant activates brain areas associated with reward and motivation. Certain common infant behaviors also elicit caregiving or other specific responses from parents. For example, infant crying motivates adults to approach and soothe and babbling to continue the dialogue (Bornstein, Putnick, Park, Suwalsky, and Haynes, 2017; Bornstein, Putnick, Rigo, et al., 2017). Other structural characteristics of infants affect parenting and the quality of parent–infant interaction: Infant health status, gender, and age are three. Preterm infants, for example, often have difficulty regulating engagements with caregivers, as made evident by that increased gaze aversion, decreased play, and lower levels of joint attention (Gattis, 2019), and their mothers are reciprocally more active and directive. Parental patterns of interaction with infant girls and boys constitute a second nuanced infant effect. On the one hand, parenting infant girls and boys is surprisingly similar as girl and boy infants alike have many of the same developmental requirements (Bornstein, Putnick, Lansford, Deater-Deckard, and Bradley, 2016). On the other, nurseries for newborn infants provide color-coded blankets, diapers, and wallpapers; infant gifts, beginning with the baby shower, are carefully selected with gender in mind; and infants are uniformly dressed in gender-typed clothing. Gender also organizes parents’ initial descriptions, impressions, and expectations of their infants (Bornstein, 2013b). 26

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Infant development per se, a third structural infant effect, exerts pervasive effects on parental beliefs and behaviors. For example, cross-cultural study shows that mothers of younger infants use more affectsalient speech but that, as infants achieve more sophisticated levels of motor exploration and cognitive comprehension, mothers increasingly orient, comment, and prepare them for the world outside the dyad by increasing maternal information-salient speech (Bornstein, Tamis-LeMonda, et al., 1992).

State Infants vary in how soon they establish a predictable schedule of behavioral states (Bornstein, Arterberry, and Lamb, 2014), and their regularity or lack thereof has critical implications for infant care and development as well as for parental well-being. State determines how infants present themselves; and much of what infants learn about people, their own abilities, and the world around them is acquired during periods of quiet alertness and attentiveness. Therefore, infant state influences infant development and adult behavior: Mothers lose hours of sleep during their infant’s first year (Hunter, Rychnovsky, and Yount, 2009), often because of multiple infant awakenings, and mothers may experience negative effects of sleep deprivation on their physiology, cognitions, and emotions even without being fully aware of it (Insana, Williams, and Montgomery-Downs, 2013; Montgomery-Downs, Insana, Clegg-Kraynok, and Mancini, 2010; Peng et al., 2016). Thus, different states determine the circumstances under which infants are with their parents and what parents do: Babies are usually with their mothers when awake, and alone when asleep. Adults soothe distressed babies instead of trying to play with them. At the same time, infant state is modifiable: Packer and Cole (2015) documented cultural conditioning of infants’ biological entrainment to the day–night cycle. Among the Kipsigis, a people of the Kenyan desert, infants sleep with their mothers at night and are permitted to nurse on demand. During the day, they are strapped to their mothers’ backs, accompanying them on daily rounds of farming, household chores, and social activities. These babies often nap while their mothers go about their work, and so they do not begin to sleep through the night until many months later than do U.S. American infants. State organization and getting “on schedule” are subject to parent-mediated experiential influences.

Physical Stature and Psychomotor Abilities Growth through the first 2 postnatal years is manifest even on casual observation because of its magnitude and scope. On average, U.S. newborns measure 20 inches and weigh 7.5 pounds. In the year after birth, babies grow half their birth length and their weight approximately triples (National Center for Health Statistics, 2010). These physical changes are paralleled by signal advances in motor skills (Adolph and Berger, 2015). Children’s achieving certain motor milestones—sitting, standing upright, and walking, for example—dramatically alters the nature and quality of their subsequent behavior and adult caregiving. Achieving sitting leads to more sophisticated visual-manual object exploration, which in turn facilitates 3-D form perception (Soska, Adolph, and Johnson, 2010). Consider the eagerness with which parents await their child’s first step. This achievement signifies an important stage in infant independence, permitting new means of exploring the environment and of determining when and how much time infants spend near their parents. By walking, infants also assert individuality, maturity, and self-mindedness. These changes, in turn, affect the ways in which parents treat the child: How parents organize the baby’s physical environment and even how they speak to the walking, as opposed to the crawling, baby differ substantially.Walking infants make moving bids; crawling infants make stationary bids. In turn, infants’ locomotor status predicts mothers’ responses to their bids: Mothers of walkers respond much more and respond with action directives, whereas mothers’ of same-age and equally verbal crawlers respond much less and in different ways (Karasik, Tamis-LeMonda, and Adolph, 2013). 27

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Psychomotor growth in infancy also reflects parenting practices: In anthropological studies (hardly allowable today), Dennis and Dennis (1940) observed that relative locomotor delay in Hopi Native Americans reflected Hopi babies’ traditional early constriction on a cradleboard; Mead and MacGregor (1951) proposed that the manner in which Balinese mothers habitually carried their infants promoted the emergence of unique developmental trajectories of motor function; and Ainsworth (1967) attributed advanced Ganda infant motor abilities to a nurturing climate of physical freedom. Antecedent to behaviors, beliefs in the form of parental expectations also play influential roles. For example, Jamaican mothers living in an English city expect their infants to sit and to walk relatively early, whereas Indian mothers living in the same city expect their infants to crawl relatively late: Infants in each subculture develop in accord with their mothers’ expected timetables (Hopkins and Westra, 1990).

Perceiving and Thinking During infancy, the capacities to take in information through the major sensory channels and to attribute meaning to perceived information improve dramatically. Although it is not always apparent, there is no question that infants have an active mental life. Infants are constantly learning and developing new ideas. Infants actively scan the environment, pick up, encode, and process information, and aggregate over their experiences (Bornstein and Colombo, 2012). Newborns are equipped to hear, to orient to, and to distinguish sounds, and babies seem especially primed to perceive and to appreciate sound in the dynamic form and range of adult speech. Newborns also identify particular speakers— notably mother—right after birth (DeCasper and Spence, 1986; Kisilevsky et al., 2003), apparently based on prenatal exposure to the maternal voice. By their preference reactions, newborns also give good evidence that they possess a developed sense of smell (Allam, Marlier, and Schaal, 2006; Goubet et al., 2002; Goubet, Strasbaugh, and Chesney, 2007; Steiner, 1979), and babies soon suck presumptively at the scent of their mothers, and reciprocally mothers recognize the scent of their baby based on only 1 or 2 days’ experience (Porter and Levy, 1995; Porter and Winberg, 1999). By 3 months of age, infants’ brains process their mothers’ face as different from an appearancematched stranger face (Bornstein et al., 2013), and by 4 or 5 months of age infants discriminate among facial expressions associated with different emotions and even distinguish variations in some emotional expressions (Kuchuk, Vibbert, and Bornstein, 1986). How parents look to infants will meaningfully supplement what they have to say to them; indeed, as infants do not yet understand speech, infants’ looks may be more telling. Looking is not solely a source of information acquisition; gaze is also a critical channel of social exchange. Eye-to-eye contact between infant and caregiver is rewarding to both and sets in motion routines and rhythms of social interaction and play and supports the role of mother-infant synchronicity in emotion regulation (Bhatt, Bertin, Hayden, and Reed, 2005; Bornstein and Arterberry, 2003; Johnson, 2015; MacLean et al., 2014). As a consequence of infants’ information-processing skills (Bornstein and Colombo, 2012), parents’ displays and infants’ imitations of them serve as particularly efficient mechanisms for infants’ acquiring information of all sorts . . . just by listening and watching. How early infants imitate, and what they can imitate, may be disputed research issues, but the existence and significance of observational learning in infancy are not. Infancy culminates with the development of representational thinking and acquisition of language. In the first year, for example, play with objects is predominantly characterized by sensorimotor manipulation (mouthing and fingering) whose primary goal appears to be the extraction of information about objects. In the second year, object play takes on an increasingly symbolic quality as infants enact activities performed by self, others, and objects in simple pretense situations, for example pretending to drink from empty teacups or to talk on toy telephones (Bornstein, 2007; Tamis-LeMonda, Kuchirko, Escobar, and Bornstein, 2019). Maternal play influences infant play, and 28

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cross-cultural comparisons confirm that, where parents emphasize particular types of play, infants tend to engage in those same types of play (Bornstein, Haynes, Pascual, Painter, and Galperín, 1999).

Speaking and Understanding Early in life, infants communicate by means of emotional expressions like crying and smiling. In remarkably short order, the infant’s repertoire of communicative tokens expands to organize speech sounds, as indicated by babbling, and to include gestures. The comprehension of speech, combined with the generation of meaningful utterances, rank among the major cognitive achievements of the infancy period, but the motivation to acquire language may be social and is born in interaction, usually with parents (Bornstein, Putnick, Cote, et al., 2015; Tamis‑LeMonda and Bornstein, 2015). That is, first language reflects the child’s early and rich exposure to the parent-provided target language environment as much as it does competencies that are a part of the child. Language learning is active but is embedded in the larger context of adult-infant social communication. Parent-provided experiences swiftly and surely channel early speech development toward the adult target language. In the space of approximately 2 years, infants master rudiments of language, often even without explicit instruction or noticeable effort, but they always speak the language to which they have been exposed.

Emotional Expressivity and Temperament Emotional expressions are evidence of how babies respond to events, and new parents pay special attention to infants’ emotions in their efforts to understand and manage them. The advent of emotional reactions—be they the first smiles or the earliest indications of stranger wariness—cue meaningful transitions for caregivers. Parents read them as indications of emerging individuality—as markers to what the child’s behavioral style is like now and what it portends. From the first days of their infants’ lives, mothers support their babies’ expressions of joy by playing with facial displays, vocalizations, and touch (Stern, 1985). Reciprocally, as early as the second half of the first year of their infants’ lives, parents’ emotional expressions are meaningful to infants (Field, 2002; Klinnert, Campos, Sorce, Emde, and Svejda, 1983; Malatesta, Grigoryev, Lamb, Albin, and Culver, 1986). Infants respond emotionally to the affective expressions they observe in other people as when, for example, their caregivers are depressed (Manian and Bornstein, 2009). Infants as young as 1 year respond to emotional messages, showing signs of distress when witness to angry interactions between family members (Geangu, Benga, Stahl, and Striano, 2010, 2011; Hutman and Dapretto, 2009; Thompson, 2006). Beyond emotional exchange, infants influence parenting by virtue of their individuality of temperament (Bornstein, 2010). Activity level, mood, and soothability define dimensions of temperament by which parents typically characterize their infants. Just as parents and other infant caregivers try to interpret, respond to, and modify infants’ emotional states, they also devote considerable energy to identifying, adapting to, and channeling infants’ temperament (Bornstein, Arterberry, and Lamb, 2014). For one example, some infants appear better able to regulate their attention and emotions and so engage parents in more rewarding bouts of joint attention (Raver, 1996). For another, babies with autism spectrum disorders (ASD) have hunger cries that are higher pitched, and adults perceive them as more aversive and demanding (Esposito, Nakazawa, Venuti, and Bornstein, 2012). Further to this point, “difficult” babies are characterized by frequent and intense expressions of negative emotion, and they demand and receive different patterns of attention than do “easy” babies (Bates et al., 2019). Mothers of irritable infants engage in less visual and physical contact and are less responsive and less involved with their babies (Van den Boom and Hoeksma, 1994), and maternal perceptions of infant difficultness predict perceptions of aggressiveness and anxiety in children as they grow (Bates, Maslin, and Frankel, 1985). In these ways and others, infant temperament influences parental cognitions and practices (Bates et al., 2019). Infants who infrequently smile and laugh from ages 4 to 12 months have 29

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mothers who engage in more negative parenting at 18 months, controlling for mother personality (Bridgett, Laake, Gartstein, and Dorn, 2013). Having a temperamentally easy child or perceiving a child as temperamentally easy (relatively happy, predictable, soothable, and sociable) enhances mothers’ feelings of competence and efficacy (Dixon and Smith, 2003; Porter and Hsu, 2003; Putnam, Sanson, and Rothbart, 2002) and promotes warmer and more responsive parenting, whereas challenging children often evoke parenting stress and harshness (Balge and Milner, 2000; Deater-Deckard and Dodge, 1997; Gershoff, 2002; Mammen, Kolko, and Pilkonis, 2002). High levels of infant distress at 1 year undermine mothers’ supportive parenting from 1 to 2 years (Scaramella, Neppl, Ontai, and Conger, 2008). Children with more difficult temperaments often require more external parental support and usually are recipients of less sensitive parenting (Ciciolla, Crnic, and West, 2012). Parents’ perceptions of child shyness at age 2 predict lower levels of parents’ self-reported encouragement of child independence at age 4, even controlling for initial levels of encouragement of independence and stability in child shyness (Rubin, Nelson, Hastings, and Asendorpf, 1999). High infant social wariness at 18 months is associated with diminished structured parenting at 27 months, even controlling for parenting at 18 months and for changes in child social wariness (Natsuaki et al., 2013); this study used adoptive children and their parents, thereby ruling out a shared-genes explanation for the child temperament effect. Just as in other spheres of infant life, cultural variation shapes interactions between infant emotional expressions or temperament and parenting. No doubt some temperament proclivities of infants transcend culture: Some smiles are more equal than others, and an infant’s smile is unquestionably first among equals. However, adults in different cultures socialize the emotional displays of their infants by responding in accordance with culture-specific requirements or interpretations of infants’ expressions and emotions. For example, infants universally respond to separation from parents in characteristically negative ways, but mothers may perceive and interpret those reactions differently according to cultural values. European American and Puerto Rican mothers both prefer infants who display a balance of autonomy and dependence; however, European American mothers attend to, and place greater emphasis on, the presence or absence of individualistic tendencies, whereas Puerto Rican mothers focus more on characteristics associated with a sociocentric orientation, that is the young child’s ability to maintain proper conduct in a public place (Harwood, 1992).Thus, the meaning of infant behavior for parents is a complex function of act and context (Bornstein, 1995). To a clinical point, the same behavioral intervention may rapidly soothe one infant yet is totally ineffective for another, leading parents of different temperament infants to reach different conclusions about their competence and effectiveness as parents, despite similarities in their parenting (Bates et al., 2019). Although in many circumstances infant difficultness may be associated with long-term negative consequences, among Ethiopian infants otherwise starving, difficult temperament elicited adult attention and feeding, and so proved adaptive (DeVries and Sameroff, 1984).

Social Life The infancy period is witness to molting the cocoon of autism and the gradual dawning of social awareness; over time babies assume increasing responsibility for initiating and maintaining social interactions. Stern (1985) wrote of only an “emergent self ” before 2 months and glimmerings of a “sense of a core self ” between 2 and 7 months. By 2 months of age, infants begin to engage in responsive exchanges with their mothers, characterized by mutual give and take in the form of coos, gazes, smiles, grunts, and sucks. On this basis, infants develop a sense of shared experience (termed intersubjectivity; Trevarthen and Delafield-Butt, 2013). The development of emotional relationships with other people—attachments mainly with parents—constitutes one of the most important achievements of social growth in infancy (Ainsworth et al., 1978; Bowlby, 1969). By the middle of the first year, the very social infant bears little resemblance to the seemingly asocial neonate. 30

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Infant-mother interactions have been referred to as the “cradle of social understanding” (Rochat and Striano, 1999) for how they presumably color later social relationships. Once infants develop the capacity to recognize specific people, they begin to prefer, and gradually form enduring attachments to, adults who have been consistently and reliably accessible during their first months in the world. Attachment formation is a product of the convergence of built-in tendencies on the part of infants and propensities of adults to respond in certain ways to infants’ cues and needs. The nature of parent–infant interactions provides a medium within which the chrysalis of the child’s future life germinates and grows. The quality of parent–infant relationships shapes infants’ relationships with others by multiple converging means: modeling the nature and course of interventions, affecting infants’ willingness and ability to engage in interactions with others, as well as influencing lessons infants take away from those interactions. The developmental changes that take place in individuals during the 2½ years after their conception— the prenatal and the infancy periods—are more dramatic and thorough than any others in the lifespan. The body, the mind, and the ability to function meaningfully in and on the world all emerge and flourish with verve.That dynamism, in turn, engages the world, for infants do not grow and develop in a vacuum. Every facet of creation they touch as they grow and develop influences infants in return.These reciprocal relations in infancy ultimately cast parenting in a featured role.

Developmental Change and Individuality in Infancy Transcending development of individual systems (just reviewed) are overarching characteristics of this first extrauterine phase of the life cycle. Development in infancy has some strong stable components: Crying in 6-month-old infants and behavioral inhibition in 18-month-old toddlers may seem different, when in fact their underlying source construct of fear might be the same (Bornstein, 2014). However, much of infancy is unrelenting change, and too soon the infant is emerging from the newborn and immediately after the toddler from the infant. Some change is common to all infants. Infant age, for example, is associated with changes in the nature of infant vocalizations which in turn alter the nature of parent language (Bornstein, Tamis-LeMonda, Hahn, and Haynes, 2008). At the same time, all children change at their own rate. Last week, Jonathan may have stayed in the spot where he was placed, this week he is creeping, and next month he will be scooting around faster than his mother can catch him. Another baby the same age may not begin to locomote for a percentage of a lifetime later. Understanding, anticipating, and responding to dynamic change in the context of individual variation present major challenges to parenting infants. Parents need to know about and be vigilant to all the complications and subtleties of infant development. Infant development involves parallel and rapid growth in biological, psychological, and social systems. Moreover, even normal developmental trajectories may be nonlinear in nature, stalling sometimes, or even regressing temporarily (Bever, 1982; Harris, 1983; Strauss and Stavey, 1981). Infant growth well illustrates the “systems” perspective on development, in the sense that the organization of the whole changes as the infant matures and is exposed to new experiences; changes also take place at many levels at once. Earlier emerging gestures (pointing) are less likely, and later merging gestures (showing) are more likely, to elicit a label for a referent from parents (Olson and Masur, 2011).The emergence of self-produced locomotion involves advances in motor skills and also affects visual-vestibular adaptation, visual attention, social referencing, and emotions. Babies who can pull themselves up to standing position and cruise (which occurs sometime between 11 and 15 months of age) engage the social and the object worlds in fundamentally new ways: The younger infant was totally dependent on adults for stimulation, whereas the older infant self-stimulates and self-educates. Standing infants seem more grown up to adults, who in turn treat them so. The Gusii of Kenya have the expression “lameness is up,” meaning that only when children begin to walk are they liable to get hurt (LeVine, 1977). By the second year, infants initiate activities with parents more than 85% of 31

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Figure 1.3 

the time (White, Kaban, Shapiro, and Attanucci, 1977). With each infant advance, parents’ behaviors toward infants change; they must now be vigilant about a range of new, and possibly dangerous, circumstances. Much more than before, parents must communicate that infants need to regulate their own behavior. The notable developmental achievements that unfold during infancy are impressive (especially when infancy is viewed in terms of the small proportion of the entire lifespan it represents), but normal variability in the timing of infant achievements is equally compelling. Characteristics idiosyncratic to specific infants influence parenting. Every infant is an original. Interest in the origins and expression of inter-infant variability occupies a central position in thinking about infant development and parenting (Bornstein, Putnick, and Esposito, 2017). The ages at which individual infants 32

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might achieve a given developmental milestone typically vary enormously (some children say their first word at 9 months, others at 29 months), just as infants of a given age vary dramatically among themselves on nearly every index of development (at 1 year, some toddlers comprehend 10 words, others 75; some produce zero words, others nearly 30). Goldberg (1977) taxonomized some salient infant characteristics that affect parenting: responsiveness, readability, and predictability. Responsiveness refers to the extent and quality of infant reactivity to stimulation. Readability refers to the definitiveness of infant behavioral signals. Predictability refers to the degree to which infant behaviors can be anticipated reliably. Each baby possesses her or his unique profile of these characteristics. Of course, when and how their infants talk or walk or what-have-you exercise a strong psychological draw on parents, even if it is temporary and the long-term significance of a given infant’s performance at a given time is meaningful in only extreme cases. Parenting an infant is, therefore, akin to trying to hit a moving target, with the ever-changing child developing in fits and starts at her or his own pace. Amidst this spectrum of developmental issues and matters that all parents confront, infants themselves are mute but potent. The very young neither understand their parents’ speech nor respond to them verbally. At the same time, they are also notoriously uncooperative and perversely unmotivated to perform or conform. Still other pervasive infant characteristics vex parents or give them pause—depending on a parent’s perspective or the moment: Infants possess limited attention spans and, in addition to lacking speech, command limited response repertoires; in their first months, they are also motorically incompetent or inept.Yet infants are insistent and unrelenting in their demands. Reciprocally, parents need to interpret aspects of infant functioning unambiguously and must do so despite changes and fluctuations in infant state. Perhaps the major problem faced by parents of infants is that, at base, parents are constantly trying to divine what is “inside the baby’s head”—what infants want, what they know, how they feel, what they will do next vis-à-vis the people and the things around them, and whether they understand and are affected by those same people and things. Thus, parents of infants seem constantly in search of patterns, often inferring them even on the basis of single transient instances. New (usually inexperienced) parents have the job of disambiguating novel, complex, and rapidly emerging uncertain information, and at the same time they are called on to caregive appropriately and effectively. Even if most face these formidable challenges of infancy with a degree of psychological naiveté, parents do not meet these tests totally unprepared. Both biology and experience equip parents to respond, understand, and interpret infancy and its vicissitudes.

Contexts of Parenting The biology and psychology of parents and infants constitute influences on parenting from the start (Bornstein and Leventhal, 2015). However, environmental and societal factors condition and channel cognitions and practices of infants’ parents as well. Immediate situation, family configuration, social support, SES, and culture are prominent examples of contexts that encourage diverse patterns of parenting.

Situation Low-challenge situations (e.g., unstructured play) prompt one kind of parenting (Miller, Wang, Sandel, and Cho, 2002), as emotional and instrumental demands are relatively minimal (Ciciolla et al., 2012), but the degree to which parents of infants are challenged during interactions affects their attitudes and actions, as parents must exert additional effort to remain calm and regulated under more taxing conditions (A. L. Miller, McDonough, Rosenblum, and Sameroff, 2002; P. J. Miller et al., 2002). Maas et al. (2013) examined effects of situational variables on mothers’ interactions at home with their 6-month-olds. Levels of sensitivity and stimulation varied systematically across situations 33

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of free play, face-to-face play, and diaper change: During free play, mothers showed the highest levels of stimulation toward their infants; face-to-face interactions evoked more positive responsiveness; and in the goal-oriented diaper change situation, mothers hardly stimulated their infants and showed less overall positive regard.

Family Configuration Although a substantial proportion of developmental science has been constructed on mother-firstborn relationships (Hoffman, 1991), roughly 80% of mothers in the United States alone have more than one child (Feinberg, McHale, and Whiteman, 2019; Volling, 2017). Among the more dramatic (and often disruptive and stressful) yet normative changes in family dynamics is one that takes place when a second baby is born; consequently, the social and physical ecologies of firstborn and laterborn infants can be very different (Bornstein, Putnick, and Suwalsky, 2018a). The births of later children alter the roles of each family member and forever affect the ways in which each interacts with all others. Parents of a secondborn infant are in many ways, therefore, not the same as parents of a firstborn infant. As siblings differ in age, temperament, needs, and abilities, parenting must adjust between children. (Older siblings also change in the transition to siblinghood; some grow and mature in response to the advent of an infant in the family, whereas others adamantly object at being dethroned;Volling, 2012.) Firstborn infants tend to receive more attention and better care as infants than do laterborn infants. Mothers also engage, respond, stimulate, talk, and express positive affection more to their firstborn babies than to their laterborn babies, even when firstborn and laterborn babies show no differences in their behavior, indicating that these maternal behaviors do not solely reflect infant effects (Belsky et al., 1984). Notably, behavioral geneticists have identified non-genetic environmental influences that lead to divergent sibling outcomes (Feinberg et al., 2019). Parental differential treatment of siblings occurs when siblings are recipients of different childrearing cognitions and practices (Solmeyer, Killoren, McHale, and Updegraff, 2011). As sibling relationships constitute among the longest lasting in a person’s lifetime, differential preferential treatment is known to last—and color sibships—well into adulthood (Jensen, Whiteman, Fingerman, and Birditt, 2013; Suitor, Sechrist, Plikuhn, Pardo, Gilligan, and Pillemer, 2009;Waldinger,Vaillant, and Orav, 2007).That said, mothers are prone to rate their firstborn babies as difficult (Bates, 1987), which may derive from the fact that firstborn babies actually are more difficult babies or, alternatively, because first-time mothers are more skittish and less at ease with their infants and thus tend to perceive firstborns as more demanding. Mothers of secondborns know more about parenting and child development than mothers of firstborns (Bornstein, Cote, Haynes, Hahn, and Park, 2010), and relatedly, multiparas report higher levels of self-efficacy than primiparas (Fish and Stifter, 1993).

Social Support Social support networks consist of the people who are important in a parent’s life, including a spouse or significant other, relatives, friends, and neighbors. Social support can improve parenting satisfaction, affecting the availability of parents to their infants as well as the quality of parent–infant interactions. Emotional integration or isolation from potential support networks mitigates or exacerbates these effects in new parents. Well-supported mothers are less restrictive and punitive with their infants than are less well-supported mothers, and frequency of contacts with significant others can improve the quality of parent–infant relationships (Crnic, Greenberg, Ragozin, Robinson, and Basham, 1983) as well as parents’ sense of their own effectance and competence (Abernathy, 1973). Mothers report that community and friendship supports are beneficial, but intimate support from husbands (“indirect effects”) has the most general positive consequences for maternal competence (Crnic et al., 1983). 34

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Socioeconomic Status SES comprises income, education, and occupation of householders and is broadly influential in parenting (Bornstein and Bradley, 2003). Mothers of different SES behave similarly in certain ways; however, SES also orders the home environment and many beliefs and behaviors of parents toward infants (Bornstein, Hahn, Suwalsky, and Haynes, 2003). Low SES is considered a risk factor in children’s development on several counts. For example, using data from the Infant Feeding Practices study, which tracked the diets of more than 1,500 infants until age 1, Wen, Kong, Eiden, Sharma, and Xie (2014) documented considerable differences in the solid foods mothers from different SES classes fed babies. Specifically, less-educated mothers from poorer households favored diets high in sugar and fat, whereas more-educated mothers from more resourced households adhered to diets that more closely followed conventionally proper infant feeding guidelines. The immediate consequence of poor infant diets is early weight gain and stunted growth. In the longer-term, the Infant Feeding Practices study analyzed data for the same children at age 6 and reported that infant feeding patterns translated into similar unhealthy or healthy childhood eating habits. Financial and social stresses adversely affect the general well-being and health of parents and demand attention and emotional energy. These circumstances, in turn, may reduce parents’ attentiveness, patience, and tolerance toward children. Low SES undermines mothers’ psychological functioning and promotes harsh or inconsistent disciplinary practices (Conger, McMarty, Yang, Lahey, and Kropp, 1984; McLoyd and Wilson, 1990; Simons, Whitbeck, Conger, and Wu, 1991). Low-SES compared with middle-SES parents typically provide infants with fewer opportunities for variety in daily stimulation, less appropriate play materials, and less total stimulation (Gottfried, 1984). Significantly, middle-SES mothers converse with their infants more, and in systematically more sophisticated ways, than do low-SES mothers, even though young infants (presumably) understand little maternal speech (Hart and Risley, 1995; Hoff and Laursen, 2019). Such social status differences in maternal speech to infants are pervasive across cultures: In Israel, for example, higher-SES mothers talk, label, and ask “what” questions more often than do lower or middle-SES mothers (Ninio, 1980). Higher-SES mothers’ encouragement in language undoubtedly facilitates self-expression in children; higher-SES babies produce more sounds (and eventually words) than do lower-SES babies (Hart and Risley, 1995, 1999). The lower-SES mother is likely to have been a poorer student, making it less likely that she will turn to books readily as sources of information about pregnancy, infancy, and parenthood; among middleSES women, reading material is a primary source of parenting information (Young, 1991). MiddleSES, more than lower-SES, parents also seek out and absorb expert advice about child development. Social class along with culture pervasively influence the complexity and the resourcefulness with which mothers view infant development (Palacios, 1990; Sameroff and Feil, 1985). Using UNICEF’s Multiple Indicator Cluster Survey, Bornstein, Putnick, Bradley, Lansford, and Deater-Deckard (2015) explored relations among maternal education, household resources, and infant growth in 117,881 families living in 39 low- and middle-income countries. Mother education led to improved infant growth through availability and use of household resources. Unfortunately, in many low- and middle-income countries around the globe, instructional capital in the form of maternal education is limited: In those 39 low- and middle-income countries, for example, the median years of education in 2010 for women aged 25 and over was only 5.17 (Barro and Lee, 2010).

Culture Like social class, culture pervasively influences who parents (Leinaweaver, 2014) as well as how parents view parenting and how they parent (Bornstein and Lansford, 2010). Culture defies ready definition, but most scholars agree that culture embraces patterns of beliefs and behaviors, acquired 35

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through socialization, that distinguish social groups (Boyd and Richerson, 2005). The majority of research in parenting refers to a Western, educated, industrialized, rich, and democratic cultural database (Bornstein, 2010; Henrich, Heine, and Norenzayan, 2010; Tomlinson, Bornstein, Marlow, and Swartz, 2014), yet cultural variation in beliefs and behaviors is always impressive, whether observed among different ethnic groups in one society or among different groups in different parts of the world (Bornstein, 2010; Bornstein and Putnick, 2012). As illustrations throughout this chapter amply attest, cross-cultural comparisons show that virtually all aspects of parenting infants are informed by culture. Parents in different cultures can differ radically in what they value for infants. Consider language and play, for example: Parents in some cultures talk to babies and see them as interactive partners (Bornstein, 2015), whereas parents in other cultures think that it is senseless to talk to nonverbal babies (Ochs, 1988). Parents in some cultures believe that play provides important developmentpromoting experiences for infants; parents in others see play primarily to amuse; and parents in still others do not include play in their job description (Bornstein, 2007; Bornstein and Putnick, 2015). Different cultural groups possess parenting ideas, approach parenting tasks, and value parenting outcomes differently (Cote, Bornstein, Haynes, and Bakeman, 2008; Goodnow and Lawrence, 2015). For these reasons, parents from different cultural groups differ in their opinions about the significance of specific competencies for their children’s successful adjustment, differ in the ages they expect children to reach different milestones or acquire various competencies, and so forth. Specific goals arise, in part, out of unique expectations of adult members of specific cultural groups. In turn, distinct belief systems provide parents with frameworks for interpreting their children’s behaviors, guiding their interactions with their children, and determining the activities and opportunities that they supply and so govern for their children’s development. Culture influences parenting patterns and child development from very early in infancy through such factors as when and how parents care for infants, how nurturant or restrictive parents are, which behaviors parents emphasize, and so forth (Bornstein and Lansford, 2010). Even very basic parenting cognitions and practices vary across cultures. Konner (1977) recorded wide variations in the frequencies of African Kalahari San, Guatemalan, and Bostonian caregivers’ vocalizations to infants; Caudill and Weinstein (1969) found that U.S. mothers talk more to their babies than do Japanese mothers; and Richman et al. (1988; Richman, Miller, and LeVine, 1992) reported that North American, Swedish, and Italian mothers vocalized to infants at higher rates than Kenyan (Gusii) mothers. European American mothers in Lafayette, Indiana, speak to infants in response to their infants’ vocalizations more than do mothers in Nagoya, Japan (Fogel, Toda, and Kawai, 1988); and mothers in different countries show different levels of contingent vocal responsiveness to infants (Bornstein, Putnick, Cote, et al., 2015). Japan and the United States maintain reasonably similar levels of modernity and living standards and both societies are child centered, but the two differ dramatically in terms of culture, including history, beliefs, and childrearing goals (Bornstein, Cote, Haynes, Suwalsky, and Bakeman, 2012). Japanese mothers expect early mastery of emotional maturity, self-control, and social courtesy in their offspring, whereas U.S. American mothers expect early mastery of verbal competence and self-actualization in theirs. American mothers promote autonomy and organize social interactions with their infants so as to foster physical and verbal assertiveness and independence, and they promote infants’ interest in the material environment. Japanese mothers organize social interactions so as to consolidate and strengthen closeness and dependency within the dyad, and they tend to indulge infants (TamisLeMonda and McFadden, 2010). Japanese mothers encourage the incorporation of a partner in infant pretense play; by contrast, U.S. American mothers encourage exploration and instrumental play. For U.S. Americans, parent play with infants and the toys used during play are more frequently the topic or object of communication; for Japanese, the play setting serves to mediate dyadic communication and interaction (Tamis-LeMonda, Bornstein, Cyphers, Toda, and Ogino, 1992).

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Cultural heritage even influences mothers of infants living in the same country. Tamis-LeMonda and Kahana-Kalman (2009) interviewed low-income urban African Americans as well as Mexican, Dominican, and Chinese immigrant mothers in maternity wards in New York City hours after the birth of their baby. Mothers’ views were assessed using open-ended questions, and their responses were coded as relevant to four main categories: child development, parenting, family, and resources. Mothers from the four ethnic groups varied in how much they spoke about child development, family, and resources. Relative to the other groups, Chinese immigrant mothers talked more about child development; African American and Dominican immigrant mothers talked more about resources; and Mexican immigrant mothers talked more about family. Latin American and African American mothers read to their children less frequently as compared to European American mothers (Yarosz and Barnett, 2001), and Spanish-speaking Latin American families have fewer children’s books available in the home than their non-Latin American counterparts (Raikes et al., 2006). An investigation of expected developmental timetables in new mothers from Australia versus Lebanon, but all living in Australia, found that cultural heritage shaped mothers’ expectations of children much more than their experiences in observing their own children, comparing them with other children, and receiving advice from friends and experts (Goodnow, Cashmore, Cotton, and Knight, 1984). Of course, culture-specific patterns of infant childrearing can be expected to be adapted to each specific society’s settings and needs. However, differences are not the only or final word. Mothers in different cultures show striking similarities in interacting with their infants as well. African American, Dominican immigrant, and Mexican immigrant mothers in the United States reported about the qualities they deemed desirable or undesirable in children age 1, 14, and 24 months. Mothers spontaneously referred to a common set of qualities, including self-maximization and connectedness; not unexpectedly, most mothers approved of desirable qualities, such as achievement, and disapproved of undesirable qualities, such as improper demeanor (Ng, Tamis-LeMonda, Godfrey, Hunter, and Yoshikawa, 2012). In the end, different peoples (presumably) wish to promote some similar competencies in their young. For example, all parents must nurture and promote the physical growth of infants if their infants are to survive and thrive. Parents of infants sometimes do so in qualitatively and quantitatively similar ways. Indeed, at the end of the day parents everywhere presumably want physical health, academic achievement, social adjustment, and economic security for their children (however those goals may be instantiated). In the parenting practices domain, Bornstein, Putnick, Park, et al. (2017) examined rates, interrelations, and contingencies of vocal interactions in almost 700 mothers and their 5½-month-old infants in diverse communities from 11 countries (Argentina, Belgium, Brazil, Cameroon, France, Israel, Italy, Japan, Kenya, South Korea, and the United States). Although rates of mothers’ and infants’ vocalizations varied across communities, mothers’ vocalizations to infants were consistently contingent on the offset of their infants’ nondistress vocalizing, as infants’ vocalizations were contingent on the offset of their mothers’ vocalizing; moreover, maternal and infant contingencies were significantly correlated. Here are the likely common origins of universal turn-taking in conversation. Parenting presents the prospect of contributing to the development of a new life, and if there are universal values in this world, it is probable that nurturing, and not abusing, children stands among them. Whether shared patterns of parenting cognitions and practices reflect common biological bases of caregiving, the historical convergence of parenting styles, or the increasing prevalence of a single childrearing pattern attributable to migration or dissemination by mass media is difficult, if not impossible, to determine (Bornstein, 2016). Even where ultimate childrearing goals are similar, cultures may still differ in proximal ways to achieve them (Bornstein, 1995). Furthermore, the parenting beliefs and behaviors of one’s own social group may seem natural but may actually be rather unusual when compared with those of other groups. Thus, social groupings likely condition parenting; all cultures prescribe certain beliefs and behaviors in their members and proscribe others (Maccoby, 2000). For parents, some prescriptions

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and proscriptions, such as the requirement that parents nurture and protect their offspring, are (as suggested) essentially universal. Others, such as what kinds of emotions can be expressed in public, vary (sometimes impressively) from one social group to another. Culturally distinct parenting beliefs provide parents with a framework for interpreting their children’s behaviors, guiding parents’ interactions with their children, and determining the activities and opportunities that parents are willing to supply for their infants’ development.

Summary Parenting stands at the confluence of many complex tributaries of influence; some flow from within the individual, whereas others have external sources in the child or context. Some reactions felt toward babies may be reflexive and universal; others are idiosyncratic and vary with personality or society. By virtue of their temperament and the quality and the contingency of their own responsiveness, infants exert a major impact on how parents parent and how parents perceive themselves as parents. Situation, family, support, status, and culture loom large in shaping the parenting ecology of infancy. Context differences color infantrearing cognitions and practices, and ideology also makes for meaningful differences in patterns of parenting beliefs and behaviors toward infants. It is certain that parenting has many determinants, and it is illogical and nonscientific to assert the preeminence of one cause over another when each in its own way contributes to some effect. Within complex developmental systems, it is unlikely that any single factor can be expected to account for substantial amounts of variation. Parenting effects are also conditional and not absolute (i.e., true for all parents under all conditions). More complex conceptualizations that incorporate larger numbers of influential variables will likely explain parenting better than simpler ones with fewer variables. The constructive enterprise is really to understand how all relevant forces work in concert to shape parenting infants. Parenting is a multilevel phenomenon and will be best understood eventually by bringing to bear evolutionary, biological, comparative, behavioral, and cultural perspectives.

Conclusions Because of infants’ intrinsic nature as well as the range, magnitude, and implications of developmental change early in life, infancy is intensely fascinating and undeniably appealing, yet unrelentingly challenging and daunting for parents. The popular belief that parent-provided experiences during infancy exert powerful influences over development has been fostered from many quarters. Human beliefs and behaviors are malleable, and plasticity remains a determinative feature of adaptation in infancy and long after. Although not all infant experiences are critical for later development, and single events are not always formative, infant experiences doubtlessly can have enduring effects. Certainly, little and big consistencies of parenting aggregate across infancy to construct the person. Parents intend much in their interactions with their infants: They promote their infants’ mental development through the structures they create and the meanings they place on those structures, and they foster infants’ emotional understanding and development of self through the models they portray and the values they display. The complex of parent cognitions and practices with infants is divisible into domains, and parents tend to show consistency as well as change over time in certain of those domains. Some aspects of parenting are frequent or significant from the get-go, but later wane in importance; others wax over the course of infancy. For new parents, the first years with an infant constitute a period of adjustment and transformation. Mothers typically assume primary responsibility for infant care within the family, and motherinfant and father-infant interactions tend to complement one another. As a result, infants’ relationships and attachments with their two parents are distinctive. The interactive and intersubjective aspects of parent and infant activities have telling consequences for the post-infancy development 38

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of the child. Infants also form relationships with siblings and grandparents as with other nonfamilial caregivers. Large numbers of infants have significant experiences outside the family—often through enrollment in childcare settings—but the immediate and lasting effects of out-of-home care vary depending on its type and quality as well as characteristics of infants and their families. Early relationships with mothers, fathers, siblings, and others all ensure that the “parenting” that the young infant experiences is rich and multifaceted. Researchers and theoreticians today do not ask whether parenting affects infant development, but which parent-provided experiences afforded by whom affect what aspects of development in infancy when and how, and they are interested also to learn the ways in which individual infants are so affected as well as the ways individual infants affect their own development. Parent biology and psychology, infants’ active mental life and intimate relationships, as well as situation and within-family experiences, in addition to economic, social, and cultural circumstances, all play important roles in determining infant parenting. A full understanding of what it means to parent an infant depends on the social ecologies in which that parenting takes place and what is expected of infants as they grow. Infants also alter their environment as they interact with it. Parent and infant therefore convey distinct characteristics to every interaction, and both are changed as a result. In other words, parent and infant actively co-construct one another through time. Infancy is a distinctive period, a major transition, and a formative phase in the life cycle of every human being, but infants are not at all self-reliant. Rather, parents have central parts to play in infants’ physical survival, social growth, emotional maturation, and cognitive development. A better understanding of the nature of the human being is afforded by examining parent–infant interaction and its consequences in this period of the dyad’s initial accommodation—the unique and specific influences of parent on infant and of infant on parent. That accommodation, in turn, shapes the experiences of the infant and, with time, the person she or he becomes. Linked, parent and infant chart that life course together. Infancy is a starting point of life for both infant and parent. With the birth of a baby, a parent’s life is forever altered.

Acknowledgments Supported by the Intramural Research Program of the NIH/NICHD, USA, and an International Research Fellowship in collaboration with the Centre for the Evaluation of Development Policies (EDePO) at the Institute for Fiscal Studies (IFS), London, UK, funded by the European Research Council (ERC) under the Horizon 2020 research and innovation program (grant agreement No 695300-HKADeC-ERC-2015-AdG).

Note 1 The Hebrew term for infant nurses and child-care workers.

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2 PARENTING TODDLERS Marjolein Verhoeven, Anneloes L. van Baar, and Maja Deković

Introduction A toddler is adorable. See the excitement on her face when she makes her first independent, short and unsteady steps, when she toddles! And a toddler can be terrible. See him lying on the floor and screaming “NO,” indicating that he does not want to put on a coat despite the cold outside! Their parents are left in awe and amazement, while wondering how to keep them safe as they explore the world, or in doubt, thinking about how to handle their temper tantrums. Being able to walk independently is often seen as the onset of toddlerhood. As children start walking independently at different ages—varying between 10 and 20 months (Van Baar, Steenis, Verhoeven, and Hessen, 2014)—the exact start and end of the toddler period is not precisely defined. Most researchers consider children to be toddlers when they are between 12 and 36 months old. Within this relatively short span of 24 months, many developmental milestones are acquired that bring joy and pride to both child and parents, but also lead to important changes in the parent–child relationship. Parents are called on to actively set limits for their children, to protect them, and to keep them safe. But they also must teach and stimulate them implicitly and explicitly how to learn, act, and behave in ways that are best for the child right now, as well as for their functioning in the near and later future. Objective, social, and moral rules need to be applied. In this chapter, first some key normative developmental changes in toddlers are briefly discussed. Next, three parenting tasks are discussed more thoroughly, as these are especially important in this developmental period: stimulating the child’s autonomy, providing structure and discipline, and maintaining warmth, responsiveness, and sensitivity. Some issues that are gaining more attention in the literature on parenting during this developmental period, like the influence of fathers and media, are highlighted, and suggestions for future research are provided.

Central Issues in Development During Toddlerhood Developmental capacities increase tremendously in toddlerhood in all domains. In gross motor development, walking independently, but also climbing, jumping, and running, need parental attention. Increase in fine motor capacities allows exploring and playing with small objects, drawing, building, and making puzzles, as well as starting to use utensils like spoon and fork or scissors. First words increase to more words and combinations that become sentences, which elaborates communication from predominantly nonverbal acts to speech and the use of language. Understanding the physical 56

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and social environment increases, with accompanying experiences of success, failure, and frustration that need to be dealt with. Every milestone accomplished reflects improved adaptation of the toddler and requires adjustment of the parents.

Cognition, Language, and Mobility Cognitive development during toddlerhood is mostly about gaining a better understanding of how the world works. To this end, toddlers actively explore new objects and deliberately try out actions to investigate their consequences. To enable goal-directed action and adaptive responses to novel, complex, or ambiguous situations, the child develops higher-order cognitive functions, such as inhibitory control, working memory, and attentional flexibility (Diamond, 2013; Garon, Bryson, and Smith, 2008). Another principal cognitive development of toddlerhood is the beginning of symbolic thought: the ability to use words, objects, or actions to represent things or events that are not physically present or actually happening. These emerging representational abilities build on the child’s growing long-term memory skills and are especially obvious in the development of symbolic, make-believe play, which marks the beginning of the awareness of a distinction between appearance and reality (Bornstein, 2007; Tamis-LeMonda et al., 2019). The acquisition of language is a specific example of the toddler’s growing capacity for symbolic representation, as the child learns to use words to represent objects and events (McCune, 2010). During the relatively short toddler period, most children progress from speaking a few isolated words to having full conversations. Toddlers learn how to put ideas into words (productive skills) and to understand what other people say (receptive skills). Next to linguistic competence, they are also developing communicative competence and learning how to use language socially. They learn about turn-taking and giving relevant responses, and they start to recognize when they are misunderstood and how to repair this.They also learn about the social routines and conventions for communication and language use, such as greetings and leave-takings (hi, how are you?, bye-bye, see you soon) and politeness (please, thank you). Growing mobility allows children to move away from their parents to play and to explore their environment; whereas infants need actual physical and visible contact with their parents to support exploration, toddlers come to rely more on psychological contact (Marvin and Britner, 2008). Toddlers become able to draw support from cues across a distance and become more comfortable with separation from their caregivers, and this in turn makes it possible to become more independent (Marvin and Britner, 2008). Toddlers start to develop a sense of personal agency, as they begin to understand that they are autonomous, with the ability to manipulate objects and influence the outcome of events. This knowledge of one’s own existence as a separate individual marks the beginning of self-awareness (Brownell and Kopp, 2007).

Social Development Supported by the rapid growth in cognition, language, and mobility, toddlers become more sociable and more competent in their interactions with adults and other children. They have greatly expanded capacities to observe and interpret other people’s actions, to imitate others, and to maintain sequences of social interaction, and as such have an increased social awareness. The changing understanding of others as independent agents, with their own roles, intentions, and aims, enables toddlers to become more sophisticated in their social interactions, as they can start to negotiate and arrive at compromises. Affective sharing (e.g., sharing pleasure) and social referencing (e.g., looking at cues in parents’ face for approval) grow during this developmental period, and toddlers develop the ability to behave in a complementary manner with a peer. As a result, their play with others evolves from parallel play to much more coordinated play, such as social pretend play (Thompson, 2007). 57

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The growing awareness of the self is also related to the emergence of new emotions that require self-consciousness, including feelings of shame and pride. Toddlers’ awareness of and sensitivity to social rules are revealed in expressions of uncertainty or distress regarding a flawed object, or distress when an external standard is violated or cannot be met. By the end of the second year, toddlers are responsive to negative emotional signals from others, and they start to experience negative feelings themselves when they are doing—or are about to do—something forbidden; the early beginnings of empathy and moral development (Hoffman, 2007). Such emotions make it possible to relate to other people at a new level, and they play a key role in the child’s beginning acceptance of social rules and standards. This is the developmental period in which internalization starts; toddlers absorb, transform, and integrate social rules and conventions into their personal functioning, come to experience these principles as their own, and feel volitional in regulating their behaviors accordingly (Kochanska and Kim, 2014; Ryan and Deci, 2000; Smetana, Jambon, and Ball, 2014). Self-regulation—the ability to effortfully modulate cognitions, emotions, and behavior—enables children to adjust their behaviors to harmonize with cognitive and social demands in specific situations (Berger, Kofman, Livneh, and Henik, 2007). In response to parental socialization, toddlers move from externally to internally controlled behavior (Bernier, Carlson, Whipple, 2010; Blandon and Volling, 2008; Forman, 2007). According to Kopp’s (1982) model of self-regulation, a first important milestone is the ability to comply with requests, which toddlers first exhibit between 12 and 18 months. By their second birthday, children have developed basic self-control:They are able to inhibit behavior and to regulate behavior even when parents are absent. Around 36 months, children can modulate their behavior to meet changing situational demands. Different categories of self-regulation, which are distinguished in literature, require an ascending level of internalization (Karreman,Van Tuijl,Van Aken, and Dekovic, 2006): compliance (i.e., the ability to initiate, cease, or modulate behavior in response to parental requests; Kochanska, Coy, and Murray, 2001; Kopp, 1982), inhibition (i.e., delaying or stopping behavior in the absence of external monitors; Kopp, 1982), emotion regulation (i.e., managing emotional arousal and support adaptive responses; Calkins, Smith, Gill, and Johnson, 1998; Eisenberg and Fabes, 1998; Thompson, 1991), and eventually effortful control (i.e., the ability to suppress a dominant response to perform a subdominant response; Kochanska, Murray, and Harlan, 2000).

Parenting During Toddlerhood As part of the socialization process, toddlers face two important developmental tasks: (1) becoming a more independent, autonomous individual and (2) learning about and complying with social rules and expectations. As a result of toddlers’ emerging developmental skills and their growing autonomy, parents find themselves guiding, protecting, and taking care of a more active child who can go places and do things that, literally, a few months ago were out of reach. As such, the task for parents during this developmental period is to find the right balance between stimulating the child to become an autonomous individual with own interests, skills, and identity, while at the same time guiding the child to acquire behaviors that are appropriate and acceptable in social and cultural contexts—guidance which is offered by setting rules and limits and disciplining the child (Grolnick and Pomerantz, 2009).

Parental Autonomy Granting Once toddlers start to see themselves as active agents, independent of others, they actively start to assert their newfound autonomy. Toddlers are intrinsically motivated to openly and spontaneously explore, play, and interact with their environment, which provides them with different kinds of learning opportunities. Satisfaction of the need for autonomy is of central importance to experience an internal locus of causality for behaviors, which is necessary to fully take in social requirements as 58

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their own (Deci and Ryan, 2008; Ryan and Deci, 2000).Thus, the extent to which parents satisfy the need for autonomy by actively supporting the child’s abilities to be self-initiating and autonomous is thought to have a great impact on children’s healthy internalization, motivation, and development (Ryan, Deci, Grolnick, and LaGuardia, 2006). Autonomy support, or autonomy-granting behavior, refers to parental behaviors aimed at supporting children’s goals, choices, and sense of volition and consists of taking the child’s perspective, following the child’s ongoing activity, scaffolding, and ensuring that the child plays an active role in successful task completion (Grolnick, Gurland, DeCourcey, and Jacob, 2002). Providing children with experiences of successful problem-based learning is thought to enhance their motivation for selfregulation (Carlson, 2003; Matte-Gagne and Bernier, 2011). Indeed, Bernier et al. (2010) found that, when mothers were more autonomy supportive when their child was 15 months of age, children had better self-regulation skills regarding executive functioning at 18 months (i.e., children performed better on working memory and categorization) and at 26 months (i.e., children performed better on conflict executive functioning). Similarly, maternal scaffolding at age 2 was associated with executive functioning at age 4 (Hughes and Ensor, 2009). Mothers showing more autonomy-supportive behavior when children were 3.5 years old had lasting impact on socioemotional development (i.e., fewer internalizing and externalizing problems, and better social skills) at pre-adolescence (MatteGagne, Harvey, Stack, and Serbin, 2015). Opposite to parental autonomy support is parental overcontrol, parents’ attempts to excessively regulate and manipulate children’s emotions, to intrude on children’s autonomous activities, or to restrict the kinds of experiences children have (Eisenberg, Taylor, Windaman, and Spinrad, 2015; Van der Bruggen, Stams, and Bögels, 2008). By giving children frequent instructions on how to think, feel, or behave in desired ways, parents can restrict children’s feelings of autonomy and sense of mastery. Intrusive parenting undermines opportunities for the child to learn behavioral and emotional self-regulation and develop autonomy and independence. By being too directive and overcontrolling, parents leave their children with few opportunities to independently learn how to self-regulate, solve problems, and behave in socially constructive ways (Eisenberg et al., 2015; Graziano, Keane, and Calkins, 2010). Intrusive parenting at 30 and 42 months predicts lower levels of executive control a year later (Eisenberg et al., 2015; Taylor, Eisenberg, Spinrad, and Widaman, 2013). In addition, toddlers who experience higher levels of maternal restrictiveness have lower scores on self-regulatory competence at age 8 (Olson, Bates, Sandy, and Schilling, 2002). Graziano and colleagues (2010) observed that high levels of maternal overcontrol/intrusiveness (i.e., displaying a no-nonsense attitude, constantly and adversely guiding the child during a teaching task and free play) at age 2 was negatively predictive of children’s effortful control at age 5.5. Parents’ use of controlling behavior (e.g., physical enforcement, threatening, criticizing, bribing) during a clean-up task with their 2-year-olds predicted a deterioration in committed compliance at 3½ years, while autonomy-supportive behavior (e.g., providing a rationale, giving choices and suggestions) predicted improvement (Laurin and Joussemet, 2017). Parental overprotection is another form of parental overcontrol, which has especially been related to anxiety in early childhood. By shielding their child from potential danger by intrusively providing unnecessary help and restricting exposure to a diverse range of experiences, parents convey the message that the world is an unsafe place. As a result, the child’s awareness of danger increases, their perceived level of control reduces, and avoidance behavior in the child is promoted, leaving them with limited opportunities to develop a repertoire of coping skills and a sense of self-competence in dealing with challenging situations (Rapee, 1997; Rubin, Coplan, and Bowker, 2009). Bayer, Sanson, and Hemphill (2006) found that low levels of parental warmth and high levels of overprotection at age 2 predict more internalizing symptoms at age 4. In a sample of parents rearing a 3- to 5-year-old child, Edwards, Rapee, and Kennedy (2010) found that both maternal and paternal overprotection predicted higher levels of anxiety symptoms 12 months later. 59

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Psychological control is generally defined as control that intrudes on the child’s psychological world and is characterized by manipulative and pressuring tactics including guilt induction, invalidation of the child’s perspective, and love withdrawal (Barber and Harmon, 2002). The child’s emerging sense of self may be threatened by such intrusive and pressuring behavior, which increases the likelihood of maladjustment and internalizing problems (Barber, 1996). In contrast to research on adolescents (Soenens, Vansteenkiste, and Beyers, 2019), studies on parental psychological control in early childhood are still scarce, despite the fact that toddlerhood is the period in which the sense of self starts to emerge, and guilt induction and love withdrawal are commonly used by parents. Toddlers and preschoolers whose parents use psychological control are more likely to display externalizing behaviors in general (Verhoeven, Junger, Van Aken, Dekovic, and Van Aken, 2010a) and, more specifically, relational and physical aggression (Casas et al., 2006). In addition, preschool children (54 months) who had psychologically controlling mothers were less compliant at age 6.5 years (Verschueren, Dossche, Marcoen, Mahieu, and Bakermans-Kranenburg, 2006). How psychological control is related to internalizing problem behavior in toddlers is not yet clear.

Parental Structuring and Discipline The goals of socialization are to support children to develop as independent beings (individuality) and to teach children to comply with social rules and regulations (conformity). When interacting with a child who wants to assert his or her own agenda in activities, parents must find a balance between supporting this growing sense of autonomy and teaching their child to control emotions and behavior to adjust to social demands and conventions. Although noncompliance is normal for toddlers, strong resistance to parents between the ages of 2.5 and 5 years is associated with poor social competence and poor parent–child relationships (Kochanska, 2002). By formulating and managing rules and helping children to internalize them, parents play a fundamental role in enhancing children’s self-regulation skills (Grolnick and Farkas, 2002). As such, the kind of requests parents pose to their child and the disciplinary techniques parents use to modify the child’s behavior have long been of interest to developmental researchers.

Parental Structuring: Setting Everyday Rules Parents have to make decisions about what behavioral standards ought to be communicated to young children, when they should be communicated, and in general how to move young children toward compliance and internalize the standards. Starting at the age of 13–14 months, the first rules parents set for their children are mainly focused on keeping the child safe, such as not touching dangerous objects or climbing on furniture (Gralinski and Kopp, 1993; Smetana, Kochanska, and Chuang, 2000). The number of safety rules increases during the toddler period. This increase in rules is a response to the increasing the number of incidents in which their child is (almost) being injured (Morrongiello, Widdifield, Munroe, and Zdzieborski, 2014), due to the fact that toddlers’ increase in cognitive skills—and therewith their appreciation of hazards—hardly keeps up with their physical and motor development. Also, parents may consider such safety rules to be more effective and come to rely more on them as their children progress in their communicative and cognitive skills (Morrongiello et al., 2014). Next to safety rules, but to a lesser extent, mothers of 13- to 14-month-olds also communicate rules regarding the protection of family properties (e.g., not tearing up books, drawing on walls) and preventing harm to others (e.g., not taking toys from others or harming them; Gralinski and Kopp, 1993; Smetana et al., 2000). During the second year of life, mothers’ network of rules expands from this primary focus on safety and survival to a concern with communicating family norms and cultural standards. From age 2.5 to 4, mothers request more independent behavior regarding issues of 60

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delays (e.g., not interrupting others’ conversations), manners (e.g., saying please and thank you), selfcare (e.g., dressing self, going to bed when requested), and family routines (e.g., helping with chores, keeping room neat; Gralinski and Kopp, 1993; Smetana et al., 2000). When imposing rules, parents recognize children’s developmental limitations and adjust their teaching strategies accordingly: Where parents initially focus on familiarizing young children with the rules by frequently restating them, later parents put more emphasis on having children understand the issue, by explaining and mentioning potential consequences (Morrongiello et al., 2014). Parents seem to believe that children are more likely to comply if they understand the rationale behind safety rules. Moreover, when parental expectations and requests are reasonable and appropriate, children are likely to feel secure and accepted and are more willing to follow parents’ suggestions and advice. Presenting behavioral rules (cleaning up, going to bed) in an autonomy-supportive manner may motivate children to comply. Providing a rationale or explanation for the behavioral request, while acknowledging the feelings and perspective of the child, offering choices, and minimizing the use of controlling language and techniques, has been suggested to help young children internalize rules (Côté-Lecaldare, Joussemet, and Dufour, 2016).

Parental Discipline Techniques Setting rules is one important task of parents during toddlerhood. Ensuring that the child complies to these rules and internalizes them is another. Discipline encounters form an important learning context for how children control themselves (self-regulation), but also for parents to develop effective disciplinary techniques that promote child prosocial behavior or discourage misbehavior. The number of mothers who explicitly discipline their child and the frequency of discipline encounters increase between the ages of 12 and 48 months, with the strongest rise in the child’s second year (Vittrup, Holden, and Buck, 2006). In their search for effective techniques that match their continuously developing child, parents use a variety of disciplinary behaviors. Cognitive disciplinary techniques. Most used are techniques from a cognitive approach with an emphasis on providing the child with a rationale for desired behaviors and for ceasing misbehavior. Almost all mothers report frequently using noncoercive cognitive control methods, such as diversion, reasoning, and negotiating, in response to toddlers’ misbehavior (Huang, O’Brien Caughy, Lee, Miller, and Genevro, 2009; Passini, Pihetm, and Favez, 2014;Vittrup et al., 2006). Inductive, authoritative discipline in which parents remind children of rules and explain them, while taking into account children’s perspective and providing them with information and guidance, is thought to be effective for promoting children’s internalization, as they direct the child’s attention to the consequences of their behavior on the well-being of others, which helps children to develop empathic motives to behave in prosocial ways (Choe, Olson, and Sameroff, 2013; Hoffman, 2007). Van Zeijl and colleagues (2007) observed mothers who had to withhold their 1- to 3-year-old children from a treat. They found that children showed less externalizing behavior when their mothers used more distraction and induction, and showed more understanding for the child’s feelings or thoughts. Chen and colleagues (2003) also found a positive association between maternal induction (i.e., encouraging children to express their opinions and reasoning with children when they misbehave) and child compliance at age 2: As mothers more often used induction, their children were more compliant during a clean-up and behavioral delay task. Mothers endorsing more inductive discipline (i.e., reminding of rules and reasoning) at child age 3 reported less physical discipline and had children with fewer externalizing problems at age 5.5 (Choe et al., 2013). Kerr, Lopez, Olson, and Sameroff (2004) found that this reminding of rules and reasoning was related to more moral regulation and less externalizing behavior in 3.5-year-olds. In response to the emergence of child language and cognitive skills, parents increase the use of inductive discipline across toddlerhood (Verhoeven, Junger, Van Aken, Deković, and Van Aken, 2007a). 61

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Behavior-Modification Techniques Behavior-modification techniques are also used frequently to make children comply with parental rules. After “explaining the rules,” parents apply social reinforcement (e.g., praise, reward) and negative sanctions (e.g., removal of privileges, time-out, planned ignoring) to manage their toddler’s behavior (McMahon and Forehand, 2003; Passini et al., 2014;Vittrup et al., 2006). By rewarding or punishing children’s actions, parents can increase wanted and decrease unwanted behavior. Reprimands and negative nonverbal responses function as punishers, and when they outweigh the benefits of noncompliance for the child, they increase compliance (Owen, Slep, and Heyman, 2012). Praise, however, has to be paired with nonverbal positive responses—including positive attention and backup contingencies (e.g., edible treats, stickers, bonus time)—to become substantial enough to motivate the child to comply (Owen et al., 2012). Another behavior-modification technique that is amongst the most common forms of child discipline used by parents of young children is the time-out: withholding the child from reinforcing stimuli (e.g., social attention, access to objects) as a response to misbehavior (Barkin, Scheindlin, Ip, Richardson, and Finch, 2007; Corralejo, Jensen, Greathouse, and Ward, 2017; Riley, Wagner, Tudor, Zuckerman, and Freeman, 2017). Giving a time-out teaches the child about the consequences of inappropriate behavior and how to calm down and manage difficult and frustrating behavior (Morawska and Sanders, 2011). Empirical evidence shows this technique to be effective for parents of toddlers, at least when used as a part of a comprehensive parenting strategy (Kaminski,Valle, Filene, and Boyle, 2008; Morawska and Sanders, 2006, 2011), and a time-out is recommended in evidencebased parenting programs (e.g., Incredible Years Program; Webster-Stratton and Dahl, 1995) and by primary care providers (Scholer, 2006). However, some concerns have been raised regarding the use of this disciplinary technique, as the time-out could be applied by parents in an authoritarian way, which labels children instead of their behavior and requires the child to excessively focus on their misbehavior (Corralejo et al., 2017; Morawska and Sanders, 2011). Empirical evidence for these concerns is lacking (Morawska and Sanders, 2011), but many parents reportedly fail to implement the time-out as intended, which can undermine its effectiveness (Riley et al., 2017). Parent education about this disciplinary technique is therefore much needed, although parenting programs, books, and online recommendations are not always consistent with available research or lack a sufficient research base (Corralejo et al., 2017). Harsh discipline. Dealing with misbehavior and noncompliance can be frustrating and tiresome for parents, especially as toddlers engage in misbehavior from 3.5 to 20 times an hour (Dix, 1991; Wahler and Dumas, 1989). Parents have certain ideas about how they would like to respond during discipline encounters, but their eventual choice for particular disciplinary techniques is not always a rational one. Many parents frequently respond to child misbehavior with acts of physical (slapping, spanking; Lee, Taylor, Altschul, and Rice, 2013; Maguire-Jack, Gromoske, and Berger, 2012; Zolotor, Robinson, Runyan, Barr, and Murphy, 2011) or psychological (angry shouting, cursing, calling names) aggression. At 12 months of age, 10–30% of mothers in a U.S. sample reported using these aggressive disciplinary techniques, with levels increasing to 59% for spanking and 93% for yelling at age 4 (Vittrup et al., 2006).Yelling is the third most common reaction to toddlers’ misbehavior, just after explaining the rules and social reinforcement (Passini et al., 2014). Such harsh, coercive disciplinary techniques are often used as a last resort, when other disciplinary methods do not work, or when the child or mother loses control (Vittrup et al., 2006). Although these techniques may lead to immediate compliance, they are generally thought to be ineffective for the child’s internalization of rules and for promoting adjusted behavior. By using power-assertive behaviors to solve parent–child conflicts, parents may teach the child to expect successful outcomes from hostile and aggressive interactions. Moreover, by solving parent–child conflicts with this kind of behavior, parents do not teach their children alternative problem-solving strategies, aside from 62

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aggression. In addition, parents’ use of power-assertive discipline may make the child feel disconnected and alienated from the parent and consequently resentful and rejecting of further parental socialization efforts (Kim and Kochanska, 2015). Results regarding the consequences of harsh discipline for the child are, however, still inconclusive. While Larzelere and Kuhn (2005) found in their meta-analysis that the effects of normative spanking (physical punishment not used severely or as the primary discipline method) on 2- to 12-year-old children are similar to the harmless effects of other common disciplinary actions (e.g., time-out, verbal reprimands), a more recent meta-analysis by Gershoff and Grogan-Kaylor (2016) showed that the effect of spanking on child outcomes does not substantially differ from physical abuse. A longitudinal study of 1- to 3-year-olds suggests that the consequences of parental physical discipline may not be limited to the child’s behavioral development (Berlin et al., 2009). Spanking at age 1 predicted child aggressive behavior at age 2 and lower cognitive scores at age 3, supporting the conclusion that spanking during toddlerhood can have negative consequences for toddler’s socioemotional as well as cognitive functioning. Regardless of whether physical punishment does or does not have a negative impact on children, there is hardly evidence that this type of discipline is associated with positive child outcomes, such as conscience development and positive behaviors and feelings (Larzelere and Kuhn, 2005). Given the potential risks of physical punishment and the unclear boundary between physical punishment and physical abuse, it is not surprising that at least 51 countries have passed laws banning all physical punishment of children by parents (UN Tribune, 2017). Another form of harsh discipline used by parents of toddlers—psychological aggression (e.g., scolding, yelling, shouting)—has received less attention and also results that are inconsistent. Vissing, Straus, Gelles, and Harrop (1991) found that children, including a cohort of 0- to 6-year-olds, who experienced frequent levels of verbal aggression from their parents, exhibited higher rates of physical aggression, delinquency, and interpersonal problems than children who did not experience parental verbal aggression frequently. Parental verbal hostility displayed when the child was 4.5 years old was related to less communal competence, individuation, self-efficacy, and more internalizing behavior during adolescence (Baumrind, Larzelere, and Owens, 2010). Examining a large group of low-income, ethnically diverse toddlers, Berlin and colleagues (2009), however, found no negative consequences of maternal use of verbal punishment (i.e., shouting, expressing annoyance with hostility, negative comments) or child aggressive behavior problems and cognitive development. By contrast, verbal punishment predicted higher Mental Development Index scores on the Bayley and a decline in aggressive behavior problems when children were Mexican American or when verbal punishment was combined with higher levels of maternal emotional responsiveness (Berlin et al., 2009). The toddler period is a significant time for parents to develop their repertoire of disciplinary techniques. Studies show that the frequency of using certain disciplinary techniques increases, and the kind of techniques a parent chooses to use is quite stable across the toddler period (Huang et al., 2009;Verhoeven, Junger,Van Aken, Deković, and Van Aken, 2007b;Vittrup et al., 2006). It is important to inform parents of toddlers about the various techniques they could apply to discipline their child, how these different techniques can promote or undermine the child’s development, and how convenient techniques may be employed in daily life.

Parental Warmth and Support Next to granting autonomy, providing structure, and helping the child to comply to social rules, parental warmth and support are important for toddlers. The parent–child relationship creates important conditions for the developmental tasks of toddlerhood (exploring, becoming autonomous, socializing), as there is clear association between the quality of the infant-caregiver relationship and how well the child functions as a toddler. Securely attached toddlers use their caregiver as a secure base 63

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to explore environments, pursue autonomous activities, and achieve self-regulation and attentionregulation skills (Bowlby, 1988; Sroufe, 2005). Indeed, securely attached toddlers show more committed compliance (Lickenbrock et al., 2013) and are more responsive and willing to cooperate with their parent (Kochanska, Aksan, and Carlson, 2005) than insecurely attached toddlers. When interacting with their parents, securely attached toddlers show enthusiasm in their compliance, are eager to respond to their parents’ cues, and have an open approach to discourse (Kochanska, Aksan, et al., 2005). Such a willing stance of the child influences the parent to behave more positively toward the child, and as such provides a strong base to keep building on a positive parent–child relationship (Kochanska et al., 2015). In contrast, being insecurely attached puts children at risk for later behavior problems (Fearon, Bakermans-Kranenburg, Van IJzendoorn, Lapsley, and Roisman, 2010), such as externalizing and internalizing behaviors (Madigen, Brumariu, Villani, Atkinson, and Lyons-Ruth, 2016; Madigan, Moran, Schuengel, Pederson, and Otten, 2007;Wang,Willoughby, Mills-Koonce, and Cox, 2016). Parents who are warm and sensitive and respond to their children’s emotions in appropriate ways may foster increased effortful control as they serve as a model for ways to cope with emotions and behaviors (Davidov and Grusec, 2006; Hoffman, 2000). Warm parents are likely to allow their children to express their feelings and use emotion coaching to help their children regulate strong emotions. The maintenance of optimal levels of arousal and creating an environment in which the child learns the basis of social relationships, warm and supportive parenting is thought to facilitate the development of effortful control (Feldman and Klein, 2003). Indeed, sensitive caregiving has been associated with toddlers’ high regulatory skills (Bernier et al., 2010; Spinrad et al., 2012), including delay of gratification (Li-Grining, 2007) and the ability to shift attention (Gilliom, Shaw, Beck, Schonberg, and Lukon, 2002) and to regulate positive affect (Davidov and Grusec, 2006) and emotions (Spinrad, Stifter, Donelan-McCall, and Turner, 2004). Moreover, high levels of maternal warmth are associated with the development of guilt, conscience (Kochanska, Forman, Aksan, and Dunbar, 2005), and empathy (Kiang, Moreno, and Robinson, 2004). Parental warmth and support are also thought to determine the associations with other parenting behaviors and child outcomes. A more positive parent–child relationship encourages the child’s receptive orientation toward their parents, their active embrace of parental rules and agendas, and their willingness to comply with parental requests, making them actively willing partners in the socialization process (Kochanska, Forman, et al., 2005; Kochanska, Kim, Boldt, and Yoon, 2013; Owen et al., 2012). Positive parenting behavior may also buffer negative effects of harsher behavior the parent shows toward the child. Kim and Kochanska (2015) found an indirect effect of maternal power assertion (at age 30 months) to children’s negative, adversarial orientation (at 33 months) to future behavioral problems (at 40 months) when mothers’ responsiveness was either low or average, but absent when mothers were highly responsive. It might be that children of responsive parents interpret their parents’ use of harsh discipline as well intentioned, legitimate, and benevolent, as has been found in research on children’s perceptions of discipline (Bugental and Grusec, 2006; Gershoff and Grogan-Kaylor, 2016;Vittrup and Holden, 2010). Nevertheless, in a study by Lee, Altschul, and Gershoff (2013), maternal warmth did not counteract the negative consequences of spanking.Verhoeven and colleagues (2010a) found that high levels of support strengthened the association between maternal spanking and boys’ externalizing behavior, instead of diminishing the negative effects of spanking. It is possible that the ambiguous signals that mothers send to their child by being both supportive and aggressive at the same time negatively affect child adjustment by arousing internal distress and negative emotions leading to externalizing behaviors (Olson et al., 2002). Another explanation might be that precisely because children of warm and supportive parents are more open to parenting behavior (Darling and Steinberg, 1993; Grolnick and Farkas, 2002), they can also be harmed more when harsh disciplinary techniques are used.

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Changes in the Parent–Child Relationship It is important that parents continue to be warm and supportive during toddlerhood. However, one of the most difficult challenges for parents of toddlers is just that: maintaining the warmth and sensitivity often easily used during infancy, but now combining this with discipline, control, and limit setting. Clashes between the parent’s limit-setting efforts and the child’s need for self-assertion lead to more frequent conflicts. Resistance to parent’s demands and often emotionally loaded negotiations with young children may leave parents fatigued or irritable and challenge parents’ own regulation abilities (Dozier and Bernard, 2017; Feinberg, Jones, Kan, and Goslin, 2010). Nevertheless, parents are capable of keeping stability in their levels of sensitivity during this developmental period (Bornstein, TamisLemonda, Hahn, and Haynes, 2008; Bornstein et al., 2010; Hallers-Haalboom, et al., 2017; Lovas, 2005; Stack et al., 2012; Verhoeven, Junger, Van Aken, Deković, and Van Aken, 2010b). Some studies found that parents become more sensitive with children’s increasing age (Braungart-Rieker, HillSoderlund, and Karrass, 2010; Kemppinen, Kumpulainen, Raita-Hasu, Moilanen, and Ebeling, 2006). Perhaps the child’s improving communication skills are an explanation, as these skills make it easier for the parent to understand their child’s needs and respond accordingly. In addition, parents might have developed more effective parenting strategies (Whiteman, McHale, and Crouter, 2003) and have become more familiar with the child’s characteristics and needs (Hallers-Haalboom et al., 2017).

Diversity in Parenting Toddlers In relation to parenting during toddlerhood, it is important to consider several specific characteristics that reflect diversity in view of their association with developmental outcomes in toddlers. In our work on establishing norms based on the Dutch population for the Bayley scales of infant and toddler development (third edition) for children between two weeks and 42 months old, the sample needed to be made representative and the analyses were weighed for gender, ethnicity, maternal education, and region of living in The Netherlands (Van Baar et al., 2014). The importance of considering such characteristics is evident, as clear differences exist between the developmental trajectories of different populations. For example, representative samples of Dutch (Steenis,Verhoeven, Hessen, and Van Baar, 2015), Australian (Walker, Badawi, Halliday, and Laing, 2010), and Danish (Krogh, Væver, Harder, and Køppe, 2012) children differed in their cognitive, language, and motor development compared to a U.S. norm sample. This is likely due to the fact that countries differ in their constellation of socioeconomic, cultural, and ethnic backgrounds of their population, factors which are known to influence child development (Steenis et al., 2015; Walker et al., 2010).

Socioeconomic Status (SES) Children growing up in families of low socioeconomic circumstances (i.e., children whose parents have low levels of education, income, and/or occupational prestige) are at increased risk for poor health outcomes and delays in social, emotional, and cognitive development (Bitsko et al., 2016).This gap in development between children growing up in low versus high SES families is already apparent in the toddler years (e.g., Bradshaw and Mayhew, 2005; Kiernan and Mensah, 2009; Fernald, Marchman, and Weisleder, 2013; Huttenlocher, Waterfall,Vasileyva,Vevea, and Hedges, 2010). To illustrate, a cohort study in the UK showed that as early as age 3, a quarter of the children living in persistently poor households exhibit cognitive delays, and a fifth of these low SES children display high levels of behavioral problems (Kiernan and Mensah, 2011). Studying a representative sample of Dutch children, Van Baar and colleagues (2014) found that—after controlling for effects of ethnicity— from the age of 12 months up to 42 months, children of mothers with a low educational level showed substantially lower levels of cognitive and language skills than children of highly educated

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mothers. When entering school, children from a disadvantaged background may be several months behind their peers regarding their school readiness, as they have difficulties in maintaining attention, regulating emotion and stress, reflecting on information and experience, and engaging in sustained positive social interactions with teachers and peers (Blair and Raver, 2015). These inequalities in cognitive and social emotional development tend to grow as children grow older, eventually leading to lower educational attainment with the accompanying reduction in chances for success in society (Heckman, 2006), perpetuating the cycle of poverty. A lack of early learning opportunities and less appropriate parent–child interactions are thought to contribute to the loss of developmental potential in low SES children (Blair and Raver, 2015; Walker et al., 2011). Low SES impacts negatively across different aspects of parenting, including reading- and learning-promoting activities, relationship and interaction with the child, and positive and negative disciplinary practices (Kiernan and Mensah, 2011). Parents with lower SES tend to talk less to their children and their nature of speech is less supportive of language development compared to higher SES parents (Hoff, 2013). Speech of parents with lower SES is more often used to direct children’s behavior instead of eliciting and maintaining conversation, and they tend to use a more restricted vocabulary and range of grammatical structures than parents from higher SES (Hoff, 2013). A study by Azad, Blacher, and Marcoulides (2014) found that mothers who reported higher levels of education showed higher levels of positive parenting—a constellation of positive affect, sensitivity, cognitive stimulation, and detachment (i.e., uninvolved, unresponsive)—when their children were 3 years of age. At the same time, a higher family income was associated with a greater increase in positive parenting over a 6-year period (Azad et al., 2014). It is important to keep in mind that many children growing up in low SES families are still faring well. Positive parenting improves the odds that children living in more disadvantaged circumstances will do better in school (Kiernan and Mensah, 2011). Programs that support parents in promoting their children’s health and development hold considerable potential for prevention of the long-term effects associated with poverty (Yoshikawa, Aber, and Beardslee, 2012). Strengthening parent’s social support and increasing positive parent–child interactions are seen as mechanisms for change (Morris et al., 2017).

Parenting in Minority Groups Empirical evidence suggests that infants and toddlers from minority groups may also be at a disadvantage with regard to various outcomes. In early childhood, minority children often score lower on cognitive development and language skills compared to majority children (DeFeyter and Winsler, 2009; Duncan et al., 2012;Van Baar et al., 2014), and they are more likely to show behavioral problems (Jansen et al., 2010). In most countries, ethnic minority families are overrepresented in the lower SES groups (Crul and Doomernik, 2003; Mesman,Van IJzendoorn, Bakermans-Kranenburg, 2012), and they experience more daily hassles and psychological distress than majority families (Yaman, Mesman, Van IJzendoorn, Bakermans-Kranenburg, 2010). This could explain why minority parents have been found to be at risk for non-optimal parenting, including lower levels of sensitivity, compared with majority parents (e.g., Fuligni and Brooks-Gunn, 2013; Yaman et al., 2010). Indeed, the association between minority status and parenting disappears or becomes substantially smaller when the analyses are controlled for SES (Mesman et al., 2012). Another stressor that might explain why minority parents are at risk for less optimal parenting is acculturation stress. Acculturation stress is a reaction to events that occur during the process of acculturation, e.g., discomfort with unfamiliar norms, missing family members, and a lack of social support (Leidy et al., 2010). Indeed, within a sample of minority mothers of young children, those within lower SES families experienced more acculturation stress as well as psychological distress, which resulted in less positive parenting—sensitivity, structuring, and nonintrusiveness (Emmen et al., 2013). 66

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Parents who have higher levels of acculturation are generally more supportive in their parenting and provide a more stimulating home environment, which influences their young child’s development (Glick, Bates, and Yabiku, 2009; Keels, 2009). The language used at home seems especially important. When parents speak the first language of the country they live in at a proficient level, this seems to support their children’s cognitive and language skills (Becker, Klein, and Biedinger, 2013; Frumkin, 2013). In addition, non-Dutch mothers who did not have good Dutch language skills reported significantly more behavioral problems in their children (Jansen et al., 2010). Not only might parents of minority families raise their children differently, it could also be that ethnicity influences how parenting is related to child outcomes. For example, maternal sensitivity and negative/intrusive behavior were found to mediate the association between family SES and child cognitive outcomes in majority children, whereas in minority children only maternal negative/ intrusive behavior played a role (Dotterer, Iruka, and Pungello, 2012). Other studies, however, did not find such differences in the role of parenting: maternal responsiveness and detachment during a mildly stressful task at 14 months of age predicted child cognitive and emotion outcomes, regardless of ethnicity (O’Neal, Weston, Brooks-Gunn, Berlin, and Atapattu, 2017). These inconclusive results suggest that more work is needed to disentangle the effects of ethnicity, minority, immigrant and legal status, acculturation, and SES on parenting quality (Mesman et al., 2012).

Modern Issues and Future Directions in Research on Parenting Toddlers Measuring Parenting During Toddlerhood As any theoretical model or empirical study designed to explain child development must account for the influence of parenting—either directly or indirectly (McKee, Jones, and Forehand, 2013)— conceptualization and measurement of parental behavior constitutes a key component of research on child development (Duppong- Hurley, Huscroft-D’Angelo, Trout, Griffith, and Epstein, 2014; Putnick, 2019; Verhoeven, Dekovic, Bodden, and Van Baar, 2016). Regarding conceptualization and measurement, toddlerhood seems to have been lost between infants and school-aged children. For infants, the focus of most measurement instruments is on parental warmth, sensitivity, and responsiveness, which is too narrow for toddlers. For school-aged children, there is a variety of measurement instruments to choose from, but most are concerned with one specific parenting behavior (e.g., discipline, autonomy granting) and the content of the questions is often not appropriate for parents of toddlers. New questionnaires for parents of toddlers have been published to overcome these issues. Zimmer-Gembeck, Webb, Thomas, and Klag (2015) developed the Parenting as Social Context Questionnaire-Toddlers (PSCQ-Toddlers), based on the self-determination theory (SDT; Ryan and Deci, 2000). It taps into six dimensions of parenting that are theoretically linked to meeting toddler’s needs of relatedness, competence, and autonomy: warmth, structure, autonomy support, rejection, chaos, and coercion. Starting from three main theories regarding the role of parenting in early childhood—attachment theory (Bowlby, 1969), Vygotsky’s learning theory, and social learning theory (Bandura, 1977)—Verhoeven and colleagues (2016) designed the Comprehensive Early Childhood Parenting Questionnaire (CECPAQ). This questionnaire assesses parental dimensions of support, structure, positive discipline, harsh discipline, and stimulation. Preliminary evidence regarding reliability and validity has been reported for both questionnaires (Verhoeven et al., 2016; Zimmer-Gembeck et al., 2015).

Child Effects, Parent Effects, and Reciprocity Parenting plays an important role in child development, but it has long been recognized that both parents and children act as active agents who co-create their emerging, bidirectional relationship 67

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(e.g., Bell and Chapman, 1986; Kuczynski and De Mol, 2015; Maccoby, 2000; Sameroff and Fiese, 2000). A growing body of studies examines this reciprocity in toddlerhood. Results are somewhat mixed.Verhoeven and colleagues (2010b) found child effects only: toddler boys’ externalizing behavior, which elicited less support and structure and more psychological control and physical punishment in both their mothers and fathers. These parental behaviors had no effect on boys’ levels of externalizing behavior. Other studies have reported both parent and child effects, but these seem to depend on the kind of child and parenting behaviors under investigation. In a small sample of lowincome families, maternal harsh parenting responses to their 1-year-old’s noncompliance during a clean-up task predicted increased children’s distress at 24 months, although child distress at 1 year did not predict harsh parenting at age 2 (Scaramella, Sohr-Preston, Mirabile, Robison, and Callahan, 2008). For maternal supportive parenting, the reverse was found. Here, child distress at age 1 predicted decreases in maternal support at age 2, while maternal support at age 1 was unrelated to child distress at age 2 (Scaramella et al., 2008). A study by Berlin and colleagues (2009) also found evidence for both parent and child effects. Child fussiness at age 1 predicted maternal spanking and verbal punishment at ages 1, 2, and 3. At the same time, spanking at age 1 predicted child aggressive behavior problems at age 2 and lower cognitive scores at age 3. Likewise, in a sample of low-income, ethnically diverse boys, boys’ negative emotionality at 18 months predicted disruptive behavior at 24 months, particularly if their mothers used more negative control to facilitate child compliance (Chang and Shaw, 2016). Child effects, however, were in an unexpected direction: Mothers whose children showed higher levels of negative emotionality decreased their negative control from 18 to 24 months. Maybe mothers reduce their attempts to control their child’s misbehavior (more lax discipline) or try alternative strategies to manage their child’s negativity (Chang and Shaw, 2016). Thus, prior findings partially support reciprocal, transactional processes between parent and child behavior. However, more research is needed to understand how parents and children reinforce each other’s behavior:Why do parents in some studies respond to child behavior in unexpected directions (Chang and Shaw, 2016) or show changes in some parental behaviors but not in others (Scaramella et al., 2008), and why are children not affected by changes in their parents’ behaviors (Verhoeven et al., 2010b)?

Fathers Whereas past research on early childhood development has mainly focused on mothers, current research increasingly focuses on both parents. This is likely due to a trend toward fathers becoming more involved in caring for their children (Marshall, 2006; Roggman, Bradley, and Raikes, 2013), although mothers continue to spend much more time with children than fathers do (Craig and Mullan, 2011; Raley, Bianchi, and Wang, 2012). Looking at activities, fathers are relatively rarely alone with their children, and they enjoy relatively more play and talking time with their children, whereas mothers do more physical care (Craig, 2006). Looking at parenting behavior, there is more congruence between mothers and fathers (Rinaldi and Howe, 2012; Verhoeven et al., 2010b), although fathers are somewhat less sensitive and more intrusive toward their toddlers than are mothers (Bergmann, Wendt,Von Klitzin, and Klein, 2012; Hallers-Haalboom et al., 2017;Verhoeven et al., 2010b). Couples tend to have similar disciplinary styles (Kim, Lee, Taylor, and Guterman, 2014), which may be the result of mutual influence (assortative mating; Luo and Klohnen, 2005; Watson et al., 2004) or socialization effects, whereby parents influence and/or adjust to each other and eventually settle on the same parenting approach. It could also be the result of both parents rearing the same child, who elicits similar behaviors of his/her parents. Parents are likely to learn from each other and to discuss their rearing techniques and together decide how to adjust their behavior (Verhoeven et al., 2007b). Although children generally experience similar parenting behaviors from their mothers and fathers, they might be differently affected by maternal and paternal behaviors. Whereas mothers are 68

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important for calming and comforting the child in times of stress, fathers play a particular role in the development of children’s openness to the world, by inciting the child to take initiative in unfamiliar situations, explore, take risks, and overcome obstacles (Grossman et al., 2002; Paquette, 2004).There is some evidence that maternal intrusive behavior—which is characterized by rejection and manipulation as opposed to warmth and affection—is more detrimental for toddlers’ developmental outcomes than paternal intrusiveness. To illustrate, maternal psychological control is a stronger predictor of toddlers’ externalizing behavior than is paternal psychological control (Brook, Zheng, Whiteman, and Brook, 2001; Verhoeven et al., 2010a). Cabrera, Shannon, and Tamis-LeMonda (2007) found that maternal, but not paternal, intrusiveness was related to child emotional functioning at age 3. However, their study also showed that supportiveness of both parents was positively related to children’s language and cognitive outcomes at 24 and 36 months. Moreover, for social and emotional development only, fathers’ supportiveness mattered. Differences in the roles of maternal and paternal behavior in child development were also found by Rinaldi and Howe (2012), who showed that permissive parenting by mothers, and authoritarian parenting by fathers, uniquely predicted toddlers’ externalizing behavior, while toddlers’ adaptive behaviors were only predicted by paternal authoritative parenting. Larger differences between mothers and fathers of young children can be found in the area of play (Cabrera, Fitzgerald, Bradley, and Roggman, 2014; Möller, Majdandžić, De Vente, and Bögel, 2013).Whereas mothers engage more in pretend play (Lindsey and Mize, 2001), fathers are generally more physical and challenging in their play (chasing, jumping, rough-and-tumble play; Fliek, Daemen, Roelofs, and Muris, 2015; John, Halliburton, and Humphrey, 2013; Möller et al., 2013) at least starting from toddlerhood (Majdandžić, De Vente, and Bögel, 2016). The arousing character of such play (e.g., physically challenging, competition) provides children with opportunities to practice how to interpret other’s emotions, manage strong impulses (e.g., hitting, kicking), and cope with failure or frustration (Peterson and Flanders, 2005). Rough-and-tumble play with fathers relates to children’s self-regulation (Flanders, Leo, Paquette, Pihl, and Seguin, 2009; Flanders et al., 2010; St George, Fletcher, and Palazzi, 2017). However, these studies only included fathers, leaving the question regarding the relative importance of maternal and paternal play in child development unanswered. Whether mothers and fathers play unique roles in their toddler’s development is not yet clear and might depend on the kind of parenting behavior under study, the quantity and quality of this behavior, and the developmental stage of the child. Due to women’s increased participation in the paid labor market, fathers have become more involved in childcare. As such, mothers and fathers are becoming more similar in terms of the amount of time they spend with their children and the parenting behaviors they show (Raley et al., 2012), and they may therefore also become more similar in how they affect their child. To shed more light on this issue, it is important for future studies to include the quality and the quantity with which mothers and fathers show particular behaviors (Fagan, Day, Lamb, and Cabrera, 2014).

Family as a System An exciting trend in research on the role of parenting in toddler development has been the push toward understanding the family as a system (Kerig, 2019). From this perspective, the association between parenting and toddlers’ behavior is influenced by maternal and paternal behavior and by the interrelated components of the family system. Understanding the combined effects of mothering and fathering on child development is more complex than just summing up the parental behaviors the child is being exposed to (Lee, Kim, Taylor, and Perron, 2011; Martin, Ryan, and Brooks-Gunn, 2007). Kim and colleagues (2014) found that when mothers and fathers of 3-year-olds were incongruent in their disciplinary styles, with mothers using high physical and psychological aggression and fathers using low levels of discipline or aggression, this was associated with significantly higher 69

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levels of child aggression than when both parents were highly aggressive. Likewise, looking at the combined effects of mothering and fathering on toddler boys’ externalizing behavior, Verhoeven and colleagues (2010a) found that in the context of low levels of maternal support, higher levels of paternal support were related to higher levels of child externalizing behavior. This suggests that the supportive behavior of one parent may not compensate for the potential negative effects of dysfunctional parenting from the other parent and that discordant parenting approaches may be problematic (Kim et al., 2014;Verhoeven et al., 2010a). Future studies are needed to achieve a better understanding of the complexity of the family system. More attention should be paid to different family structures, beyond the traditional one of a mother and father and possible siblings living under one roof. LGBT families, ‘patchwork’ families, and shared parenting after divorce are examples. How do individual family members and subsystems (e.g., mother-child, father-child, mother-father dyads) influence one another? Especially interesting in toddlerhood is the addition of a new family member, as the birth of a sibling is a normative ecological transition for toddlers (Volling, 2012). Family dynamics change when a second child is born. Parents need to adjust their coparenting behavior with their first child and develop a new coparenting system with the second, as they face the challenge of simultaneously coparenting multiple children (Szabó, Dubas, and Van Aken, 2012). Also, parents have to divide their attention and affection between two children. During early childhood, mothers and fathers tend to be more sensitive and less intrusive toward their firstborn child than laterborns (Hallers-Haalboom et al., 2014), which might be due to developmental differences between the children. These differences in sensitivity toward siblings affects children: toddlers are more compliant with their fathers and better in sharing with their younger sibling when their fathers are more sensitive toward them, but only when paternal sensitivity toward the younger sibling was low (Van Berkel et al., 2015).Toddlers might show this positive behavior to ensure their favored position, but it could also be that they try to compensate for the lack of fathers’ sensitivity toward their sibling (Van Berkel et al., 2015).

Young Children and Media Another modern issue concerns toddlers in the explosion of electronic media with videos, DVDs, games, and television networks being specifically developed for toddlers. Toddlers are growing up in a full media environment and access to and use of media have become part of daily life (Barr, 2019). Little is known about the impact of media use on child development, despite the claims of producers that these programs have educational value (Vandewater et al., 2007). The American Academy of Pediatrics (AAP) advocates that parents should avoid television viewing entirely for children who are younger than 2 years and to limit viewing time to no more than 2 hours a day for older children (AAP, 2011, 2013). Shifrin and colleagues (2015) offer more realistic, research-based recommendations for parents regarding children’s media use. For example, parents should set age-appropriate limits and ensure that media use does not displace conversation, play, and creativity. Also, parents should be attentive to their own (over)use of media, as parental behavior provides strong modeling for children’s behavior, and as parents may ignore their children while using digital media (Shifrin, Brown, Hill, Jana, and Flinn, 2015). Parental attitudes and beliefs regarding media use by their young children are mixed. Parents are concerned that media use will replace traditional play and learning and reduce social interactions, which might impact on toddlers’ interaction and communication skills (O’Connor and Fotakopoulou, 2016). At the same time, parents believe media exposure can promote their child’s development (Vittrup, Snider, Rose, and Rippy, 2016) and feel that their toddlers need to learn media skills to be successful in their future education and careers (O’Connor and Fotakopoulou, 2016). Not surprisingly, young children’s media use (including TV, computers, smartphones, and tablets) increases when parents have more positive attitudes about the impact of media on child development and 70

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educational skills and when parents frequently use media devices themselves (Lauricella, Wartella, and Rideout, 2015). There is growing interest in how media affect parent–child interactions. In a review, Anderson and Hanson (2017) found that coviewing television during early childhood changes parenting behavior; parents interact less with their children while watching TV, regardless of whether the content of the TV program is adult- or child-directed. However, when parents are actively engaged with their toddlers while viewing a children’s program, they use richer language during and after viewing, which increases the positive impact of educational programs. Moreover, program content that encourages positive parent–child interactions stimulates parents to coview and become more positively engaged with their child outside of the television-viewing situation (Anderson and Hanson, 2017). A greater risk factor for the quality of the parent–child relationship may be parents’ own media use. A field study observing families in fast food restaurants showed that about 30% of the parents were fully occupied with their mobile devices, instead of interacting with their children (Radesky et al., 2014). It is important for future studies to look beyond media time and media content for children and examine how media influences parenting. Other new media—such as video chats, interactive games, and interactive online storybooks—might promote parent–child interactions. In addition, the introduction of new electronic devices to monitor children may become important for parenting habits; for example, to keep an eye on their children through the use of cameras or GPS trackers or to monitor sleep through the mattress1 or a wet diaper through a sensor in the diaper or clothes.

Conclusions Toddlerhood marks an important period for the further differentiation and integration of parenting behavior. Parents have to set limits and start to discipline their child, while at the same time they need to stimulate their child’s growing autonomy and interdependence. How parents discipline their children during this period is predictive of their disciplinary techniques when the child grows older, as this review shows. Whether this stability in parenting behavior also holds for autonomy-granting behavior is less clear. In addition, issues like interaction with the new media that rapidly become available for toddlers and their parents require novel decisions about how to make adequate use of their potential. Examining combined effects of parental limit setting, disciplinary behavior, and autonomy granting during this developmental period and trying to discern the right balance among these important parental behaviors in different contexts will advance our understanding of the role of parenting during toddlerhood.

Note 1 “Sensi sleep pad”: a digital monitor-movement sensor that can be placed under the mattress of the child that tracks whether the child is moving or not.

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G., Jambon, M., and Ball, C. (2014). The social domain approach to children’s moral and social judgments. In M. Killen and J. Smetana (Eds.), Handbook of moral development (2nd ed., pp 23–45). New York, NY: Taylor and Francis. Smetana, J. G., Kochanska, G., and Chuang, S. (2000). Mothers’ conceptions of everyday rules for young toddlers: A longitudinal investigation. Merill-Palmer Quarterly, 46, 391–416. Spinrad,T. L., Eisenberg, N., Silva, K. M., Eggum, N. D., Reiser, M., Edwards, A., . . . Gaertner, B. M. (2012). Longitudinal relations among maternal behaviors, effortful control, and young children’s committed compliance. Developmental Psychology, 48, 552–566. Spinrad, T. L., Stifter, C. A., Donelan-McCall, N., Turner, L. (2004). Mothers’ regulation strategies in response to toddlers’ affect: Links to later emotion self-regulation. Social Development, 13, 40–55. Sroufe, L. A. (2005). Attachment and development: A prospective, longitudinal study from birth to adulthood. Attachment and Human Development, 7, 349–367. Stack, D. M., Serbin, L. A., Girouard, N., Enns, L. N., Bentley, V. M. N., Ledingham, J. E., and Schwartzman, A. E. (2012). The quality of the mother–child relationship in high-risk dyads: Application of the Emotional Availability Scales in an intergenerational, longitudinal study. Development and Psychopathology, 24, 93–105. Steenis, L. J. P.,Verhoeven, M., Hessen, D. J., and Van Baar, A. L. (2015). Performance of Dutch children on the Bayley III: A comparison study of US and Dutch norms. Plos One, 10(8), e0132871. doi:10.1371/journal.pone.0132871. St George, J., Fletcher, R., and Palazzi, K. (2017). Comparing fathers’ physical and toy play and links to child behavior: An exploratory study. Infant and Child Development, 26, e1958. Szabó, N., Dubas, J. S., and Van Aken, M. A. G. (2012). And baby makes four: The stability of coparenting and the effects of child temperament after the arrival of a second child. Journal of Family Psychology, 26, 554–564. Tamis-LeMonda, C. S. (2019). Language and play in parent-child interactions. In M. H. Bornstein (Ed.), Handbook of parenting Vol. 5:The practice of parenting (3rd ed., pp. 189–213). New York, NY: Routledge. Taylor, Z. E., Eisenberg, N., Spinrad,T. L., and Widaman, K. F. (2013). Longitudinal relations of intrusive parenting and effortful control to ego-resiliency resiliency during early childhood. Child Development, 84, 1145–1151. Thompson, R. A. (1991). Emotional regulation and emotional development. Educational Psychology Review, 3, 269–307. Thompson, R. A. (2007). The development of the person: Social understanding, relationships, conscience, self. In W. Damon, R. M. Lerner, and N. Eisenberg (Eds.), Handbook of child psychology:Vol. 3. Social, emotional, and personality development (pp. 24–98). New York, NY: John Wiley and Sons. UN-Tribune. (2017). The 51 countries that have banned corporal punishment. 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K., and Rippy, J. (2016). Parental perceptions of the role of media and technology in their young children’s lives. Journal of Early Childhood Research, 14, 43–54. Volling, B. L. (2012). Family transitions following the birth of a sibling: An empirical review of changes in the firstborn’s adjustment. Psychological Bulletin, 138, 497–528. Wahler, R. G., and Dumas, J. E. (1989). Attentional problems in dysfunctional mother–child interactions: An interbehavioral model. Psychological Bulletin, 105, 116–130. Walker, K., Badawi, N., Halliday, R., and Laing, S. (2010). Brief report: Performance of Australian children at one year of age on the Bayley Scales of Infant and Toddler Development (Version III). Australian Educational and Developmental Psychologist, 27(1), 54–58. Walker, S. P., Wachs, T. D., Grantham-McGregor, S., Black, M. M., Nelson, C. A., Huffman, S. L., . . . Richter, L. (2011). Inequality in early childhood: Risk and protective factors for early child development. The Lancet, 378, 1325–1338. Wang, F., Willoughby, M., Mills-Koonce, R., and Cox, M. J. (2016). Infant attachment disorganization and moderation pathways to level and change in externalizing behavior during preschool years. Attachment and Human Development, 18, 534–553. Watson, D., Klohnen, E. E., Casillas, A., Nus Simms, E., Haig, J., and Berry, D. S. (2004). Match makers and deal breakers: Analyses of assortative mating in newlywed couples. Journal of Personality, 72, 1029–1068. Webster-Stratton, C., and Dahl, R. W. (1995). Conduct disorder. In M. Hersen and R. T. Ammerman (Eds.), Advanced abnormal child psychology (pp. 333–352). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc. Whiteman, S. D., McHale, S. M., and Crouter, A. C. (2003). What parents learn from experience: The first child as a first draft? Journal of Marriage and Family, 65, 608–621. Yaman, A., Mesman, J.,Van IJzendoorn, M. H., and Bakermans-Kranenburg, M. J. (2010). 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3 PARENTING DURING MIDDLE CHILDHOOD W. Andrew Collins and Stephanie D. Madsen

Introduction Parents of children between the ages of 5 and 12—the period commonly referred to as middle childhood—face challenges arising from maturational changes in children and from socially imposed constraints, opportunities, and demands impinging on them. Children in diverse societies enter a wider social world at about age 5 and begin to determine their own experiences, including their contacts with others, to a greater degree than previously. Between age 5 and adolescence, transitions occur in physical maturity, cognitive abilities and learning, the diversity and impact of relationships with others, and exposure to new settings, opportunities, and demands. These changes inevitably alter the amount, kind, content, and significance of interactions between parents and children (Del Giudice, 2014; Hartup and Collins, 2000). This chapter addresses the impact of the distinctive challenges and achievements of middle childhood on parent‑child relationships and on the processes of socialization within families. The chapter includes five main sections. The first section provides a brief overview of historical considerations in the study of parenting 5- to 12-year-olds. The second section outlines key normative changes in children that affect parenting during middle childhood. The third section reviews changes in parent‑child relationships in which parenting issues are embedded. The fourth section distills findings from research on the issues of parenting and of parent‑child relationships that are especially linked to the distinctive changes of the period. These issues include adapting processes of control, fostering self‑management and responsibility, facilitating positive relationships outside of the family, and maintaining contacts with schools and other out‑of‑home settings. The concluding section underscores the key themes from research and notes persistent questions about the distinctiveness of parenting during middle childhood.

Historical Considerations in Middle-Childhood Parenting In diverse cultures, early middle childhood historically has marked a major shift in children’s relationships with adults. The age of 6 or 7 years was the time at which children were absorbed into the world of adults, helping to shoulder family responsibilities, and working alongside their elders. Well into the eighteenth century in Western nations, many children left home by the age of 6 or 7 years to work as servants in other households (Aries, 1962). If children remained at home, their parents became more like supervisors or overseers. The assumption that children were capable of tasks now

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largely reserved for adults was consistent with a general attitude toward forcing infants and young children toward behavioral rectitude and submissiveness to authority. Only in recent times have changing concepts of the family and the advent of formal schooling removed children of this age from wide participation in adult society. In industrialized nations today, the ages of 5–12 continue to be set apart from younger ages because they correspond to the beginning of compulsory schooling. Schooling provides a distinctive social definition of childhood and social structures that constrain and channel development. This secular change has meant that, rather than taking on adult responsibilities as was the case in earlier periods, middle childhood primarily is concerned with preparation for eventual responsibility. Children’s preparation for adulthood is conducted not only by parents, but also by institutions and persons outside of the family.Thus, the central contemporary issue of parenting during this period of rapid and extensive developmental change is how parents most effectively adjust their interactions, cognitions, and affectional behavior to maintain appropriate degrees of influence and guidance toward greater autonomy (Collins and Madsen, 2003).

Normative Changes in Children During Middle Childhood To most parents in industrialized societies, middle childhood is less distinctive as a period of development than infancy, toddlerhood, or adolescence. Nevertheless, ages 5–12 are universally set apart because this period encompasses major transition points in human development (Del Giudice, Angeleri, and Manera, 2009; Rogoff, Pirrotta, Fox, and White, 1975). This section briefly reviews changes in children that set the stage for transitions in parenting during middle childhood. These changes include enhanced cognitive competence and the growth of knowledge, transitions in social contexts and relationships, increased vulnerability to stress, altered functions of the self, and self‑regulation and social responsibility.

Cognitive Competence and the Growth of Knowledge Cognitive changes greatly expand capacities for solving problems and gaining information needed for greater competence and resourcefulness. For parents, changes in children’s cognitive competence necessitate adjustments ranging from the content of conversations, strategies for control and influence over children’s behavior, and expectations regarding competence and self‑regulation. Three characteristic cognitive changes of middle childhood are noteworthy. One is a growing ability to reason in terms of abstract representations of objects and events. For children younger than 5–7 years, cognition characteristically involves limitations on the number of objects that can be thought about at one time, and systematic or abstract reasoning is relatively rare. Between ages 5 and 9, most children gain capacities for reasoning effectively about increasingly complex problems and circumstances; and by 10–12 years of age, children increasingly generalize across concrete instances and evince capacities for systematic problem-solving and reasoning. Second, children organize tasks more maturely and independently than in early childhood.This more planful behavior entails adopting goals for activities, subordinating knowledge and actions in the service of a superordinate plan, and monitoring one’s own activities and mental processes. Third, increases occur in both the opportunity and the capacity for acquiring information and for using new knowledge in reasoning, thinking, problem solving, and action. Compared to younger children, 5- to 12-year-olds thus can solve more difficult, abstract intellectual problems in school and can master increased, more complex responsibilities at home and in other common settings. In middle childhood, these abilities especially mark children’s executive function, or the more deliberate, top-down neurocognitive processes involved in self-regulation. Although executive function continues to develop well into adulthood, the advancements that typically occur in middle childhood are significant (Koslowski and Masnick, 2010; Zelazo and Carlson, 2012). 82

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These cognitive expansions eventuate in increased challenges to integrate knowledge and abilities for understanding self and others, relationships, communities, and societies. Children in middle childhood contrast sharply with younger children in their abilities for social understanding (Jacobs, Lanza, Osgood, Eccles, and Wigfield, 2002). Compared to younger children, 6- to 12-year-olds evaluate others with greater accuracy and more often view classmates as teachers and other children do (Heyman, Barner, Heumann, and Schenck, 2014; Malloy,Yarlas, Montvilo, and Sugarman, 1996). Children in middle childhood also increasingly distinguish among psychological traits, such as shy–outgoing, nice–mean, and active–inactive (Heyman and Gelman, 2000). Compared to younger children, 5- to 12-year-olds more readily adopt the perspectives of others in interactions, which helps them to infer possible reasons for others’ behaviors (Crick and Dodge, 1994; Dunn and Slomkowski, 1992). Children of middle-childhood ages manifest rapid increases in understanding the content and nature of social norms as well. For example, compared to preschool children, 6- and 7-year-olds judge rule violations by other children and by themselves as equally non-normative (Diesendruck, 2012; Riggs and Young, 2016). Such social cognitive skills underlie the further growth of social competence during middle childhood, including skills for describing and explaining conditions and events (Heyman et al., 2014; Heyman, Fu, and Lee, 2007), for deceiving others and for detecting their deceptions (Heyman, Sweet, and Lee, 2009; Watson and Valtin, 1997), and for predicting the behavior of other children (Droege and Stipek, 1993; Harms, Zayas, Meltzoff, and Carlson, 2014). Concepts of parent‑child relationships move toward the idea that parents and children mutually have responsibilities to each other, rather than viewing parents as the ones who satisfy children’s needs (Nucci, Killen, and Smetana, 1996). For parents generally, the characteristic reasoning patterns of 5- to 12-year-olds necessitate more elaborate and compelling explanations and justifications to have the same degree of impact that, in earlier years, could be achieved by distracting or admonishing a child. In addition to growth in interpersonal understanding, children in middle childhood increasingly grasp many broader conditions of life. Compared to younger children, 5- to 12-year-olds generally comprehend fundamental life experiences, such as conception, illness, and death, although many of their beliefs about human biology remain inaccurate and simplistic (Morris, Taplin, and Gelman, 2000; Siegal and Peterson, 1999). At the group and societal levels, 5- to 12-year-olds generally manifest a strong sense of fairness, both in the distribution of resources and in equal treatment under the law (Helwig, 1998; Hetherington, Hendrickson, and Koenig, 2014). Moreover, they increasingly believe in the rights of children of their age to some degree of self-determination and self-expression (Helwig, 1997; Ruck, Abramovitch, and Keating, 1998). The experiences of adoptive parents of 5- to 12-year-olds illustrate some of the challenges stemming from the cognitive changes of the period (Brodzinsky and Palacios, 2005; Grotevant and McDermott, 2014). Preschool children can and often do label themselves as adopted, but greater cognitive capacities in middle childhood make it possible to form a more complex understanding of what adoption means. For example, only after age 6 do children typically identify adoption and birth as alternative paths to parenthood (Brodzinsky, Smith, and Brodzinsky, 1998). Later, children recognize that their adoptive parents’ joy in having them as a child necessarily involves the loss of parenting rights for their birth parents, which sometimes precipitates a sense of loss for their biological family. Children in mid- to late middle childhood (ages 8–12.5 years) question their parents about a significantly greater number of adoption-related issues than do younger children (Wrobel, Kohler, Grotevant, and McRoy, 1998), and parents face pressing decisions about how to address the child’s curiosity while preserving a positive view of the child’s adoptive status and heritage (Pinderhughes and Brodzinsky, in this volume).

Social Contexts and Relationships Parents of 5- to 12-year-olds also encounter additional burdens and responsibilities because children’s social networks expand significantly during middle childhood. Whereas most of children’s exchanges 83

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with others during infancy and early childhood occur in their families, 5- to 12-year-olds spend less time in the company of adults and family members, relative to peers and other adults outside of the family. The shifts are most pronounced between the ages of 5 and 9. Not until early adolescence, however, do contacts with peers, rather than those with adults, dominate social networks (Collins and Laursen, 2004; Lam, McHale, and Crouter, 2014; Chapter 4 in this volume). Middle-childhood experiences exert considerable pressure to create and maintain connections with peers (Collins, Raby, and Causadias, 2012). Entering school especially increases the number and kinds of developmental tasks and influences that children encounter. For parents, these experiences outside of the family often necessitate monitoring children’s activities and choices of companions at a distance and create new challenges in fostering positive behavior and development (Crouter, Bumpus, Davis, and McHale, 2005; Wray-Lake, Crouter, and McHale, 2010). The need for social support from a variety of others, moreover, is more apparent in middle childhood than in earlier years. Contrary to stereotypes, perceptions of parents as sources of both emotional support and instrumental help typically remain stable across age groups during middle childhood. Five- to 12-year-olds, however, recognize that others, some outside of the family, serve significant social needs in their lives (Bryant, 1985; Bukowski, Motzoi, and Meyer, 2009; Furman and Buhrmester, 1992). To maintain these extended networks, children must learn to cooperate on more complex tasks and to work without extensive oversight by adults. By ages 10–12, children become notably more skilled in using goal‑directed planful strategies to initiate, maintain, and cooperate within peer relationships. One implication of these skills is a greater ability to manage conflicts with peers (Parker and Asher, 1987). Consequently, parents may spend less time in direct management of peer relationships. Children who do not gain these skills are at a disadvantage for optimal social development and at risk for a variety of later problems (Bukowski et al., 2009). Peer relationships play an increasingly complementary role to that of parents during middle childhood (Collins and Laursen, 2004). Over the years from age 5 to age 12, children increasingly view their peers as important sources of intimacy as well as companionship. Although parents and peers influence children toward similar values and behaviors in most cases, peers also often provide experiences and expectations in areas in which families typically have limited impact, especially in areas based on an understanding of give and take with others of equal power and status (e.g., collaborative tasks). For the most part, however, parental and peer influences are reciprocal: Families provide children with basic skills for smooth, successful peer relationships; and children often “import” knowledge, expectations, and behavioral tactics from their interactions with peers that stimulate parents’ adjustments to their child’s maturing abilities (Bornstein, Jager, and Steinberg, 2012; Collins, 1995). Classrooms, playgrounds, and school buses provide ready access to peers and opportunities for more diverse contacts than many children would otherwise encounter (Hartup, 1996).Varying settings between elementary and middle schools, however, may complicate children’s efforts to form and maintain stable relationships with peers (Eccles, Lord, and Buchanan, 1996). The social field for children initially is the classroom, and most interactions are only with one teacher and the same group of students throughout the day, whereas in later grades the entire school is the social field, with multiple teachers, classrooms, and common spaces. For parents, monitoring school experiences may entail more effort as the number of teachers and settings increases.Additionally, many parents must arrange for and interact with out‑of‑home childcare personnel and with adults who provide instruction and supervision in out‑of‑school learning and recreational settings (Vandell, Larson, Mahoney, and Watts, 2015). Clearly, the transitions of middle childhood generate new tasks for parents, as well as developmental challenges for children.

Risks and Coping Parenting during middle childhood is compromised by increased risks and stressors for children, relative to early childhood. Although children between the ages of 5 and 12 years are generally the 84

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healthiest segment of the population in industrialized countries (Shonkoff, 1984), for many the physical transitions of middle childhood and the secular trend toward earlier puberty hasten exposure to some of the health risks of adulthood. Nevertheless, health problems first evident in middle childhood hold considerable risks for health and economic status in later periods (Case, Fertig, and Paxson, 2005). Accidents, the major cause of death during childhood, increase between the ages of 5 and 12. Also, middle-childhood experiences increase risks of beginning to use alcohol and tobacco by middle adolescence (Dishion, Capaldi, and Yoerger, 1999); use of other drugs has become more common for children in the middle-childhood age group as well.

Neighborhoods The broadening of opportunities for children to interact in environments outside the home frequently also broadens potential sources of risk. Children’s perceptions of their neighborhood are linked to their socioemotional adjustment. Reported feelings of loneliness vary with children’s perceptions of their neighborhood as problematic or child-friendly and by degree of perceived support from neighbors. Negative neighborhood characteristics are linked to poorer socioemotional functioning (Chase-Lansdale, Gordon, Brooks-Gunn, and Klebanov, 1997). Inner-city 9- to 12-year-olds who rated their neighborhoods high on economic disadvantage and personal exposure to stressful life events and low on personal support tend to be more involved in antisocial behavior and drug use (Dubow, Edwards, and Ippolito, 1997). The impact of neighborhood characteristics in middle-childhood development is often difficult to pin down, perhaps because familial influences are consistent and more direct sources that frequently either extend or actively counteract neighborhood influences (Chase-Lansdale et al., 1997; Chase-Lansdale and Gordon, 1996; Dubow et al., 1997). For example, parents with negative perceptions of their neighborhoods supervise children more closely (Dubow et al., 1997). Neighborhood characteristics also exacerbate familial difficulties. Low-income African American children living in a single-parent family show especially high levels of aggression if they also live in a financially disadvantaged neighborhood, whereas children from similar economic and family conditions in a middle-income neighborhood are no more aggressive than other children (Kupersmidt, Griesler, DeRosier, Patterson, and Davis, 1995). Middle-income neighborhoods do not unequivocally serve as a protective factor or potentiator of developmental opportunities, however; the opportunities and limitations impinging on children are more important than economic advantage per se.

Exposure to Violence The broader environments of middle childhood carry, for many children, increased risk of exposure to violence (Finkelhor, Turner, Ormrod, and Hamby, 2009). Risk of exposure to violence is as great for 5- to 8-year-olds as for 10- to 12-year-olds.The ready availability of weapons to individuals of all ages increases the likelihood of being a victim or perpetrator of violence during middle childhood. Although the impact of violence surely concerns parents, even parents in high-risk neighborhoods seriously underestimate the extent to which their children report exposure to violence (Hill and Jones, 1997). Experiencing violence, as a victim or witness, influences children’s sense of security and hope in the world (Lewis and Osofsky, 1997). Ethnographic research with African American children in an urban school revealed that children persistently discuss daily violent events in their community, and their discussions reflect the insidious presence of these experiences in children’s minds (Towns, 1996). Children’s perceptions of violence in their communities are correlated positively with their reports of fearfulness, distress, and depression at home and at school (Bell and Jenkins, 1993; Hill, Levermore, Twaite, and Jones, 1996; Osofsky, Wewers, Hann, and Fick, 1993). Exposure to violence and 85

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victimization at home is associated with a variety of emotional and behavior problems and diminished school performance (Emery, 1989; Guerra, Huesmann, and Spindler, 2003). One possible mechanism linking childhood stress and subsequent problems is telomere erosion, a biological phenomenon associated with aging. In a longitudinal study of a nationally representative sample, researchers found that children who experienced two or more kinds of violence exposure (maternal domestic violence, frequent bullying victimization, maltreatment by an adult) showed more telomere erosion between age 5 (baseline) and age 10 (follow-up) measurements than those with less exposure. This relative physical difference occurred even when controlling for child gender, socioeconomic status, and body mass index. In short, exposure to violence during middle childhood may be associated with premature physical aging, including vulnerability to disease and other health problems (Shaley et al., 2013). Parents may play a role by monitoring the degree of risk associated with extrafamilial settings and by imposing appropriate safety measures, including training children to respond to high‑risk situations. Furthermore, parents are critical sources of social support to children in coping with risky, threatening conditions. Children who perceive that persons are available with whom they can talk, discuss problems, and so forth cope more effectively with the stress of multiple personal and social changes during middle childhood and the transition to adolescence (Dubow,Tisak, Causey, Hryshko, and Reid, 1991; Furman and Rose, 2015).

Development of Self-Concept, Self-Regulation, and Social Responsibility Parents and other significant adults (e.g., teachers, coaches) also play a significant role in the growing capacities of 5- to 12-year-olds to function as responsible individuals (Colman, Hardy, Albert, Raffaelli, and Crockett, 2006).To attain mature self‑regulatory capacities requires knowledge of the self, emotions, and cognitive capacities to focus on long‑term goals and to take account of others’ views and needs.

Self and Self-Regulation During middle childhood, children’s descriptions of themselves become more stable and more comprehensive (Byrne and Shavelson, 1996; Raffaelli, Crockett, and Shen, 2005). This shift partly reflects the growth of cognitive concepts and awareness of cultural norms and expectations for performance. In addition, self‑evaluation intensifies as exposure to more varied persons and social contexts stimulates comparisons between self and others and provides evaluative feedback about characteristics, skills, and abilities (Pomerantz, Ruble, Frey, and Greulich, 1995). Linked to changing concepts of self are greater capacities for self‑control and self‑regulation. For most children, impulsive behavior declines steadily from early childhood into middle childhood (Maccoby, 1984). Regulation of affect, behavior, and attention, as reported by mothers, has been found to increase from early to middle childhood, with less marked increases from childhood to adolescence (Raffaelli et al., 2005). Parents and adult mentors can further capacities for self‑regulation by exposing children to standards of conduct and models of socially valued behaviors and by providing rewards and punishments in accord with those standards (Colman et al., 2006; Smoll and Smith, 2002). Parents’ and teachers’ impact on motivation is greatest when their encouragement emphasizes opportunities for learning and mastery, rather than stressing the need to succeed at social or task goals (Erdley, Cain, Loomis, Dumas-Hines, and Dweck, 1997; Kamins and Dweck, 1999). Furthermore, parents can stimulate cognitive components of self‑regulation through discussion and reasoning that convey principles for discerning right from wrong and that emphasize the consequences of transgressions. As self-regulation increases during middle childhood, parents develop new expectancies (Collins, 1995). Parents ordinarily expect more autonomy and independence in tasks at school and at home, including peer-group activities. Moreover, parents gradually allow children to assume more responsibility for interacting with health care personnel and for mastering and acting on information and 86

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instructions about medication, specific health practices, and evolving lifestyle issues with implications for physical and mental well-being. These transitions lay the groundwork for greater autonomy in adolescence and young adulthood.

Vulnerability and Coping Five- to 12-year-olds generally may be vulnerable to different stressors than children of other ages (Compas et al., 2014). For example, children of these ages generally are less distressed by short‑term separations from parents than are younger children, but grieve over the death of a parent more intensely and for longer periods (Rutter, 1983). Certain resources for coping with stress, moreover, may be more readily available to 5- to 12-year-olds than to younger children (Denham, Warren, von Salisch, Benga, Chin, and Geangu, 2011; Zimmer-Gembeck and Skinner, 2011). Among these are greater knowledge of strategies for coping with uncontrollable stress, which may modulate the degree of children’s vulnerability (Finnegan, Hodges, and Perry, 1996), and availability of social support (Dubow et al., 1991).

Normative Changes in Parent–Child Relationships Concurrent with these individual changes of middle childhood are characteristic patterns of parent‑child interactions and relationships that distinguish this period from earlier and later years of life.

Interactions and Affective Expression Interactions between parents and children become less frequent in middle childhood. Parents are with children less than half as much as before the beginning of school. This decline in time together is relatively greater for parents with lower levels of education (Hill and Stafford, 1980). Moreover, parents and children both show less overt affection during middle childhood than previously (McNally, Eisenberg, and Harris, 1991; Roberts, Block, and Block, 1984). Children also report that parents are less accepting toward them, especially during the later years of middle childhood (Armentrout and Burger, 1972). Despite a decrease between ages 3 and 12 in displays of physical affection, however, parents report little change in their enjoyment of parenting, having positive regard for their child, or having respect for the child’s opinions and preferences (McNally et al., 1991; Roberts et al., 1984). Parents and children alike are less likely to display and experience negative emotions in these interactions. Emotional outbursts, such as temper tantrums, and coercive behaviors of children toward other family members, ordinarily begin to decline in early childhood (Goodenough, 1931; Patterson, 1982). This trend continues during middle childhood, and the frequency of disciplinary encounters also decreases steadily between the ages of 3 and 9. Nevertheless, several emotional characteristics of interactions with 5- to 12-year-olds may complicate parents’ management of their relationships with children. Compared to preschool children, 5- to 12-year-olds are more likely to sulk, become depressed, avoid parents, or engage in passive non-cooperation with their parents (Clifford, 1959; Denham et al., 2000). Furthermore, children become increasingly likely to say that their conflicts with parents came about because parents provided inadequate help, did not spend enough time with the child, or (among older children) because parents had failed to meet parent‑role expectations or there was a lack of consensus on familial and societal values (Fisher and Johnson, 1990).

Mother–Child and Father–Child Relationships Gender differentiates some aspects of relationships. Children generally spend more time with mothers than with fathers (Collins and Russell, 1991). When both parents are with their children in 87

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the middle-childhood years, however, mothers and fathers initiate interaction with children with equal frequency, and children initiate similar numbers of interactions with each parent (Russell and Saebel, 1997). As in early life, fathers typically are involved relatively more in physical/outdoor play interactions, whereas mothers interact more frequently regarding caregiving and household tasks. In observational studies with both parents present, though, fathers and mothers engage in caregiving to a similar degree. Both positive and negative emotional expressions and conflictual interactions are more likely in mother‑child than in father‑child interactions (Russell and Saebel, 1997).This difference may reflect the greater amount of time and greater diversity of shared activities involving mothers.There is some indication that interactions with sons are marked by greater emotional expression than those with daughters, although findings are inconsistent regarding whether the emotions are relatively more positive or negative (for reviews, see Collins and Russell, 1991; Lytton and Romney, 1991). Researchers frequently fail to find evidence of several commonly anticipated differences between interactions with mothers and those with fathers. Collins and Russell (1991) argued that few parental differences first emerge in middle childhood. For example, fathers as well as mothers increase their attention to school achievement and homework during middle childhood (McNally et al., 1991; Roberts et al., 1984). Likewise, studies of parental reinforcements for instances of behaviors, such as competitiveness, autonomous achievement, or competence in cognitive or play activities, generally show negligible differences between mothers and fathers. Neither have differences been found in the degree to which mothers and fathers influence the development of executive function in middle childhood (Meuwissen and Englund, 2016). Furthermore, the degree to which mother‑child and father‑child relationships are complementary, rather than overlapping, is less likely to change during middle childhood than during adolescence.

Mutual Cognitions Parents’ and children’s cognitions about each other and about issues of mutual relevance also change during middle childhood, especially the latter part of the period. Parents’ knowledge of their children’s daily activities and preferences increases during the middle-childhood years (Bugental and Johnson, 2000; Crouter, Helms-Erikson, Updegraff, and McHale, 1999; Miller, Davis, Wilde, and Brown, 1993). Ten- to 11-year-olds and their parents tend to agree on the topics for which parents’ authority is legitimate, but disagreements become more likely during adolescence (Smetana, 1989). Late middle childhood is an important time for achieving more mutual cognitions. Alessandri and Wozniak (1987) found that 10- to 11-year-olds perceived their parents’ beliefs about them less accurately than 15- to 16-year-olds did. Following those same 10- to 11-year-olds for 2 years, however, the researchers found that the children, who were now ages 12–13, were more accurate in their perceptions of what their parents believed about them (Alessandri and Wozniak, 1989). Maccoby (1992) and Collins (1995) speculated that mutual cognitions are more significant determinants of relationship qualities in middle childhood than in earlier periods (Bornstein et al., 2012). By the time a child reaches middle childhood, shared experiences have created extensive expectancies about the probable reactions of both parents and children. These expectancies then guide each person’s behavior in interactions with the other. The rapid changes of late middle childhood stimulate both parents and children to adapt their respective beliefs and perceptions about the other to maintain their relationship over time. To summarize, changes in parent‑child relationships create new paradigms for interaction that affect when and how parents will respond to the behavior of children during middle childhood. Although partly resulting from adaptations to developmental changes that have already occurred, these relational patterns also affect responses to further changes during and beyond middle childhood. The next section examines findings from research on parenting of 5- to 12-year-olds. 88

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Issues in Parenting During Middle Childhood Changes in children and parent–child relationships raise the question of whether middle childhood is a distinctive period of parenting.This section addresses two related questions:What distinctive tasks devolve on parents during the middle-childhood years, and what characteristics of effective parenting have emerged in studies with 5- to 12-year-olds? These questions are examined in research findings on four central issues of parenting pertinent to the developmental changes of middle childhood: adapting control processes; fostering self‑management and a sense of responsibility; facilitating positive relationships with others; and managing experiences in extrafamilial settings.

Adapting Control Processes Changes in interactions between parents and children, together with changing demands from age‑graded activities and experiences, necessitate different strategies for exerting influence over children’s behavior. These strategies may involve different disciplinary practices than in early childhood, more extensive shared regulation of children’s behavior, and altered patterns for effective control.

Disciplinary Practices Parenting young children typically involves distraction and physically assertive strategies for preventing harm and gaining compliance. In middle childhood, however, parents report less frequent physical punishment and increasing use of techniques such as deprivation of privileges, appeals to children’s self‑esteem or sense of humor, arousal of children’s sense of guilt, and reminders that children are responsible for what happens to them (Clifford, 1959; Roberts et al., 1984). These techniques may reflect changes in parents’ attributions about the degree to which children should be expected to control their own behavior and greater likelihood of viewing misbehavior as deliberate and, thus, as warranting both parental anger and punishment (Dix, Ruble, Grusec, and Nixon, 1986; Lansford, Bornstein, Dodge, Skinner, Putnick, and Deater-Deckard, 2011). Maccoby (1984) proposed that children’s responses to parents’ control attempts during middle childhood are affected by changes in children’s concepts of the basis for parental authority. Whereas preschoolers view parental authority as resting on the power to punish or reward, children in early middle childhood increasingly believe that parental authority derives from all the things that parents do for them. After about age 8, children invoke parents’ expert knowledge and skill also as reasons to submit to their authority (Braine, Pomerantz, Lorber, and Krantz, 1991). Maccoby (1984) speculated that parental appeals based on fairness, the return of favors, or reminders of the parents’ greater knowledge and experience may become more effective during middle childhood, with parents less often feeling compelled to resort to promises of reward or threats of punishment. This line of reasoning implies that, during middle childhood, parents may find it easier to follow the disciplinary practices that have been found most effective in fostering patterns of self‑regulated, socially responsible behavior, namely, an emphasis on the implications of children’s actions for others (induction), rather than on use of parents’ superior power to coerce compliance (Barber, Stoltz, and Olsen, 2005; Hoffman, 1994). Parents’ effectiveness as disciplinarians depends in part on the clarity with which they communicate expectations and reprimands (Grusec and Goodnow, 1994). Children tend to “tune out” when instructions and reprimands are ambiguous, as when a parent is inexplicit or reprimands the child while smiling. Such ineffective messages often result from a parent’s sense of powerlessness or lack of control over the child’s behavior, but also exacerbate behaviors parents wish to correct (Bugental, Lyon, Lin, McGrath, and Bimbela, 1999). 89

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Coregulation Decreasing face‑to‑face interactions during middle childhood put additional pressures on parents’ strategies for exerting control over children’s behavior. Different methods are appropriate because of the age and capabilities of children and because children must be trained to regulate their own behavior for longer periods. At the same time, children’s increased abilities for planful, goal‑directed behavior and for more effectively communicating plans and wishes to parents permit greater collaboration and more effective monitoring (Crouter et al., 1999; Maccoby, 1992). Maccoby (1984) specified the responsibilities of both parents and children in this cooperative process. First, parents must stay informed about events occurring outside their presence and must coordinate agenda that link the daily activities of parents and child. Second, they must effectively use the times when direct contact does occur for teaching and feedback. Third, they must foster the development of abilities that will allow children to monitor their own behavior, to adopt acceptable standards of good and bad behavior, to avoid undue risks, and to know when they need parental support or guidance. This process is reciprocal: Children must be willing to inform parents of their whereabouts, activities, and problems so that parents can mediate and guide when necessary.

Effective Control in Middle Childhood Maccoby’s formulation implies that effective parental control processes are tantamount to training of skills for self‑regulation. A key component of effective control is parental monitoring, which requires careful attention to children’s behavior and associated contingencies. Monitoring is integral to child‑centered control techniques, in which parents exert influence by sensitively fitting their behavior to behavioral cues from children, rather than allowing the parents’ own needs to drive parent‑child interactions (Maccoby and Martin, 1983). Ineffective parental monitoring repeatedly has been linked to antisocial behavior in middle childhood and adolescence (Barber et al., 2005; Forgatch, Patterson, and Gewirtz, 2013). The effectiveness of monitoring, however, depends on the parents’ general style of control. Children are most likely to manifest positive developmental outcomes when parents practice child‑centered patterns of discipline, accompanied by clearly communicated demands, parental monitoring, and an atmosphere of acceptance (authoritative parenting) toward the child (Baumrind, 1989; Maccoby, 1992; Maccoby and Martin, 1983). For example, attentive, responsive care appears to be positively linked to the development of self‑esteem, competence, and social responsibility. The meager evidence now available from other cultures indicates that optimal childrearing practices frequently include somewhat more restrictiveness than is usually implied by North American findings with middle‑class families (Barber et al., 2005; Chao, 1994; Rohner and Pettengill, 1985). In every society, however, responsiveness to children’s needs and support for their development appears to foster competent, responsible behaviors. Multiple authors (Barber et al., 2005; Darling and Steinberg, 1993; Maccoby, 1992) have observed that a responsive, supportive, child‑centered parental style affects the impact of specific parental practices, such as monitoring of children’s behavior. The research findings undergirding these generalizations generally do not provide definitive evidence that the parenting characteristics specified in the studies determine particular child characteristics, but studies from which causal effects can be inferred imply that these characteristics constitute the currently best available description of effective parenting (Collins, Maccoby, Steinberg, Hetherington, and Bornstein, 2000; Maccoby, 1992; Steinberg, 2001). A striking example comes from a prevention program intended to foster more effective parenting following divorce (Forgatch and DeGarmo, 1999). School-age sons of recently divorced single mothers often manifest increased academic, behavioral, social, and emotional problems relative to sons of nondivorced mothers, and the divorced mothers themselves commonly behave toward their sons in a more coercive and less 90

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positive manner than non-divorced mothers (Lansford, 2009). The prevention program provided year-long training and discussion groups encouraging mothers to use the effective parenting principles described above during this post-divorce period. The children of these mothers underwent no intervention. At the end of 12 months, treatment group mothers generally showed less coercive behavior toward children and fewer declines in positive behavior than control-group mothers. Moreover, the degree of change in the mothers’ behavior over the course of 12 months significantly predicted the degree of change in the children’s behaviors, both at home and at school. By changing the mothers’ behavior, these researchers changed the children’s behavior, thus implicating effective parenting in the children’s improved behavior. Findings from multiple studies consistently show that parents of 5- to 10-year-olds describe their childrearing along two dimensions: nurturance–restrictiveness (ranging from positive, facilitating reactions to negative, interfering reactions) and power (amount of active control exerted by the parent, including both rewards and punishments). Moreover, no evidence of change in parents’ behavior on these dimensions during middle childhood has emerged (Deković and Janssens, 1992). Neither do children’s perceptions of firmness of control show reliable variation across groups from ages 9 to 13 years (Armentrout and Burger, 1972). Most experts now believe that firmness alone is an inadequate indicator of effective control. Lewis (1981) argued that, in many families, firmness of control co‑exists with responsive, child‑centered parenting, which in turn enhances children’s motivation to respond positively to their parents. To summarize, middle childhood does not induce dramatic changes in parents’ typical styles of childrearing. As in other periods, effective childrearing entails both attentiveness and responsiveness to children’s needs and expectations of age‑appropriate behavior. Nevertheless, during middle childhood, patterns from earlier life are altered in ways that fundamentally affect the exchanges between parents and children and the implications of those exchanges for further development. These alterations involve a gradual transition toward greater responsibility for children in regulating their own behavior and interactions with others.

Fostering Self-Management and Social Responsibility Alterations in parents’ management and control activities partly result from children’s own developing self‑management skills. Although parents do not abruptly relinquish control any more than children abruptly become autonomous, children’s enhanced self‑management skills probably contribute to a gradual transition from parental regulation of children’s behavior to self‑regulation by the child (Colman et al., 2006; Raffaelli et al., 2005). This implicit transfer of regulatory responsibility is a hallmark of adolescent development (Chapter 4 in this volume), but Maccoby (1984) argued that the transfer process begins earlier and lasts longer than has commonly been assumed. She contended that the transfer of power from parents to children involves a three‑phase developmental process: parental regulation, coregulation, and, finally, self‑regulation. In the intermediate period of coregulation, parents retain general supervisory control but expect children to exercise gradually more extensive responsibilities for moment‑to‑moment self‑regulation. This coregulatory experience in turn lays the groundwork for greater autonomy in adolescence and young adulthood. In several formulations (Collins, Gleason, and Sesma, 1997; Grusec and Goodnow, 1994; Kuczynski, Marshall, and Schell, 1997), coregulation, rather than autonomous self‑regulation, is treated as the norm for both parent‑child and other relationships. Interdependence is essential to social relationships at every age, and socialization entails more mature and complex forms of interdependence with age. Maccoby (1992, p. 1013) characterized the effective goal of authoritative parenting as “inducting the child into a system of reciprocity.” Training for autonomy is seen not as preparing children for freedom from the regulatory influences of others, but as enhancing capabilities for responsible 91

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exercise of autonomy, while recognizing one’s interdependence with others (Collins et al., 1997). Thus, parenting in middle childhood is less a matter of gradually yielding control than of transforming patterns of responsibility in response to new characteristics and challenges. Variations in parents’ behavior toward children are correlated with several distinctive aspects of self‑management and responsibility: incidence of prosocial and undercontrolled, often antisocial, behavior; internalization of moral values; and increasing responsibility for self‑care and for collective well-being. These links are discussed in the following three sections.

Incidence of Prosocial and Antisocial Behavior For most children, behaviors that benefit others increase and those that harm others decline beginning in early childhood (for reviews, see Eisenberg, Eggum-Wilkens, and Spinrad, 2015; Eisner and Malti, 2015). During middle childhood, several common changes imply that prosocial behavior probably becomes more likely, and undercontrolled, antisocial behavior less likely. Among these are declining tendencies to behave impulsively, increases in planfulness and other executive processes, greater capacity for understanding the impact of one’s actions on others, and knowledge of what is required for helpfulness (Barnett, Darcie, Holland, and Kobasigawa, 1982). Children in middle childhood also increasingly know the appropriate conditions for displaying anger and aggression (Dodge et al., 2003; Underwood, Coie, and Herbsman, 1992). Parents contribute to the development of prosocial norms in several ways. Parents’ own positive coping with frustration and distress serve to influence children’s regulation of their emotions (Kliewer, Fearnow, and Miller, 1996). Parents’ use of explanations that emphasize the implications of children’s behavior for others also is associated with helpful, emotionally supportive behavior toward others (Hoffman, 1994; Malti and Krettenauer, 2013). Furthermore, parents generally are perceived as sources of social support (Furman and Buhrmester, 1992). Children who perceive that they can talk with parents, discuss problems with them, and draw on their support appear more likely to show prosocial behaviors and attitudes, such as empathy, tolerance of differences, and understanding of others (Bryant, 1985; Gentzler, Contreras-Grau, Kerns, and Weimer, 2005). Middle childhood is significant in the development of the control of hostile aggressive actions. Although the overall likelihood of aggressive behavior is lower in middle childhood than in early childhood, 5- to 12-year-olds’ aggression is more often hostile and person‑oriented than aggression that occurs in early childhood (Hartup, 2005). Parental behaviors and family environments marked by harsh parental discipline repeatedly have been associated with the likelihood of antisocially aggressive behavior (Pinderhughes, Dodge, Bates, Pettit, and Zelli, 2000; Tolan and Loeber, 1993). A key linking the two appears to be a bias toward interpreting the actions of others as intentionally harmful (Dodge, Bates, and Pettit, 1990; Orobio de Castro, Veerman, Koops, Bosch, and Monshouwer, 2002). Children generally regard acts that are unintended, unforeseeable, and unavoidable as less blameworthy and less deserving of retaliation than other actions. However, habitually aggressive children frequently are biased toward regarding ambiguous intent as hostile. This bias is most likely in children who have experienced a history of harsh parental discipline in early childhood (Weiss, Dodge, Bates, and Pettit, 1992). Not surprisingly, antisocial behavior is highly likely when children have repeatedly experienced indifferent, unresponsive behavior from their parents (Patterson, 1982; Stoltz et al., 2013). Antisocial tendencies place children at risk for peer rejection and school failure during middle childhood and for involvement in antisocial behavior in adolescence and young adulthood (Patterson, DeBaryshe, and Ramsey, 1989). Thus, antisocial behavior is the nexus of a longitudinal process linking ineffective parenting and personal and social dysfunction (Finkelhor and Dziuba-Leatherman, 1994; also see Chapter 15 in this volume). Mass media portrayals of antisocial and prosocial behavior consistently have been shown to influence spontaneous behavior after viewing. Children who spend relatively small amounts of time with 92

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television and other electronic media generally show fewer antisocial behaviors and fare better on many school and other tasks (Anderson and Bushman, 2002; Anderson and Kirkorian, 2015; Calvert, 2015). On the average, children in middle childhood devote 3–4 hours per day to television viewing, more time than any other age group in the first two decades of life. This amount varies greatly, however, depending on the child’s gender, socioeconomic status, and many other factors. Parents’ own viewing habits and the degree to which they attempt to regulate their children’s viewing influence both the amount and kind of exposure to media models of positive and negative social behaviors. Parents can help to reduce the negative impact of television viewing by watching programs with children, providing explanations for complex situations and events, helping children differentiate between reality and fiction, and encouraging children to make responsible choices about the content of media.

Internalization of Moral Values Parents enhance social understanding by appealing to concerns for others and stimulating more cognitively complex reasoning about moral issues (Hoffman, 1994; Kochanska and Aksan, 2006). During middle childhood, these parental techniques may become more effective, because of children’s increasing abilities for understanding others’ experiences and feelings (Carpendale and Lewis, 2015). The implications for behavior come from the well‑established correlation between parental disciplinary approaches based on warmth, other‑oriented induction, and infrequent use of coercive discipline without explanations and signs of “conscience”—confessing misdeeds, offering reparations, feeling guilty (Killen and Smetana, 2015).

Responsibility for Self and Collective Well-Being The term “responsibility” encompasses broad behavioral expectations, including “(a) following through on specific interpersonal agreements and commitments, (b) fulfilling one’s social role obligations, and (c) conforming to widely held social and moral rules of conduct” (Ford, Wentzel, Wood, Stevens, and Siesfeld, 1989, p. 405). Parental practices associated with the development of prosocial behavior and acquisition of moral values during middle childhood can be regarded as factors in the development of responsibility generally. More specific strategies, however, involve parental expectations regarding household tasks and other activities considered relevant to the welfare of the family. Parents generally believe that expecting children to carry out household tasks not only provides valuable work experience, but also teaches about expected relationships with others. Goodnow (1988) viewed division of responsibility for household tasks as an instance of distributive justice, referring not only to the distribution of labor for efficiency’s sake, but also to the distribution in the sense of relational goals, such as obligation, justice, and reciprocity.Warton and Goodnow (1991) found developmental progressions from middle childhood into adolescence in understanding distribution principles, such as direct‑cause responsibility (“People should take care of the areas that they mess up.”).This progression involves moving from a direct assertion of responsibility (e.g., “It’s Mom’s job.”) or an emphasis on some concrete details of the situation, to the understanding the principle (“John should clean up the playroom because he and his friends were playing down there, and I wasn’t involved.”), followed by a move toward a modified, rather than rigid use of the principle (e.g., “John made this mess, but he has to do his paper route on time; he’ll help me out some other time.”). Although parents of 5- to 12-year-olds are most likely to be dealing with the first two phases of this progression, discussions emphasizing the third view of equality may influence the growth of concepts of responsibility during middle childhood. Amato (1989) reported that, for 8- to 9-year-olds, rearing environments characterized by high levels of parental control and parental support, along with high allocation of household responsibility, are associated with broad competence at tasks. 93

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To summarize, fostering self‑management and responsibility probably involves a more gradual process than is implied by the common image of parents’ transferring control to their children. Co‑regulatory processes, in which parents allocate responsibilities for gradually broader self‑management to children, while retaining oversight, probably influence children through two key processes: (1) training for effective self‑management and (2) enhancing capacities for interdependence, both with persons more powerful than they and with persons of equal power (Baumrind, 1989).

Facilitating Positive Relationships Parents’ relationships with their children during middle childhood, as well as in earlier periods, influence the development of supportive relationships during middle childhood and enhance competence in and beyond ages 5–12. This principle is apparent from the impact of parents on their children’s relationships with each other and on their relationships with peers (Bornstein et al., 2012).

Sibling Relationships Sibling relationships become increasingly positive, egalitarian, and companionable during middle childhood (Dunn, 1992; Dunn and McGuire, 1992). The degree to which this occurs, however, is related to parental interactions with both siblings. In a study of 10- to 11-year-old girls and their 7- to 9-year-old sisters, the daughters whose mothers were above average in responsiveness to their daughters’ needs showed more prosocial behavior and less hostility toward their siblings than the daughters of mothers who were below average in responsiveness (Bryant and Crockenberg, 1980). In other studies, rates of positive, negative, and controlling behaviors directed by mothers toward each child are correlated positively with the rates of such behaviors directed by siblings toward each other (Stocker, Dunn, and Plomin, 1989). Parents’ differential treatment has also been linked to negative relationships between the siblings. This relation is apparent from several related research findings. One such finding is that the children of parents who responded more extensively to one child over the other were more likely to behave with hostility toward one another (McHale, Updegraff, and Whiteman, 2012). Another is that rates of fathers’ and mothers’ positive behaviors directed to each child were associated with siblings’ positive behavior toward each other, and both negative parental behaviors generally and differences in behaviors toward the children were associated with negative sibling interactions (Brody, Stoneman, and McCoy, 1992). This contrast was especially likely when one child’s temperament was more difficult than the other child’s (Brody, Stoneman, and Gauger, 1996). Coder ratings of sibling enmeshment and disengagement in late middle childhood have been found to predict greater adjustment difficulties in adolescence, even after considering standard indices of sibling relationships quality (i.e., warmth, conflict) and structural characteristics (e.g., gender; Bascoe, Davies, and Cummings, 2012). It is not possible to say whether parents’ differential treatment during middle childhood affects sibling relationships more than differential behavior in other life periods. Children who perceive that they are treated less positively than their sibling, however, are somewhat more likely than their sibling to show negative personality adjustment in adolescence (Daniels, Dunn, Furstenberg, and Plomin, 1985; also see Chapter 7 in this volume).

Peer Relationships Parents facilitate their children’s positive peer relationships indirectly and directly throughout childhood (Parke, MacDonald, Beitel, and Bhavnagri, 1988). Indirect or stage‑setting effects subsume the advantages of positive, accepting, secure parent‑child relationships on children’s capacities for forming and maintaining smooth, prosocial relationships with others (Contreras, Kerns,Weimer, Gentzler, 94

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and Tomich, 2000; Dishion, 1990). Direct or intervention effects refer to parents’ management of their children’s relationships with other children and the transmission of specific social skills for effective interactions with peers (Parke and Bhavnagri, 1989). In general, the parental correlates of positive peer relationships during middle childhood parallel the more extensive findings from studies of preschool children (Hartup and Collins, 2000). In middle childhood, mothers and fathers of well‑liked children are emotionally supportive, infrequently frustrating and punitive, and discouraging of antisocial behavior in their children (Deković and Janssens, 1992).The families of these children are generally low in tension and are marked by affection toward, and parental satisfaction with, their children. Furthermore, social skills that are significant to successful peer relationships (e.g., self‑confidence, assertiveness, and effectiveness with other children) are correlated with a history of affection from both parents and dominance from the same-gender parent (Booth-Laforce et al., 2006; Parke et al., 1988). In research with 8- and 9-year-old children and their parents, popularity with peers was positively correlated with children’s perceptions of positive relationships with parents and observational measures of fathers’ receptivity to children’s proposed solutions on a teaching task (Henggeler, Edwards, Cohen, and Summerville, 1991). These findings imply both direct and indirect links between parent and peer relationships, but leave open the question of how such links come about. Relevant evidence on one possible process comes from a study of 5- and 6-year-old middle‑class European American children and their parents (Cassidy, Parke, Butkovsky, and Braungart, 1992). When with their peers, the children in this study were more cooperative and interacted more smoothly if their parents were emotionally expressive. The relation was most pronounced for children who showed understanding of emotions, including emotional expressions, experiences, conditions, and effective responses to feelings and actions. Thus, the impact of the emotional tenor of parent‑child relationships may be especially great for those children who can infer positive principles of interpersonal behavior from experiences with parents and siblings. Later research revealed that positive relationships with parents contribute to a child’s developing abilities for regulating their emotions, and this ability in turn makes the child more effective in interactions with peers (Contreras et al., 2000). Parent‑child interaction patterns also have been linked to less positive behavior in middle childhood (Dishion, 1990; Ingoldsby et al., 2006; Schwartz, Dodge, Pettit, and Bates, 1997; Vuchinich, Bank, and Patterson, 1992). In two cohorts of boys, ages 9–10 years, Dishion (1990) found that erratic monitoring and ineffective disciplinary practices marked the families of rejected boys, as did higher levels of family stress, lower socioeconomic status, and evidence of more behavioral and academic problems for the boys themselves. Parents’ ineffective disciplinary practices increased the likelihood of peer rejection by enhancing the likelihood of antisocial behavior and academic failure. Later analysis of these data, along with data from a 2-year follow-up (Vuchinich et al., 1992), showed a reciprocal relation between parental ineffectiveness and child behavior: parental discipline in these families was ineffective partly because the children behaved antisocially, but the ineffective discipline also helped to maintain these antisocial tendencies. In addition to the association between parenting and antisocial behavior, the family environment, including parents’ marital conflict and parental disagreement on childrearing standards and practices, has been linked to children’s antisocial tendencies and poor relationships with peers (Cummings and Davies, 2010; Gonzales, Pitts, Hill, and Roosa, 2000). These diverse pieces of evidence indicate that parent‑child and peer relationships are linked through complex, multiple processes.

Timing of Effects Considerable uncertainty exists about whether links between parent‑child relationships and interpersonal competence during middle childhood reflect concurrent relationships or the longer history of interactions between parent and child. Longitudinal research indicates impressive stabilities 95

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between parent‑child relationships in infancy and early childhood and extrafamilial relationships in middle childhood (Colle and Del Giudice, 2011; Sroufe, Carlson, and Shulman, 1993b). These findings come from research showing that security of attachment to caregivers at 12 and 18 months was associated with a variety of indicators of competence with peers at 10–12 years of age (Elicker, Englund, and Sroufe, 1992; Sroufe, Egeland, and Carlson, 1999). The securely attached children were more likely to be rated highly by adults on broad‑based social and personal competence and were less dependent on adults. These children also spent more time with peers, were more likely to form friendships, and were more likely to have friendships characterized by openness, trust, coordination, and complexity of activity. They also spent more time in, and functioned more effectively in, groups and were more likely to follow implicit rules of peer interactions than children with histories of insecure attachment. An example comes from research on same‑gender versus cross‑gender peer interactions. During middle childhood, frequency of cross‑gender interactions in an open-field setting is negatively correlated with social skills and popularity. Insecurely attached children more frequently engage in cross‑gender interactions than securely attached children (Sroufe, Bennett, Englund, Urban, and Shulman, 1993a). Thus, 5- to 12-year-olds children’s orientation to peers and teachers are similar to their orientations in early childhood; and both the early- and middle-childhood patterns are correlated with attachment measures taken during the first 2 years of life (Del Giudice, 2015; Kerns, Brumariu, and Seibert, 2011; Sroufe et al., 1993b; Sroufe et al., 1999). These correlations may mean that relationships with parents have similar characteristics across time. Parents who provided responsive, child-centered care in infancy might be more likely to adapt those patterns of care to the support and guidance needed by children in later years, thus providing continuity of care.The researchers suggest two other possibilities. One is that the patterns of behavior formed in early relationships may persist, eliciting characteristically different patterns of reactions from others in later life. That is, positive relationships with peers may result from skillful interpersonal behavior by the securely attached child. A second possibility is that children carry forward from early relationships an internal working model of interpersonal relationships (Bowlby, 1973). Internal working models are inferred cognitive representations or prototypes of one’s key relationships that incorporate behaviors, feelings, and expectancies of reactions from others (Sroufe et al., 1999). These possibilities are not mutually exclusive, and all three may contribute to the complex linkages between familial and peer relationships. Longitudinal analyses imply that early relationships are probably linked to middle-childhood peer competence via internal working models (Fury, Carlson, and Sroufe, 1997). Children’s internal working models of relationships were assessed at ages 4, 8, and 12 years. There were clear contrasts among groups varying in early attachment scores in early- and middle-childhood measures of internal working models. Together, infant attachment scores and later measures of internal working models accounted for 44% of the variance in ratings of social competence at age 12; early attachment alone, however, was not reliably related to later social competence. Important questions remain, such as whether and how representations are affected by variations in relationships after infancy. Findings to date, however, imply that parenting in middle childhood partly is rooted in relational patterns established in earlier periods of life.

Beyond Middle Childhood It should be noted that temporal linkages between familial and extrafamilial relationships run forward, as well as backward, in time. Rejection by peers, which consistently has been linked to relationships with parents and siblings in childhood, is a compelling marker of long-term developmental disadvantage (Parker and Asher, 1987). Individuals with unsatisfactory peer relationships in childhood face greater risks for behavioral problems, school failure, and emotional maladjustment in childhood and adolescence and for mental health problems and criminality in adulthood (Bornstein, Hahn, and Haynes, 2010; Hartup, 1996). Parent–child relationships appear to affect these developmental 96

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outcomes via their impact on antisocial behavior and academic failure in middle childhood (Patterson et al., 1989) and even via long-term unemployment in adulthood (Kokko and Pulkkinen, 2000). More positive linkages to parent–child relationships have also been documented. Franz, McClelland, and Weinberger (1991) reported longitudinal follow-ups of individuals who were first studied at the age of 5, together with their mothers. The participants were measured at age 41 on an indicator of “conventional social accomplishment,” defined as having a long, happy marriage, children, and relationships with close friends at midlife (Vaillant, 1977). Having a warm and affectionate father and mother at age 5 was correlated with affiliative behaviors and reports of good relationships with significant others 36 years later.These characteristics of parents also were associated with higher levels of generativity, work accomplishment, and psychological well-being, a lower level of strain, and less use of emotion-focused coping styles in adulthood. In a separate analysis with this same sample, parents’ characteristics at age 5 were associated with empathic concern at age 31 (Koestner, Franz, and Weinberger, 1990). As in the shorter-term longitudinal findings described earlier, a variety of possible processes may account for this link between middle-childhood familial relationships and these varied adult characteristics. Bornstein, Hahn, and Suwalsky (2010) further demonstrated that adaptive functioning, as well as externalizing and internalizing behavioral problems, reflect a developmental cascade across ages from 4 to 10 and 14 years. Even when considering child intelligence, maternal education, and social desirability, adaptive functioning in early adolescence was foreshadowed by adaptive functioning in early childhood and low levels of externalizing behavioral problems.

Parent–Peer Cross-Pressures One widely invoked possible linkage between parent–child and peer relationships in middle childhood is an inverse one: namely, that increasing involvement with peers may be associated with decreasing engagement with and influence of parents. This linkage, though, has only limited and narrow support in the literature. A more common finding is that attitudes toward both parents and peers are more favorable than unfavorable throughout middle childhood and adolescence (Collins, 1995; Collins et al., 2012).Within this general stability, however, some change does occur. For example, the number of children reporting positive attitudes toward parents declines moderately during middle childhood, although attitudes toward peers generally do not become more favorable during this period. With respect to endorsement of attitudes held by parents versus peers, the inverse relation occurs only for antisocial behavior and, furthermore, is not especially intense prior to puberty (Hartup and Collins, 2000). In a cross-sectional study of children ages 9, 12, 15, and 17 years, Berndt (1979) charted age-related patterns of conformity to parents and peers regarding prosocial, neutral, and antisocial behaviors. Antisocial behavior, in this instance, referred to such activities as cheating, stealing, trespassing, and minor destruction of property. Children and adolescents alike conformed to both parents and friends regarding prosocial behavior; there was some decline across ages in conformity to parents, but not peers, on neutral behaviors; and conformity to peers regarding antisocial behaviors increased between ages 8 and 15, but not beyond. Thus, there is relatively little evidence that pronounced parent–peer cross-pressures are the norm in middle childhood. More disruptive shifts may occur in families in which parents fail to maintain age-appropriate, child-centered control patterns. Recent findings indicate that conformity to peers may be more likely in families in which relationships with parents are perceived as unsatisfactory (Ingoldsby et al., 2006). Earlier findings (Fuligni and Eccles, 1993) from 1,771 self-report questionnaires had revealed more extreme peer orientation among 12- and 13-year-olds who believed their parents continued patterns of power assertion and restrictiveness used when they were younger. Furthermore, those who perceived few opportunities to be involved in decision-making, as well as no likely increase in these opportunities, were higher in both extreme peer orientation and peer advice seeking. Studies 97

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of school-age children and early adolescents who are on their own in the after-school hours also show greater susceptibility to peer influence cross-pressures when parent–child relationships are less warm and involve less regular parental monitoring (Galambos and Maggs, 1991; Smetana, 2008; Steinberg, 1986).

Social Support for Parents Parents’ perceptions of a supportive network beyond the family also influence their behavior and children’s development. For example, interventions with troubled families are more effective when parents perceive that social support is available to them (Sandler, Schoenfelder, Wolchik, and MacKinnon, 2011), whereas isolation from community support systems often typifies abusive families (Emery, 1989). To summarize, qualities of relationships with parents have significant implications for development in and beyond middle childhood. Furthermore, linkages to other periods indicate that middle childhood experiences are inextricable from developmental influences and processes across the lifespan. A variety of possible processes may link middle-childhood family relationships to both earlier and later functioning.

Managing Extra-Familial Experiences As children move into settings beyond the family, parents increasingly must monitor extra-familial settings and negotiate with non-familial adults on behalf of children. Of these, the most prominent is school. In addition, many parents must arrange for after-school or summer care by others or must establish and monitor arrangements for self-care by children.

School Children in the United States typically spend almost as much time at school as at home. Schools advance both academic knowledge and knowledge of cultural norms and values and provide essential supports for learning literacy skills, which greatly extend cognitive capacities in many different areas (Koslowski and Masnick, 2010). Experiences in school also affect children’s views of their own abilities to learn and their actual achievement and adjustment (Eccles, Wigfield, and Schiefele, 1998). Family experiences are linked to children’s successful adaptation to the demands of schooling. A history of shared work and play activities with parents is positively linked to a smooth entry into school, whereas early interactions characterized by a controlling parent and a resisting child, or by a directing child, are correlated with poor adjustment (Barth and Parke, 1993; Pianta and Nimetz, 1991). Several parental characteristics are linked to both short-term and long-term academic motivation: providing a cognitively stimulating home environment, regardless of socioeconomic level (Gottfried, Fleming, and Gottfried, 1998), values favoring the development of autonomy rather than conformity (Okagaki and Sternberg, 1993) and emphasizing goals associated with learning, rather than goals associated with performance and evaluation (Ablard and Parker, 1997). Children express more satisfaction with school when the authority structure of classrooms is similar to the authority practices they encounter at home (Epstein, 1983). Furthermore, parenting styles consistently have been linked to school success. Authoritative styles that emphasize encouragement, support for child-initiated efforts, clear communication, and a child-centered teaching orientation in parent–child interactions are associated with higher achievement than are strategies characterized by punishment for failure, use of a directive teaching style, and discouragement of child-initiated interactions (Pianta and Nimetz, 1991).These correlations occur in studies with both European American and African American families and with adolescents as well as younger children (Steinberg, Elmen, 98

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and Mounts, 1989). These latter findings implicate authoritative parenting in higher school achievement and lower incidence of behavior problems in school, compared to authoritarian or permissive parenting styles. In addition to parental control strategies, lower school achievement during middle childhood has been linked with family environments characterized by inter-parent and parent–child hostility (Feldman and Wentzel, 1990). Parents’ expectations regarding children’s achievement also are implicated in school success (Stevenson and Newman, 1986). Expectations have an impact from the beginning of schooling. Entwisle and Hayduk (1982) examined United States parents’ expectations for their children’s school performance each year between the ages of 5 and 9. For middle- and working-class children, parents’ expectations were strong influences on children’s first marks. After age 6, the influence of working-class parents appeared to be considerably less than that of their middle-class counterparts (Alexander and Entwisle, 1988). In European American middle-class families, parental expectations are correlated with achievement into the pre-adolescent years (Frome and Eccles, 1998; Stevenson and Newman, 1986). Changes in expectations often occur during the early school years, however, and these changes are difficult to explain. Children’s performance in school may affect these expectations, of course. Alexander and Entwisle (1988) found significant impact of first-grade (age 6 years) achievement on parents’ subsequent expectations for children’s school performance. In other instances, contrasting expectations emerge for children who are equivalent in classroom grades and in test scores. For example, although parents’ expectations for math performance do not differ by gender at school entry, boys are expected to do better than girls by the beginning of the second grade (age 7; Entwisle and Baker, 1983). High parental expectations also appear to be a key factor in cross-national differences in school achievement during middle childhood. Stevenson and Lee (1990) examined parental correlates of substantially lower levels of academic achievement by children in the United States, compared to China and Japan.They found that parents in the United States have lower expectations for and assign less importance to school achievement than Asian parents do; furthermore, mothers in the United States are more likely to regard achievement primarily as a reflection of innate ability, whereas Asian mothers emphasize the importance of hard work in attaining academic excellence. Compared to parents in China and Japan, as well as immigrant parents in the United States, parents born in the United States are more likely to believe that general cognitive development, motivation, and social skills are more important than academic skills (Huntsinger, Jose, Liaw, and Ching, 1997; Okagaki and Sternberg, 1993; Stevenson and Lee, 1990). Thus, not only expectations about children’s achievement, but the importance assigned to mastery of school tasks per se, affect the impact of parents on their children’s school experiences (Huntsinger, Jose, and Larson, 1998). Family difficulties, such as divorce, are also linked to children’s school learning and to their emerging self-concepts (Lansford, 2009). In the first year or two after a divorce, children from oneparent families frequently miss school, study less effectively, and disrupt their classrooms more often. Furthermore, teachers observe difficulties in their general social behavior, including their relationships with friends. Girls are seen to be more dependent, and boys are perceived as more aggressive and less able to maintain attention and effort at assigned tasks and, in general, to be less competent academically. One important context may compensate for difficulties in the other, as when family members provide support for school difficulties, or teachers and classmates help to buffer children’s distress over family problems. Parents’ involvement with schools and with children’s school-related tasks also is correlated positively with children’s school achievement. Parental involvement is variously defined as specific expectations of school performance, verbal encouragement, direct reinforcement of school-relevant behaviors, general academic guidance or support, and children’s perceptions of parents’ influence on school progress (Fehrmann, Keith, and Reimers, 1987). Correlations are less impressive in the secondary grades (usually, after age 12), perhaps because common forms of parental involvement at these ages are perceived as intrusions on autonomy. 99

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The most studied area of parental involvement in schooling is homework. Leone and Richards (1989) found that 11- and 12-year-old students in the top one-third of their classes spent significantly more time on homework, including time spent working with a parent on school assignments. Other studies have shown negative correlations, perhaps because parents are more likely to become involved in homework when children have not been doing well on their own. Even under these conditions, though, test scores generally improved when parents became involved, especially when parents have been trained in how best to help their children complete homework assignments (Miller and Kelley, 1991). Parental attitudes toward the importance of homework, like attitudes toward the importance of school achievement generally, vary cross-nationally. For example, parents in China, Japan, and Taiwan value school achievement more highly than U.S. parents do (Chen and Stevenson, 1989). Several factors influence the impact of parental involvement. One factor is parents’ general style of childrearing. Among authoritative parents (those who characteristically showed responsive, childcentered behavior and clear expectations for child behavior), involvement was highly correlated with academic achievement, in comparison to involvement of authoritarian (restrictive, parent-centered, controlling) parents. Likely, authoritative parents’ involvement is perceived as reflecting interest in and support for children’s school-related activities, whereas authoritarian parents’ involvement may be interpreted as intrusive, controlling, and implying disrespect and lack of trust for the child (Darling and Steinberg, 1993). Another significant socioeconomic factor is parents’ years of schooling (DavisKean, 2005; Magnuson, 2007).

After-School Care At the start of the twenty-first century, 78% of parents with children age 6–13 participated in the workforce. Because children spend only 6 hours each day in school, and these 6 hours frequently do not correspond to parents’ work schedules, large numbers of children are alone without immediate adult supervision for significant amounts of time (Capizzano, Tout, and Adams, 2000; Vandell and Shumow, 1999; Vandell, Simpkins, and Wegemer, 2019). Estimates put the number of children who spend unsupervised time at 3.6–4 million. After-school childcare arrangements vary by age of children, ethnicity, parents’ availability, and whether parents have traditional or nontraditional work hours. Parents’ and children’s reports offer discrepant views of typical after-school arrangements, with children reporting more time alone, less happiness with the arrangements, and whether the child actually adhered to the arrangement (Belle, 1999). Frequent changes occur in after-school arrangements, because of unsatisfactory arrangements, changing age, ability, and desires of the child, expense, perceived danger, degree of structure in the arrangements, and balancing children’s needs with familial or parental work needs. In the latter years of middle childhood (ages 10–12), many families from all ethnic and income groups begin a transition to letting children be on their own, rather than being supervised directly by an adult, during the after-school hours (Capizzano et al., 2000; Kerrebrock and Lewis, 1999;Vandell and Shumow, 1999). Few general differences in academic performance or psychosocial status are apparent when children in adult care arrangements are compared to those in self-care arrangements. Vandell and Corasaniti (1988) reported that 8- and 9-year-olds in center care showed lower academic achievement and lower acceptance by peers than children in other care arrangements, including mother care. Surprisingly, “latchkey” children—children who are at home alone after school—were not generally disadvantaged academically or socially relative to mother-care children. The reasons for the deficits observed in children cared for in centers are not clear. Negative effects are most likely when children on their own are not monitored regularly and when they are free to spend time away from home with peers (Galambos and Maggs, 1991; Steinberg, 1986; 100

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Vandell and Shumow, 1999).These arrangements are more common in the pre-adolescent years than the early elementary years. Older children are more susceptible to peer influences and more likely to engage in problem behaviors than children who stay at home and those who are in regular telephone contact with parents.The negative effects from being allowed to roam may result partly from generally less positive parent–child relationships. For girls particularly, permissive self-care arrangements are associated with lowered perceptions of parental acceptance and higher levels of parent– child conflicts (Galambos and Maggs, 1991). Among preadolescents and younger children alike, regular arrangements for parental monitoring and clear expectations for letting parents know where the child is seems to overcome the potential negative effects of self-care (Galambos and Maggs, 1991; Steinberg, 1986;Vandell and Corasaniti, 1988). By contrast, school-age childcare programs clearly benefit children’s development, compared to self-care. Although this conclusion may reflect the generally more positive developmental course of the middle-class children who participate, the greatest benefits come from programs that are well suited to the developmental level of the child, that offer flexible programs, and that feature a welleducated staff and low child-to-staff ratios (Vandell and Shumow, 1999). One study compared 11- to 13-year-olds who participated for 2 years in an after-school enrichment program with a comparable group of children who did not and found improved attitudes toward school, improved behavior at school, better grades, and less tension at home for participants in the after-school enrichment program (Huston et al., 2001). In summary, parents’ involvement in children’s lives away from home entails many of the same principles and processes that determine their effectiveness in direct interactions. Appropriate monitoring, in the context of warm, accepting relationships, is associated with positive school adjustment and academic achievement and with benign impact of self-care arrangements. Children with better relationships with their parents appear to be better able to understand the necessity for after-school care, even if it is not their preference (Belle, 1999). Although these areas of children’s lives require different forms of parental involvement, the general style of parents’ relationships with children is a key factor in the impact of out‑of‑home experiences on development during middle childhood.

Conclusions Parenting during middle childhood encompasses adaptation to distinctive transformations in human development that affect not only the current well-being of children, but carry significant implications for later life. The age of 5–7 years is universally regarded as the advent of “the age of reason” (Rogoff et al., 1975). In non‑Western cultures, children are assumed to develop new capabilities at this age and are often assigned expanded roles and responsibilities in their families and communities. Although the transition to adult‑like responsibilities is less pronounced in Western industrialized societies, 5- to 12-year-olds are expected to show greater autonomy and responsibility in some arenas. These issues are also discussed in Chen (2019). The unique experiences of individual children in middle childhood partly reflect changes experienced by virtually all children of this age and the interpersonal relationships and characteristics of particular communities and social institutions. Such factors as urban versus rural residence, family and domestic group status, parental and non-parental childcare arrangements, tasks typically assigned to children, and the role of women in the society all affect important dimensions of childhood socialization in both industrialized and developing countries. Common changes in children and in relationships have raised two key questions that underlie the framework outlined in the chapter. One is the question of whether parenting during middle childhood is distinctively different from parenting in other age periods. Although the particular forms of parental behavior and parent‑child interaction vary considerably, certain issues arise in virtually all families of 5- to 12-year-olds in industrialized societies: exercising regulatory influence while 101

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facilitating increasing self-regulation, maintaining positive bonds while fostering a distinctive sense of self, and providing groundwork for effective relationships and experiences outside of the family (Collins, 1995; Collins et al., 2012). These issues are integral to parent‑child relationships from birth, although often in less obtrusive or more rudimentary forms than in middle childhood, and they remain central in the adolescent years and, to a lesser degree, in early adulthood (White, Speisman, and Costos, 1983). The distinctiveness of parenting 5- to 12-year-olds largely arises from the relative novelty and salience of issues specific to this age period. Middle childhood is a period of intensifying transitions, many of which require parents to extend their activities on behalf of the child to interactions with others, including teachers, peers, and other families. In addition, behaviors of children toward parents change, as the result of cognitive, emotional, and social transitions. Consequently, both the scope of the issues and the methods available for addressing them are altered in middle childhood. Influential models of socialization imply that the most effective parental responses to changes in children’s behavior combine child‑centered flexibility and adherence to core values and expectancies for approved behavior (Barber et al., 2005). This combination may be more complex in middle childhood than in other periods. Furthermore, the balance between assuring continuity and adapting to child‑driven change may be more difficult to maintain in and after middle childhood than in early childhood. The capacity for age‑appropriate adaptation, however, likely is not exclusive to effective parenting in this period, but is inherent in the characteristics of effective parenting at every age. Barber et al. (2005) are among the few authors who show the relevance of prevailing models across diverse cultural groups. One question that is not directly addressed in this chapter concerns the linkages between parenting and individual development during middle childhood and in later periods.These associations are more often implicit than explicit. Nevertheless, research findings have documented some key connections. The most extensively replicated finding is that parenting styles marked by authoritativeness toward children, but clearly child‑centered attitudes and concerns, are correlated with a variety of positive outcomes that attain salience in middle childhood and that are predictive of successful adaptation in later life. These beneficial outcomes include peer acceptance, school success, competence in self‑care, and competence and responsibility in a broad array of tasks. Equally well established is the finding that parenting attitudes and behaviors dominated by parental concerns, rather than child characteristics and needs, are associated with less positive outcomes on all of these variables.The latter must be regarded as middle‑childhood risk factors for long‑term dysfunction. A caveat is that studies do not tell us whether experiencing negative conditions for the first time in middle childhood affects later development differently in either kind or degree than experiencing parenting problems over a longer period. Nevertheless, the documented consequences of these negative conditions for 5- to 12-year-olds leave little doubt that effective parenting powerfully affects development both during and after middle childhood.

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4 PARENTING ADOLESCENTS Bart Soenens, Maarten Vansteenkiste, and Wim Beyers

Introduction Adolescence is a developmental period with a reputation. Much like toddlerhood, it is often described as a period of vehement conflicts with parents, emotional upheaval, and irrational behavior. Such alarming portrayals of adolescence were common in early developmental research on adolescence (Hall, 1904; A. Freud, 1958), and they continue to remain prominent in contemporary popular scientific literature. Although the modern developmental science of adolescence paints a much more nuanced picture of this developmental period (Steinberg, 2014), the notion that adolescence is a time of perturbation is deeply entrenched in lay beliefs. When parental beliefs about adolescence are misguided or exaggerated, they can be harmful. Parental expectations can function as a self-fulfilling prophecy, with parents who anticipate “storm and stress” being more likely to interact with their child in a way that actually contributes to strained parent–child relationships (Laursen and Collins, 2009). Conversely, parents with more balanced or benign beliefs about adolescence may interact in a more relaxed and supportive fashion with their child. Given that stereotypes about adolescence persist and affect the quality of parent–adolescent interactions, a first aim of this chapter is to provide a state-of the-art overview of developmental changes in parent–adolescent relationships, thereby separating myths from facts. Although many stereotypes about adolescents’ functioning and parent–adolescent relationships are unwarranted, adolescence represents a key developmental period in life characterized by multidimensional and multidirectional change in various domains of functioning. As such, adolescents face new and unique developmental tasks, and parents have an important role in navigating their adolescent through these challenges. Parents generally hold the belief that they have an important impact on their adolescent’s development (Worthman, Tomlinson, and Rotheram-Borus, 2016), and research confirms that parenting indeed continues to affect adolescents’ psychosocial adjustment (Collins, Maccoby, Steinberg, Hetherington, and Bornstein, 2000). To understand exactly how parenting is related to adolescents’ development, there is a need for a clear and comprehensive framework delineating key dimensions of parenting with relevance in adolescence. Unfortunately, the complexity of the developmental issues adolescents and their parents are confronted with is mirrored in the complexity of the literature on parenting during adolescence.Therefore, the second section in this chapter aims to bring clarity to the socialization literature by proposing a theoretically well-grounded and empirically supported model of parenting dimensions. The parenting dimensions identified in this model are related to important developmental outcomes in adolescents, and the processes involved are discussed.

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Of course, parenting adolescents is not a one-way street. By the time individuals reach adolescence, their personality has been shaped to a large extent and they have developed characteristic ways of processing information and relating to others (Klimstra, Hale, Raaijmakers, Branje, and Meeus, 2009). As a result, adolescents are not merely passive recipients of parental behavior but are active agents in the process of socialization (Kuczynski and De Mol, 2015). Adolescents differ in the meanings they attribute to parental behaviors and in the ways they respond to parental requests. Also, adolescents reflect in increasingly differentiated ways about the legitimacy of parental authority (Smetana, 1995). The third section of this chapter addresses this agentic role of adolescents in interactions with parents, discussing the transactional and dynamic interplay between parents and adolescents.

Changes and Challenges in Parent–Adolescent Relationships The onset of puberty involves various physiological changes (e.g., ovarian and testicular hormone secretions) and physical changes (e.g., the growth spurt and appearance of secondary sexual characteristics) that mark the beginning of adolescence as a chronological phase in human life. These biological changes come with a cascade of developmental changes, many of which have repercussions for parent–adolescent relationships (Dahl, 2004; Paikoff and Brooks-Gunn, 1991). Some of these changes influence the parent–adolescent relationship directly, with the biological changes of puberty, for instance, being an important topic of discussion in parent–adolescent conversations. Other changes have a more indirect influence, affecting parent–adolescent relationships through psychological and social processes associated with puberty, such as increased emotionality and a stronger orientation toward peers. Irrespective of whether effects of puberty on parent–adolescent relationships are direct or indirect, they usually have an impact on the family system as a whole (Beveridge and Berg, 2007; Granic, Hollenstein, Dishion, and Patterson, 2003; Kerig, 2019; Laursen and Collins, 2009). That is, these changes have an effect not only on the individual partners in the parent–adolescent relationship but also on the very nature of the relationship itself and in many cases even on relationships between family members in which the pubescent child is not directly involved, such as the marital relationship and relationships between parents and younger siblings. Thus, with the advent of puberty, the family system is dynamically shifting, and there is a reorganization and recalibration of all relationships within the family.

Direct Impact of Puberty on Parent–Adolescent Relationships Illustrative of the systemic impact of puberty on family functioning is the way parents and adolescents discuss puberty-related changes and experiences. Some adolescents are open about these puberty-related events, disclosing freely the changes they encounter and relying on their parents for advice, information, and comfort. Other adolescents are more secretive and less likely to confide in parents about the changes they are going through (Brooks-Gunn and Ruble, 1982).Younger adolescents tend to be more secretive about their puberty-related experiences than older adolescents, with girls being more open about these changes (particularly toward their mothers) than boys (Paikoff and Brooks-Gunn, 1991). This gender difference is consistent with girls’ general inclination to communicate more about personal experiences with parents (Racz and McMahon, 2011; Youniss and Smollar, 1985). Also, pubertal changes in girls (e.g., breast growth and menarche) are more visible and more difficult to hide than changes in boys (e.g., testicular growth and spermarche). In spite of these gender differences, there is much variation also among girls in the degree of reluctance or at least ambivalence they experience to talk about these issues, especially in early adolescence (BrooksGunn and Ruble, 1982).

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Parents themselves also differ in their direct response to pubertal processes and to adolescents’ disclosure or secrecy about puberty. Some parents respond with sensitivity and provide accurate information and support, but other parents feel uncomfortable discussing these themes or have a difficult time accepting their child’s lack of disclosure (Paikoff and Brooks-Gunn, 1991). The way parents communicate with their child during puberty, in turn, affects the degree to which puberty contributes to strained parent–adolescent relationships and adolescent problem behaviors. When parents communicate with adolescents in a supportive way, elevated levels of testosterone (in both boys and girls) are unrelated to problem behavior (Ge et al., 2002). In contrast, low-quality parental communication during early adolescence amplifies the risks associated with puberty, including vulnerability to both emotional distress (e.g., depressive symptoms) and risky behavior (e.g., truancy and alcohol use; Booth, Johnson, Granger, Crouter, and McHale, 2003). Among some parents, the child’s puberty also awakens midlife concerns, including concerns about their own declining health and fitness, physical attractiveness, and sexual appeal (Steinberg and Silverberg, 1987). While the child is maturing, making plans for the future, and displaying increased interest in sexual relationships, some parents (particularly mothers) become painfully aware of their age and of the more limited time still ahead of them. Thus, the child’s puberty can be reason for parents to reassess their own identity. Parents who struggle with these midlife concerns and who have a difficult time coming to terms with the identity-related challenges of middle adulthood display more ill-being and lower marital quality (Silverberg and Steinberg, 1990). To summarize, pubertal changes can represent either a topic of constructive conversation strengthening the parent–child bond or a taboo subject contributing to distance and alienation in parent–child relationships and even adolescent maladjustment. These changes can also elicit existential concerns in parents, with these concerns ultimately affecting parents’ mental health and marital quality. In addition to being directly relevant for parent–child relationships and family dynamics, puberty brings about numerous emotional and social changes that have an impact on parent–child relationships. In the remainder of this first section, we focus on four important sets of changes: emotional development, parent–child conflict, peer orientation, and independence.

Emotional Development Developmental Changes In stereotypical portrayals of (early) adolescence as a period of emotional upheaval, adolescents are said to be moodier, that is to experience more negative and fewer positive emotions compared to younger children, as well as to be on a rollercoaster of emotions, with positive and negative emotions oscillating quickly on a moment-to-moment basis. The transition into adolescence indeed marks a decrease in positive emotions and an increase in negative emotions (Larson and Lampman-Petraitis, 1989). However, these changes level out between middle and late adolescence (particularly among girls), and individuals return to pre-adolescent levels of happiness during late adolescence (Holsen, Kraft, and Vittersø, 2000). In addition to (early) adolescents’ tendency to experience more overall moodiness, adolescents’ emotional functioning is more variable, with adolescents displaying more pronounced emotional fluctuation from day to day (Maciejewski, Lier, Branje, Meeus, and Koot, 2015) and even from moment to moment (Larson, Moneta, Richards, and Wilson, 2002). Together with these changes in the quality and variability of adolescents’ mood, adolescents undergo changes in the capacity for emotion regulation (Silk, Steinberg, and Morris, 2003). Although the ability to regulate emotions improves throughout childhood and into adolescence, the capacity for emotion regulation is still more limited in adolescence compared to adulthood (Labouvie-Vief, DeVoe, and Bulka, 1989; Zimmermann and Iwanski, 2014).

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Adolescents’ heightened emotionality and limited capacity for emotion regulation can be explained by a combination of neurobiological processes (e.g., hormonal changes and structural brain development; Luciana, 2013) and social influences (e.g., an increase in stressful life events; Ge, Conger, and Elder, 2001). At the neurophysiological level, the production of reproductive hormones and cooccurring activation of neuroendocrine systems (mainly the secretion of cortisol in the hypothalamuspituitary-adrenal axis) plays a role in adolescents’ heightened sensitivity to negative emotions (Forbes and Dahl, 2010).Throughout adolescence, there are also important changes in brain structure and function (Somerville, Jones, and Casey, 2010). Increased activation in limbic structures (such as the amygdala and hypothalamus), with a peak in middle adolescence, causes heightened reward sensitivity. At the same time, the prefrontal cortex, which serves to regulate affective-motivational impulses originating in subcortical areas, is maturing (through synaptic pruning and myelinization) only gradually and at a slow, linear pace throughout adolescence.The different timing and pace of development in these brain regions cause a temporary imbalance between bottom-up motivational and emotional impulses and top-down regulation of these impulses (Casey, Jones, and Hare, 2008). To use a metaphor, it is as if the teenage brain is hitting the gas while the brake is in repair (Casey, Jones, and Somerville, 2011). This imbalance between affective-motivational processing and inhibitory control is said to be responsible for the limited capacities for emotion regulation in adolescence and during middle adolescence in particular. Connections between subcortical areas responsible for affective processing and prefrontal areas responsible for cognitive regulation and inhibitory control (e.g., the ventromedial prefrontal cortex) continue to develop even during late adolescence (Spear, 2000). Due to these neurobiological changes, there is room for improvement in capacities for emotion regulation well into the later phases of adolescence. At the same time, adolescents’ still somewhat limited capacity for emotion regulation is challenged by social stress. Adolescents are confronted with a variety of stressors, including increased demands for maturity, higher expectations for academic achievement, a transition to larger schools (with fewer opportunities for close teacher-student relationships), and more intense peer interactions (Eccles et al., 1993).

Implications for Parents Whatever the sources of adolescents’ heightened emotionality and difficulties regulating emotions, parents are affected both directly and indirectly. Parents and adolescents influence each other directly and reciprocally via a process of emotional contagion. A vicious cycle of negative emotions exists both in the long term (for instance with intervals of 6 months or more between measurement points; Hughes and Gullone, 2008) and in the short term, with diary studies showing associations between adolescents’ and parents’ daily display of negative emotions (Larson and Almeida, 1999). Parents’ and adolescents’ proneness to depressive symptoms has also been shown to covary across time in clinically depressed adolescents, with research showing that adolescents may also affect their parents’ emotions in a more positive way (Perloe, Esposito-Smythers, Curby, and Renshaw, 2014). As adolescents’ symptom severity decreases throughout treatment, mothers’ depressive symptoms decline in tandem, showing that mothers themselves also benefit from their adolescent’s treatment. Long-term reciprocal affective influences have been documented primarily in mother-son dyads and in father-daughter dyads, with pubertal timing also playing a role in these reciprocal processes (Ge, Conger, Lorenz, Shanahan, and Elder, 1995). Daughters’ negative affect was most strongly predictive of fathers’ distress when daughters were maturing early. Daughters’ early puberty and accompanying emotionality may be particularly worrisome for fathers because fathers are concerned about the consequences of their daughters’ premature sexuality and romantic involvement, issues they feel more uncomfortable discussing with their daughters (Paikoff and Brooks-Gunn, 1991). Adolescents’ emotions also affect parents in an indirect fashion, with heightened intensity and lability of emotions increasing the odds of conflicted parent–adolescent interactions, which, in turn, 114

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impact on parents’ mental health, quality of parenting, and even marital quality. These processes are interrelated in a dynamic and complex fashion, with (low) marital quality for instance being both an antecedent and outcome of emotionally troubled and conflicted parent–adolescent interactions (Hughes and Gullone, 2008). In addition to being influenced by their adolescents’ emotions, parents themselves contribute to adolescents’ emerging emotional competence, that is, adolescents’ capacity to adequately handle emotions. Parents do so through at least three different pathways (Morris, Silk, Steinberg, Myers, and Robinson, 2007; Morris, Criss, Silk, and Houltberg, 2017). First, through the expression of their own emotions and their own style of dealing with emotions, parents serve as direct role models for adolescents’ emotion regulation (Bariola, Gullone, and Hughes, 2011). By witnessing their parents’ expression and modulation of emotions, adolescents receive implicit or explicit messages about appropriate and common ways of handling emotion-laden situations. Consistent with principles of social learning, adolescents of parents displaying emotion regulation difficulties report more problems in adequately regulating emotions themselves, with these problems in turn forecasting both internalizing and externalizing problem behaviors (Buckholdt, Parra, and Jobe-Shields, 2014). A second source of influence is parents’ attitude toward emotions and their corresponding attempts to coach adolescents’ emotion regulation. When parents think of emotions as interesting and informational signals that provide opportunities to grow and to build intimate relationships (i.e., an emotion-coaching philosophy), parents are more inclined to engage in adequate emotion coaching (Gottman, Katz, and Hooven, 1996).That is, parents with an emotion-coaching philosophy actively attend to their own emotions and their child’s emotions, thereby taking an accepting stance and providing adequate advice for dealing with emotions in future situations.This emotion-coaching approach can be contrasted with an emotion-dismissing approach, where parents ignore, minimize, or even invalidate and criticize children’s display and regulation of emotions (Gottman et al., 1996). Although parental emotion coaching has been examined mainly among younger children, studies indicate that parental emotion coaching is also beneficial for adolescents’ emotional development, personal well-being, and resilience against distress and behavioral problems (Katz and Hunter, 2007; Shortt, Stoolmiller, Smith-Shine, Eddy, and Sheeber, 2010; Yap, Allen, Leve, and Katz, 2008). Moreover, parental emotion coaching contributes to the quality of parent–adolescent relationships, with the likelihood of escalating emotional parent–adolescent exchanges decreasing when parents recognize and accept adolescents’ negative emotions during interactions (Katz and Hunter, 2007). Acceptance of the adolescent’s emotions appears to be particularly important in this regard (relative to, for instance, active advice about problem solving). Compared to younger children, adolescents may need less direct parental advice but may, instead, want parents simply to be available and to serve as a “mirror” reflecting the adolescent’s feelings. Conversely, also among adolescents an emotion-dismissing parental orientation is associated with deficits in adolescent emotion regulation and problem behaviors (Buckholdt et al., 2014; Yap, Allen, and Ladouceur, 2008). The critical role of parental emotion coaching in adolescents’ development was demonstrated also in interventionbased research, which found that a training to improve parents’ ability to respond to adolescents’ emotions in an accepting manner led to decreased emotional problems in adolescents (Kehoe, Havighurst, and Harley, 2014). A third, somewhat more distal, route through which parents can influence adolescents’ emotion regulation is through the general quality of their parenting style (Morris et al., 2007). The role of general parenting style is discussed in greater detail in the second part of this chapter. It suffices here to say that parents’ general style of communicating with their adolescent (also in domains other than emotions and feelings) determines the emotional climate in the family and, in doing so, yields repercussions for adolescents’ emotional experiences at home (Darling and Steinberg, 1993). Also, parents’ general parenting style contributes to the development of several resources required for adequate regulation of emotions, such as mentalizing capacities (i.e., the ability to understand and reflect on 115

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one’s own and other people’s mental states and feelings) and the establishment of a positive and secure sense of self-worth (Morris et al., 2007). To summarize, compared to younger children, adolescents are more prone to experience negative emotions and to display emotional lability, particularly in early adolescence. This heightened emotionality represents a challenge to parent–adolescent relationships and to parents’ own well-being. Although adolescents have begun to develop more independent and sophisticated emotion regulation strategies, their capacity for emotion regulation is far from complete. Parents still have important roles to play, both as role models and as active coaches of their adolescent’s response to emotionally charged episodes.The changes in emotional development taking place in adolescence have repercussions for the quality of parent–adolescent relationships, including the occurrence of conflict, a theme discussed in greater detail next.

Parent–Adolescent Conflict The widespread notion that parent–adolescent relationships are deeply troubled and conflict-ridden has a long history and is rooted in several theories, including classic psychoanalysis and evolutionary models of adolescent development (Laursen and Collins, 2009). Considered from a Freudian perspective, puberty marks a resurgence of sexual and aggressive drives that were relatively silent during middle childhood (i.e., the latency phase of psychosexual development).The energy and urges released by these biological drives create increased potential for inner conflict (i.e., between immediate gratification of needs and the internalized social demands of the super-ego) and for conflict with the outer world and with family members in particular (S. Freud, 1905/1962). Similarly, evolutionary accounts of adolescence assume that conflict plays an adaptive role in separating adolescents from parents, thereby launching adolescents into the broader social world (Laursen and Collins, 2009). As such, conflict would be functionally adaptive to create opportunities for independent survival and sexual reproduction. These strong claims about normative and puberty-driven increases in high-intensity parent–child conflicts during (early) adolescence do not stand the test of contemporaneous research on adolescent development. A meta-analysis by Laursen, Coy, and Collins (1998) showed that the frequency of conflicts between parents and children increases from pre-adolescence to early adolescence and peaks between the ages of 10 and 14 years (see also McGue, Elkins, Walden, and Iacono, 2005). However, conflict frequency does not increase further between early adolescence and middle adolescence and even decreases slightly. Still, the emotional intensity of conflict is elevated during middle adolescence (Laursen et al., 1998). Although parent–child conflicts become somewhat less prevalent, middle adolescents suffer more from these conflicts emotionally. In terms of content, it is more apt to describe parent–adolescent conflicts as temporary disagreements rather than as fundamental and enduring differences of opinion (Adams and Laursen, 2001; Steinberg and Silk, 2002). Most disagreements revolve around mundane issues, such as chores, homework, and family rules, rather than ideological issues (Smetana, 1989). The content of these disagreements is relatively stable across adolescence. An exception is the issue of homework, which is more prevalent in early adolescence, when children typically transition to new school settings and are confronted with increasing expectations for academic achievement. Contrary to lay beliefs and to early developmental theories on the role of puberty in parent– adolescent conflicts, pubertal status is associated with conflict only weakly (Steinberg, 1988). Chronological age appears to be a more robust predictor of conflict than pubertal maturation (Laursen et al., 1998). As such, rather than being primarily biologically determined, increases in conflict seem to be mainly a consequence of changing social expectations (e.g., demands for maturity) and social roles (e.g., more time spent with peers). Further highlighting the limited role of puberty in parent–adolescent conflicts is the fact that the timing and course of conflicts depends also on children’s birth order (Shanahan, McHale, Osgood, 116

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and Crouter, 2007). Firstborn children experience a peak in conflict frequency in early adolescence (around the age of 12–14 years), whereas their laterborn siblings display this peak earlier, that is, toward the end of middle childhood (around the age of 9–11 years). One explanation for this phenomenon is that there is spillover from conflicts occurring between older siblings and parents to conflicts occurring between younger siblings and their parents. Such spillover may occur simply through witnessing older siblings’ engagement in conflict or through active attempts by younger siblings to intervene in the older siblings’ conflicts with parents. In addition to this spillover mechanism, parents and children seem to learn from experience. Laterborn children’s conflicts with parents wane more quickly than firstborn children’s conflicts, suggesting that experience with the firstborn children’s conflicts strengthens parents’ expertise in dealing more effectively with conflicts with laterborn children (Shanahan et al., 2007). These within-family differences in the timing of conflict testify to the complexity of factors involved in puberty-related influences on parent–child relationships. Specifically, these differences underscore that changes in adolescence do not only occur at the level of individual parent–child relationships but also need to be understood in the context of the family as a whole. Apart from changes in the frequency and intensity of conflicts, parent–adolescent relationships also witness fluctuations between harmonious and more troubled episodes (Granic et al., 2003). Particularly during the transition into adolescence, when parents and children face a pile-up of developmental changes, parents and adolescents oscillate quickly between positive (e.g., humorous, affectionate) and negative (e.g., conflictual, hostile) interactions.This interactional variability subsides by mid-adolescence, when parent–adolescent relationships return to more steady and predictable patterns of interaction (Granic et al., 2003). Early adolescence in particular is a period of reorganization where parents and adolescents establish new modes of interaction through trial and error. This variability in conflictual episodes, and the ups and downs in emotions associated with it, are assumed to be normative during early adolescence and to play an adaptive role in the renegotiation of parent–adolescent relationships (Granic, 2005). Conversely, a lack of variability in emotions displayed during conflicts may indicate a lack of openness and flexibility among family members to express and regulate emotions during conflicts. Consistent with these assumptions, adolescents expressing lower variability in conflict-related emotions in mother-child interactions during early adolescence are at higher risk for aggression and internalizing distress in the later phases of adolescence (Van der Giessen et al., 2015). Adolescents experiencing a richer and fuller repertoire of emotions during parent–child conflicts in early adolescence seem to be armed better to cope effectively with emotions and challenges later in adolescence. The finding that a lack of emotional variability during conflicts is associated with problem behaviors further underscores the importance of opportunities for emotional expressiveness in the family. As discussed above, a family climate characterized by openness and flexibility is of key importance for adaptive emotional development. To summarize, although early adolescence is a period of heightened conflict frequency in parent– adolescent relationships, the intensity and long-term impact of these conflicts should not be overstated. In most families, conflicts deal with everyday topics and do not signal an enduring deterioration of the parent–adolescent relationship. When parents and adolescents are emotionally expressive during conflicts, these episodes may even contribute to adolescents’ capacities for emotion regulation and may ultimately strengthen the parent–adolescent bond.

Heightened Orientation Toward Peers Developmental Changes Toward the end of middle childhood and in early adolescence, children begin to spend substantially more time with peers and friends (Berndt, 1982; Larson and Richards, 1991; Richards, Crowe, 117

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Larson, and Swarr, 1998). This increased orientation to peers coincides with a decrease in time spent with parents (Larson, Richards, Moneta, Holmbeck, and Duckett, 1996) and with decreased sharing of information with parents (Keijsers and Poulin, 2013). Adolescents turn more frequently to peers to disclose personal experiences and rely more often on peers for support and advice. Due to the more central role of peers in adolescents’ social life, experiences with peers more strongly affect children’s self-evaluation than in earlier developmental periods, with experiences of peer approval contributing to self-esteem and with experiences of exclusion or even victimization strongly undermining confidence and well-being (Sebastian,Viding, Williams, and Blakemore, 2010). Adolescents are very sensitive to feedback and social cues encountered in interactions with peers and friends, a hypersensitivity rooted to some extent in the neurobiological changes characteristic of adolescence (Blakemore and Mills, 2014). Experimental research demonstrates that the presence of peers recruits neural circuits and brain areas involved in sensitivity to rewards, such as the ventral striatum and orbitofrontal cortex, and does so more strongly among adolescents than among adults (Albert, Chein, and Steinberg, 2013; Smith, Steinberg, Strang, and Chein, 2015). Similarly, adolescents have been shown to take more risks in experimental games when observed by peers (Gardner and Steinberg, 2005), an effect associated with increased activation of reward-related brain regions (Chein, Albert, O’Brien, Uckert, and Steinberg, 2011).

Implications for Parents For quite a long time, this orientation toward peers and its accompanying impact on self-evaluation and problem behavior has been considered from a risk perspective, with research focusing on themes such as peer pressure and susceptibility to deviant peer affiliation (Steinberg and Monahan, 2007). Consistent with this risk perspective, adolescents’ affiliation with peers represents a source of concern for many parents, who worry about negative peer influence and about risky behavior in the company of friends (Bogenschneider, Wu, Raffaelli, and Tsay, 1998). Adolescents’ peer orientation may also be perceived as a threat to the parent–child bond itself. Particularly parents high on separation anxiety report heightened feelings of distress when discussing peer-related issues with their adolescent, indicating that these parents are strongly concerned about their adolescent’s increasing independence (Wuyts, Soenens,Vansteenkiste,Van Petegem, and Brenning, 2017). Adolescents’ orientation toward peers also poses challenges to parents’ desire to know about their adolescent’s whereabouts and activities (Crouter and Head, 2002). During adolescence, it becomes more difficult for parents to stay aware of their child’s whereabouts because direct and proximal modes of information gathering (such as direct supervision) can be applied less often (Laird, Criss, Pettit, Bates, and Dodge, 2009).These difficulties are exacerbated by the fact that adolescents increasingly seek contact with peers and friends in the virtual world (e.g., in multiplayer games and social media) and by the fact that adolescents disclose information about themselves on digital fora (Liu, Ang, and Lwin, 2013). As a result, parents need to resort to more distal channels to stay informed, such as solicitation of information from adolescents or conversations with other adults, such as teachers and neighbors (Waizenhofer, Buchanan, and Jackson-Newsom, 2004). There is increasing recognition, however, that peer relationships not only represent a risk for problem behavior but also contribute to adolescent development in many positive ways (Brown, 2004). Peers can serve as role models for desirable behavior, such as high educational aspirations and prosocial behavior. Only when adolescents develop an extreme peer orientation, at the expense of school engagement and high-quality relationships with parents, do peers represent a threat to parent– child relationships and to healthy psychosocial development (Fuligni, Eccles, Barber, and Clements, 2001). With this more balanced perspective on the role of peers, research has begun to show that the relative influences of parents and peers on adolescent development are not a zero-sum game (Laursen 118

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and Collins, 2009). That is, the contribution of parents and peers to adolescent development is not simply additive. Instead, parents and peers each have unique roles, being primarily involved in somewhat different life domains, with peers being highly influential in areas such as lifestyle (e.g., clothing and music preferences) and with parents remaining important sources of influence in the academic domain. Further, there are complex interactions between parents’ and peers’ contributions, with parents affecting the degree to which either the adaptive potential or the risks associated with peer involvement become prominent (Henry, Tolan, and Gorman-Smith, 2001; Kerr, Stattin, Biesecker, and Ferrer-Wreder, 2003). Mounts and Steinberg (1995), for instance, showed that adolescents reared by authoritative parents (i.e., parents combining clear rule setting with high levels of warmth) were more susceptible to the positive effects of having high-achieving friends on adolescents’ own academic achievement. At the same time, these adolescents were more resilient to adverse effects of affiliation with drug-using friends on adolescents’ own substance use. According to Mounts and Steinberg (1995), authoritative parents provide adolescents with a set of internalized rules for conduct that allow them to reap the benefits of peer relationships while at the same time being armed better against detrimental peer influences. Given that parents and peers represent interconnected (rather than isolated and mutually exclusive) contextual sources of influence, an important question is exactly how parents affect peer relationships. Much like parents are involved in adolescents’ emotion regulation through a variety of direct and indirect pathways, parents affect adolescents’ peer relationships both directly and indirectly (Brown and Bakken, 2011; Ladd and Pettit, 2002). Indirectly, parents’ general parenting style fosters competence in relationships with peers and romantic partners by contributing to intervening processes such as positive expectations and beliefs about peer interactions and constructive problem-solving skills (Allen, Moore, Kuperminc, and Bell, 1998; Dekovic and Meeus, 1997; Zimmer-Gembeck,Van Petegem, Ducat, Clear, and Mastro, 2018). In addition, parents can be involved in adolescents’ peer relationships in more direct ways, thereby managing and coaching adolescents’ social relationships through proximal strategies (Mounts, 2002; Tilton-Weaver and Galambos, 2003). Mounts (2002, 2007) developed a model of parental peer management strategies, distinguishing between consulting strategies (i.e., offering help with problem solving and encouraging activities with peers) and mediating strategies (i.e., guiding an adolescent’s selection of friendships). Associations between these peer management strategies and adolescents’ social adjustment are complex, with consulting strategies yielding small and somewhat inconsistent relationships with social and behavioral outcomes and with mediating strategies typically being related negatively to social competence and adaptive behavior (Mounts, 2001, 2002, 2007; Soenens, Vansteenkiste, Smits, Lowet, and Goossens, 2007). Prohibiting friendships in particular is related to maladaptive outcomes, such as affiliation with deviant peers and delinquency (Keijsers et al., 2012; Soenens,Vansteenkiste, and Niemiec, 2009). Given that associations between parental peer management strategies and adolescent outcomes are not straightforward, research has focused on both contextual and personal characteristics that may influence the effectiveness of parental involvement in adolescents’ social relationships. When adolescents face a transition necessitating the formation of new peer relationships and friendships (e.g., because the family moves to a new community), they seem to benefit from certain forms of parental peer management.Vernberg, Beery, Ewell, and Absender (1993) found that parents’ facilitation of adolescents’ formation of new friendships after relocation to a new school district was related positively to better quality of adolescent friendships. Parents’ capacity to enable proximity with peers in particular (e.g., allowing friends to sleep over and letting the adolescent go out with friends) was beneficial to adolescents’ social adjustment in this period of transition. In such periods of transition, adolescents are perhaps more likely to actively solicit parental guidance because they feel that they need parental assistance and, therefore, to experience their parents’ involvement as self-chosen rather than as meddlesome and inappropriate. 119

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Another contextual factor determining the role of parental peer management is the general quality of parents’ rearing style. Mounts (2002) demonstrated that parental mediation is particularly detrimental (i.e., related to increased drug use) when parents are generally uninvolved. Uninvolved parents are more likely to engage in peer management in a reactive fashion, that is when adolescents are already involved in problems. Because these parents have little legitimate authority overall, adolescents are less likely to accept such reactive parental involvement and may oppose against it by engaging in even more problematic behavior. Conversely, adolescents are more receptive to parents’ social coaching within a generally warm and positive parenting emotional climate (Gregson, Erath, Pettit, and Tu, 2015). In addition to these contextual influences on the effectiveness of parental peer management, adolescents’ personal characteristics also play a role. Tu, Erath, and El-Sheikh (2017) found that adolescents with low ability for behavioral and emotional self-regulation (as indexed by low autonomic nervous system activity) benefited from parental involvement in peer management. Among these adolescents, parental mediation of friendships predicted decreased affiliation with deviant friends and peer rejection. Thus, parents’ peer management is most effective among adolescents who lack the skills to make wise friendship choices themselves and among adolescents who are most sensitive to the temptations presented by deviant peers. These findings illustrate that adolescents most in need of guidance in the social realm benefit the most from parental coaching and involvement in peer relationships. To summarize, parents and peers do not constitute disconnected parts of adolescents’ social world. Instead, they represent dynamically intertwined parts of adolescents’ social environment (Bornstein, Jager, and Steinberg, 2012). Parents stay involved in adolescents’ peer relationships in both indirect and direct ways. While parents can yield an indirect influence through their more general childrearing style, they can also intervene more directly, for instance through their peer management strategies. A key issue in parents’ degree and style of involvement in peer relationships is undoubtedly whether parents accept adolescents’ increasing distance taking and independence, an issue we turn to next.

Distance Taking and Independence Developmental Changes Adolescents’ inclination to gravitate toward peers is part of a more general tendency to strive for more independence from parents (Fuligni and Eccles, 1993). For quite a long time, this search for independence has been described in terms of processes of parent–child separation and distance taking. Inspired by classic psychoanalytic theory (A. Freud, 1958) and separation-individuation theory in particular (Blos, 1979), it was maintained that a normative developmental task for adolescents is to relinquish childish dependencies on parents to achieve more independence. This process of distance taking was thought to be temporarily painful yet inevitable in the service of establishing a mature level of independence as well as to realize an individuated identity. Particularly in early adolescence, adolescents would need to disengage from parents to explore the social world, to affiliate with peers, and to develop a healthy sense of self (Steinberg and Silverberg, 1986). In accordance with separation-individuation theory, adolescents increasingly deidealize parents and strive for non-dependency, with these changes occurring mainly between early and middle adolescence (Beyers, 2001; Chang, McBride-Chang, Stewart, and Au, 2003; Steinberg and Silverberg, 1986). Around the same time, the degree of closeness and support experienced in parent–adolescent relationships dips (De Goede, Branje, and Meeus, 2009; McGue et al., 2005), followed by a tendency by parents to gradually relinquish regulation of adolescents’ behavior from middle adolescence onwards (Keijsers and Poulin, 2013). Together, these developmental changes point to increased separation and distance taking during early and middle adolescence. 120

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Although adolescents increasingly take distance from parents, the field has now moved away from the view that disengagement and separation are sufficient or even essential conditions for healthy development of autonomy and psychosocial adjustment. An important reason for this change of view is the observation that high scores on measures for parent–adolescent separation [such as Steinberg and Silverberg’s 1986 Emotional Autonomy Scale (EAS)] do not necessarily forecast healthy independence (as anticipated on the basis of separation-individuation theory) nor adolescent adjustment. Using the EAS, Steinberg and Silverberg (1986) found that separation was related negatively (rather than positively) to adolescent self-reliance. Other studies found inconsistent associations between separation and self-reliance (Beyers and Goossens, 1999). Thus, although adolescents typically display some distancing toward parents in early to middle adolescence, adolescents who do so more than others are not necessarily better able to become self-reliant and to develop a healthy sense of independence. Further questioning the adaptive role of parent–adolescent distancing, some studies have shown that adolescents who deidealize parents and who separate from parents are at increased risk for problems, including internal distress, deviant behavior, and lower school grades (Beyers and Goossens, 1999). Other studies have shown that separation is unrelated to problematic development (Jager,Yuen, Putnick, Hendricks, and Bornstein, 2015), but few studies have demonstrated a systematic protective role of parent–adolescent separation against maladjustment, let alone a positive role of separation in fostering well-being. To explain the potential risks associated with adolescent distance taking, it has been argued and shown that a stronger-than-average tendency to disengage from parents is often rooted in lowquality parent–adolescent relationships (Fuhrman and Holmbeck, 1995; Ryan and Lynch, 1989). Disengagement then represents a coping response to deal with insecure parent–adolescent relationships. Although distance taking may be a natural response to such relationships, it does not guarantee that adolescents develop a capacity to take independent decisions and, even more, it may diminish the odds that adolescents will begin to rely on their own internal resources (Van Petegem,Vansteenkiste, Soenens, Beyers, and Aelterman, 2015).

Boundary Conditions of Successful Independence These findings about the potentially detrimental role of parent–adolescent distance taking have led to more nuanced views of adolescent independence. It is now generally acknowledged that independence ideally develops within the context of ongoing relatedness with parents (Cooper and Grotevant, 2011; Grotevant and Cooper, 1986; Lamborn and Steinberg, 1993; Youniss and Smollar, 1985). When disconnected from parent–adolescent relatedness, adolescent independence is largely unrelated to healthy psychosocial development or even predictive of problematic outcomes. Adolescents who engage in unilateral decision-making, thereby making decisions fully independently and without consulting with parents, are more at risk for delinquency and rule-breaking behavior (Dornbusch et al., 1985; Lamborn, Dornbusch, and Steinberg, 1996). To avoid such unilateral decision-making, strivings for independence need to happen against the background of a warm and trusting relationship with parents. Research on observed parent–adolescent discussions about disagreements supports the notion that the combined presence of independence and relatedness within parent–adolescent relationships is beneficial for adolescents’ psychosocial adjustment (Kansky, Ruzek, and Allen, 2018). Adolescents who are able (and allowed by parents) to assert their own point of view (i.e., independence) while still maintaining connectedness with parents during discussions (e.g., by collaborating with parents to reach a solution to the disagreement) display adaptive developmental outcomes, such as higher self-esteem and better ego development (Allen, Hauser, Bell, and O’Connor, 1994) and a less hostile style of interaction with peers (Allen, Hauser, O’Connor, and Bell, 2002). Indeed, parent–adolescent relationships characterized by a combination of independence and connectedness foster not only 121

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adolescents’ personal adjustment and well-being but also their social development. Such relationships serve as a template for interacting with peers and romantic partners and for constructively dealing with disagreements in such relationships (Allen and Loeb, 2015). In addition to highlighting the importance of combining strivings for independence with ongoing connectedness with parents, scholars also forwarded alternative conceptualizations of adolescent autonomy, defining autonomy not only in terms of independence (Hill and Holmbeck, 1986; Zimmer-Gembeck and Collins, 2003). One prominent alternative conceptualization of autonomy is based on self-determination theory (SDT), a general theory of motivation and social development (Deci and Ryan, 2000; Ryan and Deci, 2000, 2017). According to this theory, autonomy basically entails volitional functioning. When functioning volitionally, adolescents experience a sense of ownership of their behavior, psychological freedom, and authenticity (Ryan and Deci, 2000). Such experiences of volition ensue when adolescents’ behaviors and goals originate from, and are well-aligned with, personal values, interests, and preferences (Deci and Ryan, 2000). Importantly, the experience of volition is distinct from the pursuit of independence (Ryan, Deci, and Vansteenkiste, 2016; Soenens, Vansteenkiste, Van Petegem, Beyers, and Ryan, 2018). Independence (relative to dependence) mainly concerns an interpersonal phenomenon because it deals with the question of who is regulating a certain behavior or goal (adolescents, parents, or both). Whereas adolescents are in charge in making decisions by themselves in the case of independence, they rely on parents for advice and support in the case of dependence. In contrast, volition denotes an intrapersonal experience, reflecting the degree of self-endorsement of one’s behavior and goal pursuits. Specifically, volitional functioning entails regulation of behavior and goals based on deeply endorsed values, preferences, and interests. The opposite of volitional functioning is heteronomy, which manifests in feelings of being pressured to act, think, or feel in certain ways. Illustrating the distinction between independence and volition, adolescents can display independence in either more volitional (self-endorsed) or more heteronomous (pressured) ways. When selecting an extracurricular activity at school, an adolescent may deliberately choose to decide alone (without parental input), thereby displaying volitional independence. However, an adolescent may also feel forced to decide independently, for instance because parents leave the adolescent to his or her own devices (e.g., saying that at her/his age s/he should be able to make such decisions alone). In this example, an adolescent has no choice but to act independently and, hence, displays heteronomous (pressured) independence. Conversely, adolescents can display dependence on parents for either more volitional or more heteronomous reasons. An adolescent can ask parental advice about extracurricular school activities because s/he is genuinely interested in and values parents’ opinion, which will help to make a more thoughtful decision. This adolescent volitionally chooses to depend on parents for advice. However, an adolescent may also feel pressured to rely on parents, for instance because parents express a strong opinion about the most appropriate (or even prestigious) extracurricular activities and/or because parents use guilt to enforce their own opinion. In the latter example, an adolescent is forced to depend on parents and even to comply with the parents’ decision, thereby displaying heteronomous dependency. Consistent with the conceptual differentiation between autonomy-as-independence and autonomyas-volition, research shows that measures of adolescent independence are distinct from measures of volitional functioning (Van Petegem,Vansteenkiste, and Beyers, 2013). More importantly, independence contributes to adolescents’ well-being only when regulated by volitional reasons (Van Petegem, Beyers, Vansteenkiste, and Soenens, 2012). Overall, adolescent independence and volition are typically positively related, but independence as such is less predictive of healthy psychosocial development than volitional functioning (Chen,Vansteenkiste, Beyers, Soenens, and Van Petegem, 2013). For adolescents to experience well-being and to develop secure social relationships outside the family, it seems more important that they regulate their behavior based on self-endorsed values and interests rather than because they are

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independent and no longer rely on parents. Also, dependency on parents is not necessarily a problem or a sign of immaturity. Dependency can contribute to adolescents’ well-being and psychosocial adjustment if adolescents volitionally choose to rely on parents for support and advice (Chen et al., 2013; Ryan, La Guardia, Solky-Butzel, Chirkov, and Kim, 2005). In contrast, when adolescents feel pressured to depend on parents (e.g., because parents enforce loyalty and emphasize the sacrifices they have made for their adolescent), adolescents are prone to ill-being and may even be inclined to display reactance against parental authority (Mayseless and Scharf, 2009; Van Petegem et al., 2012; Van Petegem, Vansteenkiste, Soenens, Beyers, and Aelterman, 2015). To summarize, adolescents gradually strive for more independence, thereby taking more distance from their parents. However, this movement toward self-reliance does not guarantee healthy psychosocial development. Important boundary conditions determine the degree to which independence contributes to adolescent well-being and social adjustment. For adolescents to benefit optimally from their increasing independence, their search for independence needs to occur in the context of ongoing connectedness with parents. Accordingly, it remains important for parents to invest in a close and secure relationship with their adolescent. Presumably, under these conditions, adolescents are better capable of regulating independence volitionally, thereby grounding their decisions based on self-endorsed values, interests, and preferences.When functioning volitionally, adolescents experience authenticity and psychological freedom, experiences that are indispensable for well-being and social competence. Although independence can be accompanied by such feelings, this is not always the case. Adolescents reap the benefits of independence mainly when they deliberately choose and feel free to display independence. Also, adolescents do not strive for independence all the time. On a regular basis, adolescents choose to take comfort in parents and choose to rely on parental advice. Rather than insisting on independence, parents do well to be available and supportive when such volitional dependence is called for by adolescents.

Conclusion Adolescence is a time of change in parent–child relationships, with puberty being involved in some changes either directly or indirectly. However, the nature and intensity of these changes are less dramatic than was assumed in the early days of research on adolescent development and in lay beliefs. Chronic and severe disruptions of parent–child relationships are the exception rather than the rule. Rather than being a period of fundamental disruption, adolescence is a period of gradual transformation toward a more egalitarian and horizontal parent–child relationship. Throughout this period of transformation, parents remain key socialization figures. Parents are not simply replaced by peers as a primary source of social influence. Instead, parents continue to affect adolescents’ development and peer relationships in both direct and indirect ways. While adolescents display increased strivings for independence, parents and adolescents need to stay connected for this development toward independence to foster psychosocial adjustment. The normative changes in parent–child relationships during adolescence need to be nuanced in two important ways. First, when considered in an absolute sense, the average quality of parent–child relationships remains high in adolescence (Steinberg and Silk, 2002). Most adolescents continue to experience the parent–child relationship as supportive and secure (De Goede et al., 2009).Yet, when parents use prior developmental periods as a point of reference, parents may be struck by the changes occurring in the parent–adolescent relationship. In spite of the differences noted by parents between adolescence and childhood, it is important for parents also to consider and appreciate the overall quality of the parent–adolescent relationship in a more absolute sense. Second, normative changes in parent–adolescent relationships need to be considered against the background of relatively stable inter-individual differences between parent–child dyads and families

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(Laursen and Collins, 2009). While there is an average trend toward temporarily more strained and less supportive parent–child relationships during adolescence, pre-adolescent patterns of interaction are predictive of the degree of turmoil and conflict (versus support and harmony) experienced during adolescence. Parents and children displaying relatively better quality of relationships prior to adolescence fare comparatively better in navigating the changes and challenges of early adolescence than parents and children with a history of troubled interactions. One factor contributing to this relative (or rank-order) stability in relationship patterns is parenting style, which represents a fairly stable interaction pattern between parents and their children (Darling and Steinberg, 1993; Holden and Miller, 1999). In contrast to the relatively specific parenting practices discussed in this first part of the chapter (e.g., emotion coaching and peer management), parenting style refers to the more general affective tone and emotional climate in parent–child interactions (Darling and Steinberg, 1993). General parenting style is assumed to affect adolescents’ development directly, with a more supportive style, for instance, contributing to higher adolescent well-being, and indirectly, that is, by altering the effectiveness of specific parenting practices (Darling and Steinberg, 1993). Parents convey their involvement in specific life domains differently depending on their overall style of interaction. Also, adolescents’ perceptions of parental practices differ depending on the overall quality of parenting style. Both these differences in parental communication style and adolescents’ perception of parenting practices, in turn, affect adolescents’ willingness to accept (or defy) parents’ involvement. In the next section, we discuss in greater detail how quality of parenting style can strengthen (or undermine) youth capacity to navigate the many challenges of adolescence.

Parenting and Adolescent Psychosocial Development Research on parenting and adolescent development has a rich yet rather complicated history. At least two trends characterize the field. First, the literature has witnessed a shift from a configurational approach to a more dimensional approach. Second, research is informed increasingly by a top-down and theory-driven approach. Today, there is increasing consensus about the importance of a dimensional approach, and there is growing convergence between bottom-up and top-down approaches to parenting. Consequently, socialization scholars agree about the key parenting dimensions with relevance to adolescent development. To understand the complexity of conceptualizing parenting in relation to adolescent adjustment, this section first provides a brief historical description of research on parenting and adolescent development. Next, we discuss the theory-driven approach to conceptualize parenting based on self-determination theory, arguing that this approach may help to resolve some inconsistencies and conceptual problems in research on parenting adolescents.Throughout, we discuss research examining associations between key dimensions of parenting style and important areas of adolescent development, including well-being, social competence, emotion regulation, and identity formation.

From a Configurational to a Dimensional Approach to Parenting The Configurational Approach Inspired by Baumrind’s (1971, 1991) seminal work, much research on parenting and adolescent development focused on the tripartite distinction of authoritative, authoritarian, and permissiveindulgent parenting styles. Authoritative parents make demands for maturity and set clear rules for acceptable behavior.They do so within a climate of open communication and opportunity for negotiation. Authoritarian parents insist on obedience and respect for authority, thereby attempting to shape the adolescent’s behavior to a strict set of standards and leaving little room for the adolescent’s 124

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input. Permissive parents take an overly tolerant attitude toward the adolescent’s desires and behaviors. These parents fail to sufficiently restrict the adolescent’s behavior and leave too many decisions up to the adolescent. Maccoby and Martin (1983) proposed a model locating these parenting styles in a fourfold scheme defined by two underlying dimensions: parental responsiveness (i.e., sensitivity, warmth, and acceptance) and demandingness (i.e., control, consistent discipline, and high maturity demands). The three parenting styles identified by Baumrind could be placed in this model, with authoritative parenting involving a combination of high responsiveness and demandingness, with authoritarian parenting involving demandingness in the absence of responsiveness, and with permissive parenting involving low demandingness combined with high responsiveness. Furthermore, the fourfold scheme identified a fourth parenting style, indifferent-uninvolved parenting. This parenting style, which is characterized by a combination of low demandingness and low responsiveness, is typical of parents who neglect their childrearing responsibilities or who even actively reject their child. A key assumption in research based on Baumrind’s theorizing is that parenting styles represent typologies or configurations, combinations of underlying parenting dimensions. Each parenting style needs to be considered as a “Gestalt,” with combinations of parenting dimensions being “more and different from the sum of their parts” (Baumrind, 1991, p. 63). As a result, effects of one parenting dimension cannot be understood in isolation from the combined presence or absence of other parenting dimensions. For instance, parental maturity demands are thought to have fundamentally different repercussions for adolescent competence depending on whether these demands are communicated in a climate of parental responsiveness (as in the authoritative parenting style) or whether they are conveyed in a cold fashion (as in the authoritarian parenting style). Relying on this configurational approach to parenting, research systematically examined associations between parenting style and a broad variety of adolescent outcomes, including self-worth, problem behavior, academic performance, and social adjustment (see Steinberg, 2001, for an overview). Adolescents were typically classified into one of the four parenting styles based on their ratings of parental responsiveness and demandingness. Using this methodology, Lamborn, Mounts, Steinberg, and Dornbusch (1991) found that adolescents reared by authoritative parents reported the most adaptive profile of adjustment and that adolescents perceiving parents as uninvolved, in contrast, reported the most psychosocial problems (e.g., internalizing distress, school misconduct, and drug use). Adolescents perceiving parents as authoritarian or permissive displayed adjustment patterns situated in between these two extremes. Longitudinal research showed that the differences in psychosocial adjustment between adolescents perceiving parents as authoritative or uninvolved even widened as adolescents grew older (Steinberg, Lamborn, Darling, Mounts, and Dornbusch, 1994). The benefits of an authoritative parenting style were also demonstrated specifically with regard to adolescents’ engagement at school and academic performance (Steinberg, Elmen, and Mounts, 1989; Steinberg, Lamborn, Dornbusch, and Darling, 1992). Finally, research addressed the generalization of associations between parenting style and adjustment to various populations, including juvenile offenders (Steinberg, Blatt-Eisengart, and Cauffman, 2006) and adolescents with different socioeconomic, ethnic, and cultural backgrounds (Steinberg, Mounts, Lamborn, and Dornbusch, 1991). Overall, authoritative parenting was found to relate to better adolescent adjustment compared to the other parenting styles within and across these more heterogeneous populations, with one notable exception. In African American and Asian American adolescents, authoritarian parenting was related to equally high school performance as authoritative parenting (Steinberg, Dornbusch, and Brown, 1992), a finding replicated sometimes (but not consistently) with native Asian adolescents (e.g., Leung, Lau, and Lam, 1998). Based on a meta-analysis examining effects of parenting in more than 150 samples, Pinquart and Kauser (2018) concluded that, overall, there are more similarities than differences in associations between parenting styles and adolescent adjustment across countries and ethnic backgrounds. 125

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Because of the developmental benefits associated with authoritative parenting, at the beginning of this century Steinberg (2001) called for a translation of this scientific knowledge about adaptive parenting to practice (e.g., through public health campaigns and prevention programs). This call for the application of parenting research to policy and practice was laudable, but it raised the question whether the field was ready for this move to practice. Although the configurational approach to parenting had its merits, it remained unclear whether the distinguished dimensions (i.e., responsiveness and demandingness) sufficed to describe the variety of parenting styles comprehensively. Relatedly, this approach did not provide detailed insight in the question of whether specific dimensions of parenting relate to specific domains of adolescent development.To address this question, research would need to deconstruct the configurations into their constituting dimensions and examine their unique associations with aspects of adolescent development. Such dimension-specific knowledge is important for applied purposes, for instance to tailor advice to parents to the specific problems or challenges adolescents are faced with. Also, in the configurational approach, little attention was devoted to the underlying psychological processes accounting for associations between parenting dimensions and developmental outcomes. What is happening in the “black box” of adolescents’ functioning when they are reared in a certain way and how do these processes relate to adolescent adjustment? Such knowledge is again important from an applied perspective. With insight into the mechanisms behind effects of parenting on adjustment, prevention and intervention efforts can focus on parental behavior and on the underlying mechanisms. Because of these considerations, research on parenting in adolescence gradually moved to a more dimensional approach.

Toward a Dimensional Approach In the dimensional approach to parenting, the parenting typologies were deconstructed into their constituent dimensions, and associations between these specific dimensions and distinct features of adolescent development were examined (Forehand and Nousiainen, 1993; Gray and Steinberg, 1999; Smetana, 2017). An important source of inspiration for this dimensional approach was Schaefer’s (1965a) early research on parenting. Schaefer (1959, 1965a, 1965b) administered large numbers of parenting-relevant items to adolescents and young adults and conducted factor analyses to examine the internal structure of the parenting domain. Consistently, he arrived at a three-dimensional solution, distinguishing between acceptance versus rejection, psychological autonomy versus psychological control, and firm control versus lax control. The first dimension was similar to the dimension of responsiveness identified in Maccoby and Martin’s (1983) model of parenting typologies and was most commonly referred to in the dimensional approach as “parental support” (sometimes also as involvement, warmth, or acceptance). Parental support entails the degree to which parents interact with adolescents in a warm and affectionate manner and at the same time are sensitive to the adolescent’s distress and provide adequate support and comfort to alleviate distress (Davidov and Grusec, 2006). Based on Schaefer’s work, scholars adopting a dimensional approach to parenting distinguished between two dimensions within Maccoby and Martin’s dimension of demandingness (control). This differentiation within the control dimension was referred to most often as a distinction between behavioral control and psychological control (Steinberg, 1990), a distinction that received widespread attention through the work of Barber and colleagues (Barber, 1996; Barber, Olsen, and Shagle, 1994). Barber (1996) defined parental behavioral control as a set of parental behaviors aimed at regulating adolescents’ behavior and preventing misconduct (e.g., through rule setting, monitoring, and consistent discipline). Behavioral control would provide guidance to adolescents and would create a predictable home environment in which capacities for self-regulation of appropriate behavior can develop (Barber et al., 1994). As such, this parenting dimension was expected to play a protective role against disruptive behavior and externalizing problems. Barber (1996) distinguished this dimension 126

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from psychological control, which involves “socialization pressure that is nonresponsive to the child’s emotional and psychological needs. . ., that stifles independent expression and autonomy. . ., and that does not encourage interaction with others” (Barber, 1996, p. 3299). Key examples of psychologically controlling practices include guilt induction, shaming, and love withdrawal. Because of the intrusive and manipulative nature of these strategies, psychologically controlling parenting was expected to interfere with the development of a secure sense of worth and with healthy identity formation, resulting in a susceptibility to psychopathology and to internalizing distress (Barber, 1996). The notion that parental behavioral control would play an adaptive role in adolescent development (protecting against externalizing problems in particular) and that psychological control would contribute to risk for psychopathology (and internalizing distress in particular) received support in Barber et al.’s (1994) initial studies. Behavioral control was related specifically and negatively to adolescents’ externalizing problems, and psychological control was related positively to internalizing problems. These findings were replicated in several studies, some of which were longitudinal in nature (see Pinquart, 2017, for a meta-analysis). In some of these studies psychologically controlling parenting was related positively to externalizing problems as well (e.g., Barber, 1996; Pettit, Laird, Dodge, Bates, and Criss, 2001). Apparently, psychologically controlling parenting has a robust emotional cost for adolescents and, in some adolescents, additionally provokes a tendency to engage in disruptive behavior (possibly in an attempt to defy parental authority; Brauer, 2017; Van Petegem, Soenens,Vansteenkiste, and Beyers, 2015). In addition to increasing risk for ill-being and problem behaviors, psychologically controlling parenting undermines important resources for well-being and resilience, and it affects various areas of adolescents’ psychosocial functioning. For instance, parental psychological control impairs adolescents’ capacity for emotion regulation, as indexed by a higher likelihood of being overwhelmed by negative emotions, such as anger and sadness (Cui, Morris, Criss, Houltberg, and Silk, 2014). It also interferes with processes involved in healthy identity formation, a crucial developmental task in late adolescence (Erikson, 1968). Adolescents experiencing parents as psychologically controlling have a particularly difficult time making clear and personally meaningful commitments in life (Luyckx, Soenens, Vansteenkiste, Goossens, and Berzonsky, 2007). Both these emotional and identity-related difficulties possibly derive from the feeling of being pushed by parents in a certain direction, such that adolescents become alienated from their emotions, personal preferences, and interests. In the social realm, parental psychological control increases adolescents’ display of relational aggression in interactions with peers (Kuppens, Laurent, Heyvaert, and Onghena, 2013; Loukas, Paulos, and Robinson, 2005), with relational aggression in turn relating to lowered friendship quality and even loneliness (Soenens, Vansteenkiste, Goossens, Duriez, and Niemiec, 2008). Relational aggression involves manipulative social behavior aimed at damaging others’ social relationships and reputation (e.g., through threats of exclusion and gossip). Apparently, psychologically controlling practices serve a modeling function, with adolescents exposed to manipulative parental behaviors being more inclined to engage in similar manipulative practices in their relationships with peers and friends. Along similar lines, adolescents experiencing more maternal psychological control in early adolescence are less able to constructively assert independence in peer relationships in middle adolescence (Hare, Szwedo, Schad, and Allen, 2015). Thus, in addition to undermining adolescents’ personal well-being and behavior, parental psychological control also hampers adolescents’ social adjustment (Oudekerk, Allen, Hessel, and Molloy, 2015). Barber’s initial work focused mainly on the distinction between behavioral control and psychological control, but subsequent studies also included assessments of parental support to determine the unique and specific predictive value of each of the three parenting dimensions to adolescents’ development. In addition to confirming the differential associations of behavioral and psychological control with adolescents’ problem behaviors, these studies found that perceived parental responsiveness was primarily predictive of adolescents’ positive psychosocial adjustment, as indicated by 127

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self-reliance and self-worth (Gray and Steinberg, 1999) and by social initiative and social competence (Barber, Stolz, and Olsen, 2005).

Explanatory Processes The “unpacking” of authoritative parenting yielded a more detailed picture of specific associations between parenting dimensions and domains of adolescent development, and it created room for an in-depth examination of intervening processes (i.e., mechanisms) behind associations between parenting and adolescent adjustment. Such processes were examined mainly with regard to parental responsiveness and psychological control. One theory often invoked to explain effects of parenting on adolescents’ well-being and social adjustment is attachment theory (Bowlby, 1980, 1988). In adolescence, quality of parenting is assumed to continue to affect internal working models of interactions (Kobak and Sceery, 1988), even though adolescents’ attachment representations show significant (yet relatively modest) continuity with internal working models developed in childhood (Fraley, 2002; Groh et al., 2014). Warm and sensitive parenting would still contribute to secure parent–adolescent attachment representations (involving the feeling of being lovable and expectations that parents are available and trustworthy), with such representations being carried forward in relationships with others (e.g., teachers, friends, and romantic partners). In contrast, psychologically controlling parenting would contribute to insecure attachment representations and, more specifically, to the anticipation that other people’s love and support are conditional, dependent on the degree to which one displays loyalty toward others (i.e., preoccupied or anxious attachment). These attachment theory-based hypotheses have received support, with perceived parental responsiveness being associated with secure attachment and with psychologically controlling parenting being related to insecure attachment and to preoccupied/anxious attachment in particular (Allen, Grande, Tan, and Loeb, 2018; Doyle and Markiewicz, 2005; Karavasilis, Doyle, and Markiewicz, 2003). Booth-LaForce et al. (2014) even found that decreases in observed maternal responsiveness from toddlerhood to middle adolescence were predictive of a decrease in attachment security between early childhood and late adolescence (see also Beijersbergen, Juffer, Bakermans-Kranenburg, and van IJzendoorn, 2012). These findings suggest that changes in parenting from early childhood to adolescence continue to matter for attachment representations in adolescence, and they underscore the notion that both parenting and attachment representations are still susceptible to change in adolescence. The attachment representations associated with parenting dimensions also have been found to account for (i.e., mediate) associations between parenting and adolescent adjustment, with attachment, for instance, playing an intervening role in differential associations of parental responsiveness and psychological control with adolescents’ internalizing problems (Brenning, Soenens, Braet, and Bosmans, 2012). Another psychological process involved in effects of parental responsiveness is empathy. Consistent with several models of the developmental origins of empathy (Eisenberg and Valiente, 2002; Fabes, Carlo, Kupanoff, and Laible, 1999), perceived parental responsiveness is related to adolescents’ capacity for empathy (Laible and Carlo, 2004) and even predictive of over-time increases in adolescent empathy (Miklikowska, Duriez, and Soenens, 2011). Adolescents who perceive parents as responsive are willing and able to consider other people’s internal states and cognitions as well as feel with other people’s emotions and express sympathy with those emotions. In turn, adolescent empathy has been found to mediate associations between parental responsiveness and indicators of adolescent social development, such as quality of friendships (Soenens, Duriez,Vansteenkiste, and Goossens, 2007). Research also identified mediating processes with specific relevance to psychologically controlling parenting. Consistent with Barber’s (1996) claim that such parenting represents a threat to the formation of a secure and positive sense of worth, studies have shown that parental psychological 128

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control is related to lower self-worth, with low self-worth in turn predicting internalizing distress (Garber, Robinson, and Valentiner, 1997). In addition to predicting overall low levels of self-esteem, parental psychological control also relates to a contingent and fragile type of self-esteem (Wouters, Doumen, Germeijs, Colpin, and Verschueren, 2013). Such contingent self-esteem denotes a tendency to let feelings about one’s worth as a person depend heavily on the attainment of standards for performance in a given life domain (Deci and Ryan, 1995; Kernis, 2003). Much like psychologically controlling parents provide or withdraw love based on the child’s ability to meet parentally imposed standards, children of psychologically controlling parents have their own self-esteem hooked on the attainment of standards for excellence. In turn, this fragile type of self-worth involves vulnerability to psychopathology and to internalizing problems in particular (Heppner and Kernis, 2011;Van der Kaap-Deeder et al., 2016). The tendency of adolescents of psychologically controlling parents to develop a fragile sense of worth is visible also in these adolescents’ vulnerability to develop self-critical perfectionism (Bleys, Soenens, Boone, Claes,Vliegen, and Luyten, 2016; Kopala-Sibley and Zuroff, 2014; Soenens, Luyckx, Vansteenkiste, Luyten, et al., 2008; Soenens, Vansteenkiste, Luyten, Duriez, and Goossens, 2005). In line with developmental theories about the origins of perfectionism (Blatt, 1995; Flett, Hewitt, Oliver, and MacDonald, 2002), studies show that adolescents who perceive parents as psychologically controlling are more inclined to make their self-worth contingent on the attainment of very high (to even unrealistic) standards and to engage in harsh self-scrutiny when failing to meet these standards. In turn, self-critical perfectionism is a robust predictor of adolescent risk for psychopathology (Blatt, 2004; Luyten and Blatt, 2013).

Unresolved Issues in the Dimensional Approach Although the dimensional approach to parenting yielded much additional insight into the specificity and processes involved in effects of parenting on adolescent development, it also raised new questions and unresolved issues. Two main issues involved (1) difficulties defining the high and low ends of each parenting dimension and (2) the problematic conceptualization of parental behavioral control. Although Schaefer had labeled both the positive and the negative sides of each parenting dimension in his early work, subsequent studies did not systematically address both sides. With the dimensions of responsiveness and behavioral control, there was a tendency to focus on the positive (high) ends of the continuum, to the neglect of research on the negative (low) ends of the continuum, which were labeled by Schaefer (1965a) as rejection and laxness, respectively. In contrast, psychological control was situated by Schaefer (1965a) on a continuum ranging between psychological autonomy and psychological control, and research largely focused on the negative (low) end of this continuum, at the expense of research on parental support for autonomy. Hence, there was an imbalance in the focus on either the positive or the negative side of these parenting dimensions. This imbalance raised the question of whether low scores on one side of each parenting dimension can be equated with high scores on the other side of the dimension (and vice versa) or whether, in contrast, each side of the dimension is better examined in its own right. For instance, some scholars used only items tapping into psychologically controlling parenting to measure the dimension of “psychological autonomy versus psychological control” and sometimes even used a reverse-scored scale for parental psychological control as an indicator of parental support for autonomy. Other scholars objected to this practice, arguing that an absence of psychological control does not necessarily entail the presence of active parental efforts to support a child’s autonomy (Barber, Bean, and Erickson, 2002; Silk, Morris, Kanaya, and Steinberg, 2003). This objection in turn raised the question of exactly how parental support for autonomy should be defined and whether it has unique relevance for adolescent development. Such conceptual questions are important from an applied perspective. If active parental support for autonomy has unique predictive value for adolescents’ 129

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adjustment (beyond an absence of psychological control), insight in the nature of parental support for autonomy would be important for prevention and intervention efforts targeting parents’ ability to strengthen adolescents’ resilience and well-being. Parents could then be advised to avoid engagement in psychologically controlling practices and could be informed about ways in which to actively contribute to adolescents’ experiences of autonomy. Further, the construct of behavioral control remained conceptually problematic. Much like the original term parental control, the term behavioral control is used to refer to a wide variety of tactics to regulate and influence a child’s behavior. Such tactics include setting expectations, attempting to monitor the child’s behavior, and enforcing rules through disciplinary measures. In at least some studies, harsh and punitive parenting practices, such as verbal hostility and (physical) punishment, have also been considered operational indicators of parental behavioral control (Janssens et al., 2015; Nelson and Crick, 2002). Although these harsh tactics were then said to represent “excessive” or “inappropriate” types of behavioral control, they were still considered instantiations of parental behavioral control. Further, some well-known measures of behavioral control contain items tapping into harsh and punitive parenting. For instance, the behavioral control scale from the Child Report of Parent Behavior (CRPBI; Schaefer, 1965b), one of the most widely used measures of parenting, contains an item “My mother/father gives hard punishment.” This is remarkable because, contrary to the notion of behavioral control as a protective parenting dimension, punitive and harsh parenting practices are negatively related to adolescents’ self-regulatory capacities (Brody and Ge, 2001) and positively related to problem behavior (Coie and Dodge, 1998; Patterson, 1982; Prinzie, Onghena, and Hellinckx, 2006; Wang and Kenny, 2014). Thus, an important problem with the concept of behavioral control is that it encompasses both potentially protective parental strategies (such as communication of rules and supervision) as well as harmful strategies (such as verbal hostility and harsh punishment). Because of this problem, the differentiation between parental behavioral control and psychological control also risks getting blurred (Kakihara and Tilton-Weaver, 2009; Smetana, 2017). That is, at high (or even excessive) levels of behavioral control (resulting in a harsh parental approach), effects of behavioral control would be essentially similar as effects of parental psychological control. In both cases, adolescents would experience parents as intrusive and would be more likely to display emotional and behavioral problems (Kakihara and Tilton-Weaver, 2009). Thus, the concept of behavioral control seems to have become an umbrella term for a variety of parental behaviors with widely differing implications for adolescent development (Grolnick and Pomerantz, 2009; Soenens and Vansteenkiste, 2010). The usage of such an umbrella term is confusing not only in the scientific debate but also in the translation of research findings to practice.

Summary Although the dimensional approach to parenting advanced the field in important ways, essential conceptual questions about the definition of the parenting dimensions and their significance for adolescents’ adjustment remained unresolved. Possibly, these conceptual difficulties are due, at least partly, to the bottom-up approach through which the dimensional approach to parenting initially developed. Indeed, Schaefer’s work was mainly empirically driven rather than informed by an overarching theoretical framework. In recent years, a more top-down and theoretically driven approach to parenting gained prominence in the literature. In particular, self-determination theory (Deci and Ryan, 2000; Ryan and Deci, 2000, 2017; Vansteenkiste, Niemiec, and Soenens, 2010) increasingly serves as a conceptual framework for research on parental socialization (Grolnick, 2003; Joussemet, Landry, and Koestner, 2008; Soenens, Deci, and Vansteenkiste, 2017).We next present this perspective on parenting and discuss how it helps to resolve some of the problems uncovered in the dimensional approach to parenting. 130

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A Self-Determination Theory Perspective on Parenting Adolescents Basic Psychological Needs and Adolescent Development According to SDT, individuals have three innate, universal, and fundamental psychological needs, the satisfaction of which is essential for individuals’ psychosocial adjustment: the needs for autonomy, competence, and relatedness (Deci and Ryan, 2000; Ryan and Deci, 2000, 2017). Satisfaction of the need for autonomy manifests in experiences of psychological freedom, authenticity, and ownership of one’s behaviors and choices. When the need for competence is satisfied, people feel efficacious and able to deal with challenges. The need for relatedness is satisfied when people feel loved and appreciated by important others (e.g., parents, peers, and friends). In SDT, psychological need satisfaction is considered essential for healthy psychological development across the lifespan (Deci and Ryan, 2000; Vansteenkiste and Ryan, 2013). Consistent with this strong claim, there is evidence that psychological need satisfaction and contextual support for psychological needs matter from infancy (Bindman, Pomerantz, and Roisman, 2015; Frodi, Bridges, and Grolnick, 1985) to old age (Kasser and Ryan, 1999). Research with adolescents demonstrates the importance of psychological need satisfaction for adolescents’ psychosocial adjustment. For example, while Veronneau, Koestner, and Abela (2005) showed that early adolescents’ general satisfaction of each of the three needs was related to positive affect, and Milyavskaya et al. (2009) found that psychological need satisfaction within specific life domains with particular relevance to adolescents (i.e., in friendships, at home, and at school) was also related to adolescents’ well-being. Further, psychological need satisfaction is related negatively to ill-being, as indexed by depressive symptoms (Veronneau et al., 2005) and non-suicidal self-injury, a type of self-harm quite common in adolescence (Emery, Heath, and Mills, 2016). Psychological need satisfaction also matters for adolescents’ approach to the process of identity development. Luyckx,Vansteenkiste, Goossens, and Duriez (2009) found psychological need satisfaction to foster adolescents’ thorough exploration of identity options and stronger commitments to identity choices. Psychological need satisfaction would provide the energy to engage in an open and flexible exploration of different lifestyles as well as the courage to make determined and personally endorsed choices in life. Perhaps because of the beneficial role of psychological need satisfaction in identity development, experiences of need satisfaction also contribute to adolescents’ sense of authenticity (Thomaes, Sedikides, van den Bos, Hutteman, and Reijntjes, 2017). Adolescents experiencing psychological need satisfaction feel that they can truly be themselves, a feeling of utmost importance to adolescents’ well-being. According to SDT, these three psychological needs are universally important (Deci and Ryan, 2000). Cross-cultural research increasingly confirms this claim, showing that psychological need satisfaction relates positively to adolescents’ well-being and more adaptive psychosocial functioning in nations across the globe (Ahmad, Vansteenkiste, and Soenens, 2013; Chen et al., 2015). In sum, psychological need satisfaction is of key importance to adolescents’ overall well-being, to their resilience against ill-being, and to their successful management of central developmental tasks such as identity formation. Recent work has also focused on the dark side of the psychological needs, that is on the role of psychological need frustration in individuals’ development (Bartholomew et al., 2011). Psychological need frustration manifests in experiences of feeling pressured to do things against one’s will (autonomy frustration), feelings of failure and inferiority (competence frustration), and feelings of loneliness and social alienation (relatedness frustration). An important recent insight in SDT is that the dark side of the psychological needs (i.e., need frustration) is distinct from the absence of the bright side of these needs (i.e., need satisfaction). Need frustration ensues when psychological needs are actively undermined rather than merely unsatisfied (Vansteenkiste and Ryan, 2013). For instance, experiences 131

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of exclusion by friends from social activities (i.e., relatedness need frustration) are worse than experiencing that friends are less friendly than usual (i.e., low relatedness satisfaction). Because experiences of needs frustration indicate a stronger and more direct threat to individuals’ psychological needs than an absence of need satisfaction, need frustration would render adolescents particularly vulnerable to ill-being and psychopathology (Ryan, Deci, and Vansteenkiste, 2016). Research increasingly supports the notion that psychological need frustration cannot be reduced to the deprivation of psychological need satisfaction (Chen et al., 2015) as well as the prediction that need frustration is particularly predictive of maladaptive developmental outcomes (Vansteenkiste and Ryan, 2013). For instance, research with adolescents has shown that need frustration is related to physiological indicators of stress (Bartholomew et al., 2011), internalizing distress (Cordeiro, Paixao, Lens, Lacante, and Sheldon, 2016), and eating-disorder symptoms (Boone,Vansteenkiste, Soenens,Van der Kaap-Deeder, and Verstuyf, 2014).

The Role of Parents in Adolescents’ Basic Psychological Needs Research demonstrating the pivotal role of basic psychological needs in adolescents’ well-being and adjustment offers important insights into the question of how parents can contribute to healthy adolescent psychological development. Indeed, SDT argues that parents, in interaction with other key individuals (i.e., teachers, peers, and friends), play a crucial role in the nurturing versus thwarting of adolescents’ psychological needs. Specifically, SDT distinguishes between three central dimensions of parenting style, with each dimension corresponding largely (but not uniquely) to one of the three needs (Grolnick, Deci, and Ryan, 1997; Joussemet, Landry, and Koestner, 2008). Involvement primarily nurtures the need for relatedness and involves parenting high on respect, warmth, and sensitivity. Much like the concept of responsiveness in the dimensional approach to parenting, it is characteristic of parents who express affection toward adolescents and who provide adequate support when adolescents experience distress. Structure is most relevant to the need for competence. Parents high on structure offer clear expectations for adequate behavior, provide help when needed, and give positive, process-oriented feedback to adolescents. Finally, autonomy support is essentially about taking the adolescent’s frame of reference and creating conditions for adolescents to experience psychological freedom. Parental autonomy support entails acknowledging the adolescent’s perspective, providing choices, encouraging initiative, and giving a meaningful rationale when introducing rules. Each of these parenting dimensions is mainly involved in one of the psychological needs, but there is not a perfect one-to-one relation between the parenting dimensions and the needs (Grolnick et al., 1997; Ryan and Deci, 2017;Vansteenkiste, Niemiec, and Soenens, 2010). Each parenting dimension is relevant to some extent for each of the three needs. For instance, when parents allow an adolescent to choose between different study choices (thereby being autonomy supportive), an adolescent is likely to experience a sense of autonomy, and parental confidence in the ability to make a sound choice (i.e., competence), and appreciation of who one is as a person (i.e., relatedness). There are clear correspondences between the three parental dimensions proposed in the SDTbased literature and the three dimensions identified in the broader developmental literature (Gray and Steinberg, 1999; Schaefer, 1965a). This convergence is striking because it emerged from two different approaches to chart the domain of parenting, that is a mainly top-down and theory-driven approach (i.e., the SDT-based literature) and a more inductive and bottom-up approach (i.e., the broader developmental literature on parenting). In spite of these differences in approach, both literatures arrived roughly at a similar set of dimensions, with one dimension being about love and care, a second dimension being about parental guidance and regulation, and a third dimension dealing essentially with autonomy (Barber et al., 2005). This convergence strengthens confidence that these dimensions are fundamental to describe the quality of parenting style. Still, there are also important differences between the two approaches, with some differences being helpful to address unresolved 132

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issues in the dimensional approach to parenting described above, such as the difficulty to conceptualize a counterpart for each of the three parenting dimensions and the problems of clearly defining parental (behavioral) control.

Differentiating Between the Bright and Dark Sides of Parenting Recent theorizing in SDT underscores the importance of differentiating between need-supportive parenting (i.e., the bright side of parenting) and need-thwarting parenting (i.e., the dark side of parenting). Much like psychological need frustration cannot be equated with a lack of need satisfaction, parenting that actively thwarts adolescents’ psychological needs is distinct from parenting characterized by low support for psychological needs (Vansteenkiste and Ryan, 2013). Need-thwarting parenting involves a stronger and more direct undermining of adolescents’ needs than the mere absence of need-supportive parenting. To illustrate, when parents rebuff or ignore adolescents’ calls for comfort and emotional support they thwart adolescents’ need for relatedness in a more direct fashion compared to when parents merely display little affection and warmth in parent–adolescent interactions (which involves low relatedness need support). Similarly, critical and humiliating comments represent a stronger and more direct threat to adolescents’ need for competence than low frequency of parental positive feedback (which involves low competence need support). Conversely, parental need thwarting involves low parental support for adolescents’ psychological needs. When parents undermine adolescents’ psychological needs experiences, by definition they are low on need support. Thus, there is an asymmetrical relation between parental need support and parental need thwarting, with low support not necessarily involving need thwarting but with need thwarting implying low support (Vansteenkiste and Ryan, 2013). Accordingly, SDT formulates a need-thwarting dark side for each of the three need-supportive concepts (Joussemet et al., 2008; Soenens et al., 2017), as can be seen in Figure 4.1. Rejection primarily thwarts the need for relatedness and includes parental behaviors that are cold, neglectful, and insensitive to adolescents’ calls for support. Chaos involves thwarting the need for competence and involves parenting that is unpredictable and/or highly lenient (i.e., an absence of rules and limit setting). When parents are unpredictable or unclear about their expectations for adolescents’ behavior

PARENTAL NEED SUPPORT

PARENTAL NEED THWARTING Need for Relatedness

Involvement Warm, supportive, and sensitive parenting

Rejection Cold, aloof, neglectful parenting

Need for Competence Structure Clear expectations, help and assistance, and positive, process-oriented feedback

Chaos Unpredictable parenting, laissez-faire, or even parental criticism

Need for Autonomy Autonomy support Acknowledgment of adolescent’s perspective, encouragement of initiative, provision of choice, and formulation of relevant rationale

Controllingness Pressuring, manipulative, and domineering parenting

Figure 4.1  The Self-Determination Theory (SDT) perspective on parenting

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and goals, it is very difficult (if not impossible) for adolescents to build a sense of competence in the process leading toward meeting those expectations. Further, parents can thwart adolescents’ need for competence in an even more direct fashion by being highly critical of adolescents’ accomplishments and performance. Controlling parenting involves parenting that is domineering and pressuring in nature. Parents high on controllingness impose their own agenda and engage in pressuring, intrusive, and manipulative practices to enforce their agenda. Research with adolescents increasingly supports this conceptual differentiation between needsupportive (bright) and need-thwarting (dark) sides of parenting. Skinner, Johnson, and Snyder (2005) administered measures of each of the six parental concepts depicted in Figure 4.1 to both parents and adolescents. They obtained clear evidence for a differentiation between need-supportive and need-thwarting concepts relevant to each need. Hence, rather than representing the parenting domain in terms of three bipolar dimensions (contrasting parental involvement with rejection, structure with chaos, and autonomy support with controlling parenting), distinctions among the six parenting concepts depicted in Figure 4.1 were found to be more valid. The distinction between need-supportive and need-thwarting parenting is important, because these two sides of the parenting process are said to have differential implications for adolescent development, with need-supportive parenting primarily fostering positive adjustment and need-thwarting parenting creating risk for maladjustment (Vansteenkiste and Ryan, 2013). Consistent with this prediction, needsupportive parenting relates most strongly to positive developmental outcomes in adolescents (e.g., well-being, academic competence, and social adjustment) and need-thwarting parenting relates most strongly to maladjustment (e.g., ill-being and externalizing problem behaviors) (Cordeiro, Paixao, Lens, Lacante, and Luyckx, 2018; Costa, Soenens, Gugliandolo, Cuzzocrea, and Larcan, 2015; Costa, Cuzzocrea, Gugliandolo, and Larcan, 2016; Mabbe, Soenens,Vansteenkiste, and Van Leeuwen, 2016). These findings suggest that, to understand fully the role of parenting in adolescent development, it is important to attend to both the bright and dark sides of parenting. Rather than assuming that an absence of need-supportive parenting equals the presence of need-thwarting parenting, need-thwarting parenting deserves to be studied in its own right.These findings also have implications for practice. A key implication is that interventions targeting parenting do well to focus both on a reduction of need-thwarting parenting (e.g., by informing parents about the nature and consequences of such parenting) and on the promotion of need-supportive practices (e.g., by explaining, demonstrating, and providing exercises for good practices).To really strengthen parents’ role in fostering adolescents’ growth and resilience, it is of key importance to inform and teach parents about the benefits of a need-supportive approach (rather than to focus mainly on the pitfalls associated with need-thwarting parenting). In summary, SDT is more explicit than the general developmental literature on the dimensional approach to parenting about the need to differentiate systematically between need-supportive and need-thwarting features of parenting (i.e., the bright and dark sides of parenting, respectively). In addition, the SDT-based conceptual model of parenting allows for an alternative and refreshing view of more specific parenting concepts strongly relevant to adolescent development and concepts of parental control, structure, and autonomy support in particular.

Further Clarification of the Concept of Parental (Behavioral) Control Considered from the SDT perspective, much of the confusion surrounding the concept of behavioral control stems from the ambiguous meaning of the term “control” itself (Grolnick, 2003; Grolnick and Pomerantz, 2009; Soenens and Vansteenkiste, 2010). Control may refer to parents’ regulation and supervision of adolescents’ behavior, and it may refer to parents’ use of a pressuring, manipulative, and coercive rearing style. To resolve this problem, Grolnick and Pomerantz (2009) suggested using the term “controlling parenting” only in reference to parenting that is pressuring, intrusive, domineering, and manipulative in nature. Rather than using the term “parental control” to refer to potentially 134

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adaptive parental practices (e.g., rules and supervision) and more maladaptive parental practices (e.g., harsh punishment), in SDT the concept of controlling parenting is reserved for parenting that is pressuring in nature. Because this type of parenting thwarts basic psychological needs and the need for autonomy in particular, it is supposed to increase risk for adolescent maladjustment. The concept of controlling parenting is then differentiated from the concept of parental structure, which refers to parental behaviors aimed at facilitating adolescents’ sense of competence (Grolnick and Pomerantz, 2009; Soenens and Vansteenkiste, 2010). Among other strategies, parental structure involves the communication of clear and reasonable expectations and adequate supervision of adolescents’ behavior in relation to these expectations (i.e., the more adaptive features of parental behavioral control). Such transparent parental communication about and monitoring of expectations is a minimal prerequisite for adolescents to be aware of parentally and socially valued standards and to begin building a sense of competence in meeting those standards. Importantly, harsh parental strategies, such as (threats of) punishment and verbal hostility (i.e., the more maladaptive features of behavioral control), would not be considered examples of structure because those strategies do not foster a sense of competence and even undermine adolescents’ feelings of worth. Instead, these strategies would be considered as controlling (i.e., pressuring and intrusive) strategies much like psychologically controlling strategies. Thus, the concept of controlling parenting in SDT encompasses both blunt and externally pressuring parental behaviors (such as verbal or physical threats and withdrawal of privileges) and more subtle, insidious, and internally pressuring strategies (such as guilt induction and love withdrawal). Indeed, SDT distinguishes between two categories of controlling parenting, internally controlling and externally controlling parenting (Soenens and Vansteenkiste, 2010). Internally controlling parental behaviors appeal to internally pressuring feelings in adolescents’ own functioning, such as feelings of guilt, shame, loyalty, and separation anxiety. Guilt induction and love withdrawal represent key examples of internally controlling parenting because such practices make adolescents feel pressured “from within” to meet parental expectations and standards. Failure to meet parental standards would come with feelings of failure, disappointment, and anxiety about losing parental approval. These practices have in common that they reflect a conditionally approving parental attitude (Assor, Roth, and Deci, 2004). Adolescents can earn parental approval and respect by meeting parental standards, yet they can also lose affection when they fail to meet these standards. As a consequence, adolescents feel internally conflicted and trapped between a desire to escape pressuring parental demands and a desire to gain parental approval. Although this internal conflict may elicit short-term compliance with parental demands, it also evokes resentment vis-à-vis parents and it has an emotional cost in terms of internalizing distress (Assor et al., 2004; Soenens et al., 2005). In the long run, internally controlling parenting may even elicit adolescent reactance against parental standards and subsequent disruptive behavior (Van Petegem, Soenens, Vansteenkiste, and Beyers, 2015). The concept of internally controlling parenting is largely consistent with the concept of parental psychological control, the key manifestations of which (such as guilt induction, shaming, and love withdrawal) indeed are internally pressuring in nature (Soenens and Vansteenkiste, 2010).Thus, the evidence linking psychologically controlling parenting to adolescents’ internalizing problems and sometimes also externalizing problems (see Barber and Xia, 2013) is consistent with the SDT-based argument that this type of parenting thwarts adolescents’ needs, thereby creating risk for emotional difficulties and in some case even provoking defiance against parental authority. In addition to using internally controlling tactics, parents can engage in more externally controlling practices, thereby pressuring adolescents “from the outside” (Soenens and Vansteenkiste, 2010). Internally controlling parenting can be subtle and insidious (with parents, for instance, expressing disappointment nonverbally), whereas externally controlling parenting is typically more explicit and blunt. It involves practices such as taking away privileges, threats of punishment, and actual engagement in verbal or physical coercion.With such parenting, adolescents are likely to feel pressured from without to comply with parental expectations, resulting in an inclination to react against parental 135

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rules for conduct and heightened risk for externalizing problems. Many studies have demonstrated effects of externally controlling parenting, and physical punishment in particular, on adolescent externalizing problems, such as alcohol abuse (Brody and Ge, 2001), antisocial behavior (Burnette, Oshri, Lax, Richards, and Ragbeer, 2012), and delinquency (Bender et al., 2007). Thus, in SDT internally controlling parenting (which is akin to parental psychological control) and externally controlling parenting are considered instantiations of a need-thwarting parental style and of autonomy need thwarting in particular. The two types of controlling parenting may have somewhat differential implications for adolescent maladjustment (Soenens and Vansteenkiste, 2010). For instance, internally controlling parenting may elicit at least some short-term behavioral compliance, but it is likely to come at an emotional cost because of the internal conflict it creates. In contrast, adolescents may be more likely to directly oppose externally controlling parenting, resulting in an immediate lack of compliance and a greater likelihood of externalizing problems. However, the manifestation of developmental problems associated with controlling parenting probably depends on various factors, including adolescents’ personality-based and temperamental characteristics (Kiff, Lengua, and Zalewski, 2011; Mabbe et al., 2016). In addition, internally controlling and externally controlling parenting practices often co-occur, rendering it difficult to fully tease apart effects of the two types of controlling parenting (Soenens and Vansteenkiste, 2010). These reservations notwithstanding, from the SDT perspective it is conceptually most accurate and parsimonious to group together both psychologically controlling practices (e.g., guilt induction and love withdrawal) and harsh behavioral practices (e.g., verbal hostility and physical punishment) under the umbrella of controlling parenting (defined as parenting that is pressuring in nature) because these practices have in common that they thwart adolescents’ psychological needs and increase the risk for maladjustment. By grouping these practices together (instead of splitting them up in the relatively blurry distinction between psychological and behavioral control), they can also be differentiated more clearly from adaptive parental attempts to regulate adolescents’ behavior and to strengthen adolescents’ competence. Considered from the SDT perspective, the latter parental behaviors belong to the concept of structure, a concept which has strong potential to contribute to a fuller understanding of the role of parents in adolescent development (Grolnick and Pomerantz, 2009).

There Is More to Structure Than Rule Setting and Supervision The concept of structure shares with the concept of behavioral control an emphasis on clear and consistent parental communication about rules and expectations. However, there is more to structure than clear parental rule setting and attempts to follow-up on rules (e.g., through monitoring; Crouter and Head, 2002; Dishion and McMahon, 1998). Structure is essentially about assisting adolescents in building a sense of competence. Parents high on structure try to enable the development of adolescents’ skills and do so not only with respect to adolescents’ ability to control impulses and follow rules but also with respect to many other activities involving competence (e.g., school-related work, sports, leisure activities, and social interaction; Reeve, 2006; Vansteenkiste and Soenens, 2015). Specifically, parents who provide structure try to provide a level of support and help that is attuned to the adolescent’s skill level. Structure can be contrasted with chaos, which is characteristic of parents who do not match their level and type of involvement to what the adolescents need.They provide unclear or confusing guidelines for adequate behavior, and they are inconsistent in the feedback they provide. They give unwanted help and irrelevant information, and, at times, they may become explicitly critical of the adolescents’ behavior and achievements (Skinner et al., 2005). Parents can provide structure before, during, and after adolescents’ engagement in an activity (Reeve, 2006; Soenens et al., 2017;Vansteenkiste and Soenens, 2015). Prior to adolescents’ engaging in an activity (e.g., going out to a party, playing a soccer game, or preparing for exams), parents high 136

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on structure provide clear guidelines (pointing out for instance at what time to be back home) and help adolescents to set goals (discussing for instance what the adolescent hopes to achieve in terms of exam results). Ideally, this is done with room for negotiation, asking adolescents whether they consent with the guidelines and what they themselves think about the goals for a certain activity. Also, it is important for parents to avoid providing redundant and unnecessary guidelines and expectations, which may provoke irritation and possibly defiance in adolescents. Parents can also provide structure during the activities by monitoring adolescents’ behaviors and progress in a process-oriented fashion. When parents and adolescents have agreed to a rule, parents high on structure are consistent in following up on the rule. They signal to adolescents in consequent ways when agreements are not respected. Further, parents high on structure provide adequate help during adolescents’ engagement in tasks, thereby being available in case help is needed. When their help is solicited, parents give advice or help to break down the task (e.g., making an exam schedule) into smaller units to make the task more feasible to the adolescents. In many cases, there is a thin line between providing appropriate and inappropriate help—that is, providing information and instruction—with inappropriate help being unwanted or excessive, such that the parents are essentially taking over the task and precluding a possible learning opportunity for adolescents. Because of their increased desire for independence, adolescents are highly sensitive to the nature and amount of help provided, with inappropriate parental involvement eliciting feelings of incompetence and/or anger (Pomerantz and Eaton, 2000). Finally, providing structure also entails giving informational feedback during and after the activity. Ideally, this feedback is process-oriented and focused on the adolescents’ efforts and strategies (e.g., “You did a good job defending on your opponent.”) rather than on general and personal qualities (e.g., “You are such a star player, the next Cristiano Ronaldo.”; Kamins and Dweck, 1999). Even when adolescents do not do well at a task or fail to meet a rule, parents can provide structure. Instead of giving their own take on the situation right away, parents high on structure would promote selfreflection. They would invite adolescents to reflect on what happened, and perhaps ask adolescents whether they see different ways they might try the task next time. By doing so, adolescents are able to identify their own strengths and weaknesses. In summary, there is more to structure than rule setting and the communication of expectations. Clear expectations and rules are necessary, but not sufficient, conditions for adolescents to develop a sense of competence (Grolnick, 2003; Joussemet et al., 2008; Soenens et al., 2017). Adolescents are more likely to feel competent when parents also provide adequate help, give process-oriented feedback, and assist adolescents in reflecting on their behavior and learning process. Further, structure is relevant to not only rules and appropriate behavior but to activities that involve learning and competence (e.g., homework) and that appeal to adolescents’ interests and passions (e.g., hobbies). As such, the implications of parental structure for adolescents’ development go beyond the prevention of inappropriate behavior (the developmental outcome typically focused upon in research on parental behavioral control). Structure is about the proactive promotion of competence and about strengthening skills in various areas of adolescents’ lives. The concept of parental structure has been examined mainly in the academic domain, with studies showing that structure is related positively to adolescents’ experiences of competence in school and to subsequent academic engagement and performance (Farkas and Grolnick, 2010; Grolnick, Raftery-Helmer, Flamm, Marbell, and Cardemil, 2015). Parental structure also plays a protective role when adolescents are confronted with academic failure (Raftery-Helmer and Grolnick, 2016), with structure relating to more adaptive coping responses after failure, such as problem solving and adaptive help seeking. However, structure is relevant in other domains as well, with structure playing an even more pronounced role in life domains and activities that are relatively new or unfamiliar to adolescents. Using interviews with parents of early adolescents, Grolnick et al. (2014) showed that parents were 137

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more likely to provide structure in the domain of unsupervised activities (e.g., spending time with peers outside the home) relative to other domains (e.g., academics and household chores). Probably because these unsupervised activities are relatively new to early adolescents, parents feel that their children need the most guidance and help in this unfamiliar domain. Moreover, associations between structure and feelings of competence are most pronounced in this unfamiliar domain, indicating that the provision of structure is most needed and effective when adolescents have little experience with activities. Similar results were obtained asking parents and early adolescents to discuss both a neutral topic of their choice (e.g., what to do for summer vacation) and the topic of sex, which represents a more sensitive and unfamiliar topic at this age (Mauras, Grolnick, and Friendly, 2013). Again, parental structure was found to relate most strongly to positive outcomes (e.g., feelings of relatedness and satisfaction with the conversation) in the unfamiliar domain of sexuality. Laird (2014) found that novice adolescent car drivers easily accept parental guidance regarding driving, which further demonstrates the adaptive role of parental structure when adolescents have little expertise or experience with an activity. Overall, these findings suggest that parents’ provision of structure is relevant in different life domains and most of all in life areas in which adolescents are still novices.

The Pivotal Role of Parental Autonomy in Adolescent Development An absence of (psychologically) controlling parenting does not necessarily imply that parents actively encourage and support adolescents’ autonomy (Barber et al., 2002; Silk, Morris, et al., 2003). Because the development of autonomy is so central to adolescent development, it is important to be clear about what it means for parents to facilitate autonomy. SDT is a useful framework in this regard because autonomy is at the heart of this theory (Ryan and Deci, 2017). Autonomy-supportive parents essentially focus on their adolescent’s perspective (Grolnick, 2003; Soenens et al., 2017). Rather than prioritizing their own personal agenda, these parents are interested in and try to connect to the adolescent’s point of view (Deci, Eghrari, Patrick, and Leone, 1994; Mageau, Sherman, Grusec, Koestner, and Bureau, 2017). Also, they unconditionally accept the adolescent as s/he is so the adolescent feels able to be who s/he wants to be (Roth, Kanat-Maymon, and Assor, 2016). Against the background of this general orientation, autonomy-supportive parents allow input from their adolescent and encourage dialogue. They leave room for negotiation, offer choices, and encourage initiative (Soenens, Vansteenkiste, et al., 2007). Such a participatory approach allows adolescents to explore possibilities and to have a say in important decisions. Of course, parents cannot always allow their adolescent to make decisions freely. Sometimes they introduce rules that set limits to the adolescent’s behavior. But even in these instances parents can be autonomy supportive by providing a meaningful rationale and by hearing the adolescent’s voice. Rather than simply imposing a rule, they give explanations that are relevant to the adolescent. Doing so helps adolescents internalize the personal importance of the rule (Deci et al., 1994; Grolnick et al., 1997). Parental support for autonomy also entails an open attitude toward adolescents’ negative emotions, oppositional behaviors, and diverging opinions. Rather than minimizing such experiences or behaviors, autonomy-supportive parents show an active interest in these “deviant” feelings, behaviors, and opinions. Rather than perceiving them as irritating, they curiously explore their meaning to fully understand the adolescent’s perspective (Vansteenkiste and Soenens, 2015). For instance, even when adolescents defy parental rules, autonomy-supportive parents pay attention to adolescents’ reasons for doing so and to the feelings that elicited reactance. Having heard the adolescent’s opinions, they acknowledge the adolescent’s perspective and perhaps flexibly adjust the rule or, if the rule cannot be changed, explain why the rule is meaningful and needs to be maintained. Consistent with SDT, autonomy-supportive parenting predicts psychological need satisfaction (and satisfaction of the need for autonomy in particular) and subsequent well-being in adolescents (Costa et al., 2016; Grolnick, Levitt, and Caruso, 2018; Joussemet et al., 2008; Lekes, Gingras, Philippe, 138

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Koestner, and Fang, 2010). Thus, adolescents who experience parents as autonomy supportive have more secure self-worth, experience more positive affect, and are more energetic because they feel that they can be themselves and that their actions are self-chosen. Parental autonomy support is also beneficial for the quality of the parent–adolescent relationship itself, as it fosters more open, honest, and satisfying conversations (Bureau and Mageau, 2014; Mauras et al., 2013; Roth, Ron, and Benita, 2009; Wuyts,Vansteenkiste, Soenens, and Van Petegem, 2018). Autonomy-supportive parenting also relates positively to adolescent adjustment in specific life domains. For instance, this type of parenting is related positively to academic performance (Vasquez, Patall, Fong, Corrigan, and Pine, 2016), with this association being accounted for by experiences of competence and by high-quality (autonomous) motivation (Grolnick, Kurowski, Dunlap, and Hevey, 2000; Grolnick, Ryan, and Deci, 1991; Soenens and Vansteenkiste, 2005;Vansteenkiste, Zhou, Lens, and Soenens, 2005). That is, perceived parental autonomy support is beneficial for adolescents’ engagement and performance because it contributes to a sense of confidence and control over academic outcomes and because adolescents find an interest in their study material and see the personal relevance of their efforts. Similarly, autonomy-supportive parenting is related to high-quality motivation and adjustment in other domains of adolescents’ life, such as sports (Gagné, Ryan, and Bargmann, 2003) and friendships (Soenens and Vansteenkiste, 2005). Overall, adolescents who perceive their parents as autonomy supportive adjust better to a variety of contexts because in these contexts they engage in activities with a sense of volition.They are involved in activities because they want to rather than because they have to. Further, autonomy-supportive parenting contributes to developmental skills and processes with crucial importance in adolescence, such as emotion regulation and identity development. Autonomysupportive parenting predicts adolescents’ integrative emotion regulation, which refers to the capacity to attend to emotions in an accepting and nonjudgmental fashion and to learn from emotions for future behavior (Brenning, Soenens,Van Petegem, and Vansteenkiste, 2015; Roth, Assor, Niemiec, Ryan, and Deci, 2009). Similarly, autonomy-supportive parenting creates room for adolescents to become aware of and actively explore identity-relevant self-attributes (Ryan and Deci, 2017). Thus, autonomy-supportive parenting would contribute to the formation of an inner compass, which represents an integrated set of personal values, preferences, and interests (Assor, 2018). This inner compass serves as a basis for the selection and regulation of authentic identity commitments, with such authentic identity choices giving rise to feelings of self-congruence and self-acceptance. Consistent with this reasoning, autonomy-supportive parenting relates to adolescents’ experiences of self-congruence (i.e., feelings that behaviors reflect deeply endorsed values and interests; Yu, Assor, and Liu, 2015) and to stronger convergence between adolescents’ implicit and explicit attitudes toward sexuality (with such convergence signaling more self-acceptance; Weinstein et al., 2012). In brief, autonomy-supportive parenting contributes to an open, curious, and nondefensive orientation toward emotional experiences and toward identity-relevant personal attributes, resulting in a strong sense of adolescent authenticity and self-acceptance. Two additional clarifications need to be made regarding the meaning of autonomy-supportive parenting. First, autonomy-supportive parenting is not synonymous with parental promotion of independence (Ryan et al., 2016; Soenens, Vansteenkiste, et al., 2007; Soenens et al., 2018). Autonomysupportive parents do not necessarily encourage adolescents to be self-reliant, let alone leave adolescents to their own devices. Indeed, parents can be autonomy supportive also in situations where adolescents turn to parents for advice and input (i.e., situations of dependence). In such situations of dependence, parents can be autonomy supportive by recognizing adolescents’ need for parental guidance and by actually offering advice, thereby still providing options and asking about the adolescent’s point of view. Conversely, parents who promote independence do not necessarily do so in an autonomy-supportive fashion (i.e., in a way supporting adolescents’ sense of volition) and can even do so in a controlling fashion. Indeed, parents can also insist on adolescent self-reliance 139

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and convey the importance of independence using pressuring language (e.g., pointing out that an adolescent, at his/her age, should be able to stand on his/her own two feet).Thus, for parents to really support adolescents’ need for autonomy (defined as the need to experience authenticity and volition), it is more important to take an adolescent’s perspective than to merely highlight the value of acting independently. Second, autonomy support should not be equated with a permissive (“laissez-faire”) approach. That is, parents can be autonomy supportive when setting rules and when communicating expectations for behavior (Grolnick and Pomerantz, 2009).They can do so by providing a meaningful rationale when introducing guidelines and, if needed, by showing understanding for adolescents’ negative feelings or objections associated with the guidelines. In fact, this combination of clear guidelines (as an aspect of structure) and autonomy support is considered ideal for adolescents to accept and understand the personal relevance of guidelines (Soenens and Vansteenkiste, 2010). Indeed, adolescents of autonomy-supportive parents display deeper internalization of parental rules and values (Roth, 2008; Vansteenkiste, Soenens,Van Petegem, and Duriez, 2014) and better subsequent behavioral adjustment (Sher-Censor, Assor, and Oppenheim, 2015). With an autonomy-supportive parental approach, adolescents follow rules and adopt values because they accept and understand them rather than because they feel compelled to do so, resulting in more wholehearted and persistent adherence to guidelines for appropriate behavior.

Conclusion Although the search for a comprehensive framework to conceptualize parenting in relation to adolescent development is complicated and remains ongoing, there is consensus that the quality of parents’ general parenting style relates in important and meaningful ways to adolescents’ psychosocial adjustment (Collins et al., 2000; Darling and Steinberg, 1993). Authoritative parenting and the dimensions representing such parenting (i.e., high warmth, adequate regulation of adolescent behavior, and low engagement in psychologically controlling practices) are systematically predictive of adolescent well-being and resilience (Steinberg, 2001). Moreover, the field witnesses a striking and promising convergence between bottom-up and top-down approaches to the conceptualization of parenting, with self-determination theory increasingly serving as a theory-driven framework for understanding effects of parenting on adolescent adjustment. These trends in research on parenting in adolescence are displayed graphically in Figure 4.2. SDT essentially represents a needs-based approach to the conceptualization of parenting (Joussemet et al., 2008; Soenens et al., 2017), meaning that the nature of parenting dimensions as well as their repercussions for adolescent development are understood through the lens of adolescents’ psychological needs for autonomy, competence, and relatedness. Such a needs-based approach has two important advantages. First, it allows for clear and a priori predictions about how parental behavior affects adolescent adjustment, with adolescents’ needs-based experiences serving as a criterion to evaluate the effectiveness of parental behavior. Importantly, this needs-based criterion for understanding effects of parenting has led to a distinction between parental structure (i.e., parental behaviors aimed at supporting the need for competence) and controlling parenting (i.e., behaviors that thwart adolescents’ need for autonomy). Second, because the basic psychological needs assumed in SDT have both a bright and a dark side and help to explain both adolescent resilience and vulnerability (Vansteenkiste and Ryan, 2013), the needs-based approach to parenting allows for more balanced attention to both growth-promoting and dysfunctional dimensions of parenting. Because the three basic psychological needs are considered universally important (Deci and Ryan, 2000; Ryan and Deci, 2017), it is assumed that all adolescents benefit when they perceive parents as supporting these needs. Conversely, perceptions of parents as thwarting these needs would be universally detrimental to adolescents’ development. Consistent with these assumptions, there is 140

Figure 4.2  Trends in research on parenting adolescents

PSYCHOLOGICAL CONTROL

STRUCTURE - Rule Setting and Monitoring - Other Strategies to Foster Competence (e.g., Processoriented Feedback)

BEHAVIORAL CONTROL - Rule Setting and Monitoring - Excessive and Harsh Control

DEMANDINGNESS

INVOLVEMENT

RESPONSIVENESS

RESPONSIVENESS

AUTONOMY-SUPPORT

Need-Supportive Parenting

CONTROLLING PARENTING - Externally Pressuring - Internally Pressuring

CHAOS

REJECTION

Need-Thwarting Parenting

Evaluates the effectiveness of parenting on the basis of adolescents’ psychological needs, thereby distinguishing between the bright and darks sides of parenting

THE NEEDS-BASED APPROACH (SDT)

Examines separate effects of three parenting dimensions

THE DIMENSIONAL APPROACH

Discerns four parenting typologies on the basis of two underlying dimensions

THE CONFIGURATIONAL APPROACH

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increasing evidence that perceived autonomy-supportive parenting is related to beneficial developmental outcomes in countries across the globe and that associations between perceived controlling parenting and adolescent maladjustment also generalize across countries and cultures (Barber et al., 2005; Cheung, Pomerantz, Wang, and Qu, 2016; Chirkov, Ryan, and Willness, 2005; Wang, Pomerantz, and Chen, 2007). However, this assumption of universality does not preclude the possibility of contextual and person-related differences in effects of parenting (Grolnick et al., 2018; Soenens,Vansteenkiste, and Van Petegem, 2015). One important way in which contextual conditions (e.g., cultural background) and individual differences (e.g., personality-based characteristics) can affect the consequences of parenting is through their effects on adolescents’ appraisal of parental behavior. That is, depending on their (cultural) background and personal characteristics, adolescents may perceive and interpret parental behavior differently (Bornstein, Putnick, and Suwalsky, 2018; Lansford et al., 2010). For instance, adolescents from more collectivist cultural backgrounds have been found to interpret potentially controlling parental behaviors (e.g., guilt induction) in relatively more benign ways compared to adolescents with a more individualist cultural background (Camras, Sun, and Wright, 2012; Chao and Aque, 2009; Chen et al., 2016; Helwig et al., 2014). Still, even in adolescents with a collectivist cultural orientation, perceived parental controllingness is related to distress and problem behavior in much the same way as in adolescents reared in individualistic contexts (Pomerantz and Wang, 2009; Soenens and Vansteenkiste, 2010). Hence, there is room for interpreting parental behavior differently depending on contextual and personal characteristics, and subjective experiences of parental support (versus thwarting of) basic psychological needs appear to be universally relevant. Because research on contextual and individual differences in effects of parenting is still relatively scarce, an important avenue for future research is to examine more systematically the degree to which personal characteristics (including personality and biological differences such as genetic variants) and contextual characteristics (such as culture, ethnic background, and socioeconomic status) affect parenting-adjustment associations in adolescence. To unravel the specific processes involved herein, research ideally considers adolescents’ appraisal of parental behavior and their specific ways of responding to parental interventions (Soenens et al., 2015).These micro-processes involved in effects of parenting on adolescent adjustment bring us to the final topic of this chapter, adolescents’ agency in the socialization process.

Adolescents as Active Agents in the Socialization Process Throughout the lifespan, interactions between parents and children are dynamic and reciprocal. By the time individuals transition into adolescence, they have accumulated many personal and social experiences. As a consequence, their personality and style of social interaction have become gradually more crystallized (although there is still room for change; Caspi, and Roberts, 2001; Caspi, Roberts, and Shiner, 2005; Roberts, Caspi, and Moffitt, 2001). Because adolescents’ personality and interpersonal style become more stable (Klimstra et al., 2009; Soto, John, Gosling, and Potter, 2011) and at the same time affect the way adolescents interact with others (Neyer and Asendorpf, 2001; Robins, Caspi, and Moffitt, 2002), adolescents’ own characteristics are likely to increasingly determine the nature and quality of their relationship with parents. Testifying to the increasing role of adolescents’ own characteristics in parent–child interactions, the heritability of various behaviors (e.g., externalizing behavior) and attitudes (e.g., conservatism and religiousness) has been found to increase as children grow older, and throughout adolescence in particular (Bergen, Gardner, and Kendler, 2007). Apparently, adolescence is a life period in which genetically predisposed characteristics manifest more strongly than in earlier life periods.This genetic amplification of various characteristics is assumed to occur at least partly through active gene– environment associations (Scarr and McCartney, 1983). Genetically determined characteristics affect the type of environments adolescents seek (or even create) as well as their selection of relationship 142

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partners (e.g., friends, peers, and romantic partners). For instance, adolescents with an inclination toward impulsiveness and sensation seeking are more likely to seek the company of deviant friends. This proactive influence of genetically determined characteristics on individuals’ environment manifests more strongly in adolescence, because this is a developmental period in which individuals become more independent from parents and have more room to shape their own environment outside the home context. Because these genetically determined characteristics in turn affect relationships with parents (with impulsiveness and sensation seeking, for instance, eliciting more conflict and less warmth) across adolescence, the quality of parent–adolescent relationships becomes influenced more strongly by adolescents’ own characteristics (Ludeke, Johnson, McGue, and Iacono, 2013).This effect is caused by evocative gene–environment associations, with adolescent characteristics eliciting certain reactions from parents, and with these reactions in turn further reinforcing these characteristics. For instance, parents may be inclined to grant much confidence to an adolescent who is naturally conscientious (thereby further reinforcing the adolescent’s capacity for self-control), but parents may respond in more controlling and harsh ways to an adolescent with impulse control difficulties (thereby further undermining the adolescent’s capacity for independent self-regulation). Evidence suggests that such evocative gene–parenting associations become more prominent in adolescence compared to early childhood (Avinun and Knafo, 2014). Thus, over time adolescent characteristics and parental behaviors get intertwined in a complex, dialectical interaction (Collins et al., 2000), with adolescents’ own characteristics playing an increasingly important role in the quality of parent–child relationships (Klahr and Burt, 2014). Cognitive development also contributes to adolescents’ agency in parent–child relationships. Adolescents think in increasingly sophisticated and differentiated ways, thereby displaying a stronger ability to reflect about abstract and hypothetical issues (Eccles, Wigfield, and Byrnes, 2003). Because of these changes in cognitive maturation, adolescents discuss, reason, and negotiate with parents in more sophisticated ways, thereby thoughtfully considering the quality of arguments and reflecting about how things could be different (rather than uncritically accepting the status quo). As a consequence, parental authority is taken less for granted and parents face the challenge of renegotiating authority, of reflecting about the necessity of rules that were once self-evident, and of finding valid and personally meaningful arguments for rules that still apply. Because of these various reasons, parenting adolescents is by no means a unidirectional process. Instead, parental characteristics (e.g., behaviors and experiences) are related to adolescent characteristics in an inherently reciprocal and dynamic fashion (Grusec and Goodnow, 1994; Maccoby and Martin, 1983). This reciprocity manifests in at least two important ways, one of which is through bidirectional influences in parent–adolescent relationships. These bidirectional influences involve mutually reinforcing, quantitative changes in parents’ and adolescents’ behaviors or characteristics. For instance, higher levels of adaptive parental behavior elicit a stronger display of positive adolescent behavior (and vice versa), but higher levels of dysfunctional parenting are related to more adolescent engagement in problem behaviors (and vice versa). There is more to the dynamics of parent–adolescent relationships than simple bidirectionality (Kuczynski and De Mol, 2015; Sameroff, 1975). Parents and adolescents contribute to more profound, complex, and qualitative changes in the parent–adolescent relationship. That is, through transactional exchanges they transform the very nature of their relationship, thereby redefining and renegotiating each other’s position in the relationship and seeking new ways of relating to each other. Central to this process of qualitative transformation is adolescents’ appraisal of and response to parental practices (Kuczynski, 2003). With benign adolescent appraisals of parental behavior and subsequent constructive ways of responding to parental behavior, such as negotiation (Skinner, Edge, Altman, and Sherwood, 2003; Van Petegem, Zimmer-Gembeck, et al., 2017) or willing compliance (Kuhn, Phan, and Laird, 2014), there is a stronger likelihood that the parent–adolescent relationship 143

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will become more balanced, mature, and egalitarian. Instead, with more hostile adolescent appraisals of parental behavior and corresponding maladaptive ways of responding to parental behavior, such as reactance (Parkin and Kuczynski, 2012), it is more likely that the parent–adolescent relationship will undergo a power struggle, with both partners in the relationship striving for dominance in the hierarchy. As such, these transactional processes ultimately define the nature and quality of the parent–adolescent relationship (Kuczynski, 2003). Because reciprocity in parent–adolescent relationships can take different forms, in this final part of the chapter we review research on bidirectionality in parent–adolescent relationships and research on more complex manifestations of adolescents’ agency in the transformation of parent–adolescent relationships. Specifically, we discuss adolescents’ (1) negotiations about legitimate parental authority in different social domains, (2) strategies to manage information in interactions with parents, and (3) styles of resolving conflicts with parents.

Bidirectional Influence in Parent–Adolescent Relationships The quality of parent–adolescent relationships is related to adolescents’ adjustment in a bidirectional fashion. For instance, Branje, Hale III, Frijns, and Meeus (2010) showed that high-quality parent–adolescent relationships played a protective role against adolescents’ susceptibility to depressive symptoms. At the same time, adolescents’ risk for depression was found to erode the quality of the parent–adolescent relationship, with depressive symptoms eliciting a decrease in parent–adolescent relationship quality. Similarly, there is increasing evidence that associations between parenting style and adolescent developmental outcomes are reciprocal in nature (Meeus, 2016). Reciprocal associations have been demonstrated using both configurational and dimensional approaches to the assessment of parenting (see Pinquart, 2017a, 2017b for meta-analyses demonstrating these bidirectional associations). For instance, relying on a configurational approach, Padilla-Walker, Carlo, Christensen, and Yorgason (2012) found that mothers’ authoritative parenting was predictive of adolescents’ prosocial behavior toward their mother, with this behavior in turn predicting increased maternal authoritativeness. An authoritative parenting style likely contributes to adolescents’ internalization of the importance of altruistic behavior in the family and to subsequent enactment of more prosocial behavior. In turn, this prosocial behavior makes it easier for mothers to be warm and to allow the adolescent’s input when communicating rules (i.e., to be authoritative). While adaptive parenting sets in motion a positive spiral of parent–adolescent interactions, maladaptive parenting evokes a negative spiral of inadequate parental practices and difficult adolescent behavior. Harris, Vazsonyi, and Bolland (2017) found that permissive parenting predicted increased deviance in a sample of inner-city African American adolescents and that deviance, in turn, predicted increased parental permissiveness. Confronted with adolescent deviance, parents appear to give up on attempts to regulate the adolescent’s behavior. Instead, they step down and no longer even try to provide guidelines for appropriate behavior. This increased parental leniency in turn reinforces adolescent problem behavior (Kerr, Stattin, and Pakalniskiene, 2008). Such reciprocal effects between parenting and adolescent adjustment have also been demonstrated using a dimensional approach to parenting. Associations between psychologically controlling parenting and internalizing problems (Soenens, Luyckx, Vansteenkiste, Duriez, and Goossens, 2008; Wang et al., 2007) and externalizing problems (Janssens et al., 2017) are bidirectional, with such parenting not only increasing risk for problems but with adolescent problems also eliciting more psychologically controlling parenting across time. Adolescents displaying more difficult behavior seem to pull for more controlling parental practices. Possibly, parents experience more negative emotions when faced with adolescent problem behavior (including worry and disappointment or even anger), emotions that increase the likelihood of a parent-centered and domineering response (Dix, 1991). In 144

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addition to this emotional mechanism, parents may believe that a controlling response is the most effective way to alter their adolescent’s behavior in the short term. Some forms of controlling parenting, such as love withdrawal, relate to adolescent compliance with parental requests in the short term (Assor et al., 2004), leading parents to believe that a controlling approach is an efficient short-cut to obtain immediate compliance. Ironically, these controlling practices often contribute to an escalation of further problem behavior in the longer term. Thus, consistent with Patterson’s notion of coercive cycles (Patterson, 1982; Reid and Patterson, 1989), parents and adolescents risk getting caught in a downward spiral of pressuring and reactant interactions (Vansteenkiste et al., 2014). At first sight it may seem contradictory that parents respond to difficult adolescent behavior with both permissiveness (Harris et al., 2017) and increased controllingness (Janssens et al., 2017). However, both types of parental reactions can co-occur in daily life. Confronted with persistent adolescent problem behavior, parents may become generally inclined to give up on attempts to monitor the adolescent’s behavior or to apply consequences. Driven by a sense of helplessness, these parents may wait (too) long to intervene, leaving opportunities for adolescents to engage in additional rulebreaking behavior, and leading parents to suppress their own negative emotions (e.g., worry and anger) regarding the adolescent’s continued (or even increased) problem behavior. However, parents can suppress these negative emotions for only so long, and when negative emotions boil over (e.g., because of a new incident), parents are likely to intervene in a harsh and impulsive fashion, resulting in an abrupt controlling response. These bidirectional dynamics apply to long-term exchanges between parents and adolescents and to short-term (e.g., daily) episodes and interactions. Diary studies demonstrate that, although there are fairly stable inter-individual differences in parental behavior, parenting also fluctuates on a dayto-day basis, with parents for instance showing substantial daily variation in psychologically controlling (Aunola, Tolvanen, Viljaranta, and Nurmi, 2013) and autonomy-supportive parenting (Van der Kaap-Deeder,Vansteenkiste, Soenens, and Mabbe, 2017). Particularly in adolescence, a developmental period characterized by substantial ups and downs in adolescents’ and their family members’ experiences, parental behavior oscillates quite strongly on a daily basis (Mabbe, Soenens,Vansteenkiste, van der Kaap-Deeder, and Mouratidis, 2018). Part of the daily variation in parental behavior seems to be driven by daily fluctuations in adolescents’ daily experiences and behaviors. For instance, research identified bidirectional associations between adolescents’ daily emotional distress and daily conflicts with parents (Chung, Flook, and Fuligni, 2009; Fuligni and Masten, 2010). In summary, there is mounting evidence that the quality of parent–adolescent relationships and parenting are related to adolescents’ psychosocial adjustment in a bidirectional fashion, with parents and adolescents affecting each other’s behaviors and experiences not only on a long-term basis but also in the short term (and even on a daily basis).

Reasoning About Legitimate Parental Authority In toddlerhood, children begin to reason in differentiated ways about different social domains, distinguishing for instance between moral issues (i.e., acts that pertain to others’ welfare or rights, such as fighting, lying, or stealing) and conventional issues (i.e., acts that pertain to social norms, such as table manners; Nucci and Nucci, 1982; Nucci, 2014; Turiel, 1998). With increasing age, children differentiate more clearly between social domains and they add more domains. Children begin to develop fine-grained conceptions of the prudential domain (which pertains to issues of health and safety, such as healthy eating habits and behavior in traffic) and of the personal domain (which involves private issues and choices with personal consequences only, such as clothing and preference for music; Smetana, 2006; Smetana, Crean, and Campione-Barr, 2005). Adolescence marks a substantial change in individuals’ reasoning about social domains, with adolescents considerably expanding the personal domain and considering more issues as falling under 145

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their personal jurisdiction (Smetana, 1995). Because of the tendency for adolescents to consider more issues as personal, there is also an increase in multifaceted issues, that is issues showing an overlap between several domains. Multifaceted issues are a common source of conflict because adolescents and parents often disagree about the nature of these issues, with adolescents mainly emphasizing their personal nature and with parents primarily highlighting their prudential, conventional, or moral nature of these issues. For instance, gaming entails overlap between the moral, prudential, and personal domains. Parents may be concerned about the display of violence in games (i.e., a moral feature) and about the health costs of the sedentary lifestyle associated with gaming (i.e., a prudential issue), but adolescents may consider gaming a matter of individual preference and even an expression of their identity (i.e., a personal issue).The increase in discussions about multifaceted issues in (early) adolescence helps to explain the increase in parent–adolescent conflicts observed in this period (Smetana, 1989; Smetana and Asquith, 1994). As adolescents begin to reason about social domains in more differentiated ways, their conceptions of legitimate parental authority change. Adolescents generally believe that parents maintain legitimate authority about moral, conventional, and prudential issues, but they increasingly reject parents’ authority about personal issues. From early to middle adolescence, adolescents’ acceptance of parental authority over multifaceted issues also declines (Smetana and Asquith, 1994; Smetana et al., 2005). Much like adolescents, parents themselves believe that they retain authority over moral, conventional, and prudential issues, and parents indicate that they have more legitimate authority over these issues than over personal and multifaceted issues. Moreover, as their adolescent grows older, parents assert less authority over multifaceted issues.Yet, the pace of parents’ changing conceptions of legitimate parental authority lags behind on the pace of adolescents’ changing conceptions (Smetana et al., 2005). As a result, in early and middle adolescence, parents and adolescents have a substantially different point of view on personal and multifaceted issues, with parents continuing to affirm relatively high levels of authority over these issues and with adolescents rejecting authority in these domains more firmly. These developmental patterns of conceptions of authority as well as the mismatches between parents and adolescents in terms of these conceptions have been documented in different ethnic groups (Fuligni, 1998) and in different cultures (Yau and Smetana, 1996). Thus, adolescents across the globe seek to redefine their position in the parent–child relationship, thereby asserting more independence in the personal domain in particular (Smetana, 2006, 2018). Adolescents thus take the lead in renegotiating the boundaries of legitimate parental authority. Adolescents’ responses to parental involvement in different social domains signal to parents whether the involvement is considered appropriate or not. When parents intervene in the personal domain, adolescents typically perceive parental interventions as intrusive and meddlesome (Smetana and Daddis, 2002). Possibly because of this perception of parental involvement in the personal domain as intrusive, adolescents are more likely to display reactance against parental authority in the personal domain (Smetana, 2005; Smetana, Wong, Ball, and Yau, 2014). This reactance indicates to parents that, from the adolescent’s perspective, the boundaries of the personal domain were violated. Confronted with this signal, parents then face the challenge of reflecting about their involvement in the adolescent’s life. Such reflection may result in parents adjusting their involvement, with parents for instance intervening less often in the personal domain. However, parents differ in their ability and/or willingness to adjust their involvement to different social domains. For instance, parents with a generally authoritarian parenting style are less inclined than parents with other parenting styles to grant adolescents jurisdiction over personal and multifaceted issues (Smetana, 1995). Parents with a generally authoritative parenting style have been shown to discriminate most clearly between the social domains, allowing adolescents to make independent decisions in the personal domain but keeping parental authority in the moral, conventional, and prudential domains (Smetana, 1995). Because adolescents increasingly delineate the boundaries of their personal domain, parents become gradually less inclined to intervene in issues that fall under adolescents’ personal jurisdiction. 146

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On average, parents are less restrictive, set fewer rules, and introduce fewer prohibitions in the personal domain compared to other domains, such as morality (Van Petegem,Vansteenkiste, et al., 2017). Still, parents differ in the degree to which they intervene within each of the social domains. This within-domain variation between parents is important because the effectiveness of parents’ socialization practices depends on the domain involved. Research increasingly shows that the developmental outcomes of parental interventions differ depending on the social domain involved (Grusec, Danyliuk, Kil, and O’Neill, 2017; Hasebe, Nucci, and Nucci, 2004; Smetana, Campione-Barr, and Daddis, 2004). For instance, parents’ communication of rules is related differentially to adolescent outcomes within different social domains (Arim, Marshall, and Shapka, 2010).While parental rule setting in the moral-conventional domain is unrelated (or even related negatively) to adolescent problem behaviors, rule setting in a more personal or multifaceted domain, such as friendships, is related positively to problem behaviors, and to externalizing problems in particular. Thus, parental rule setting in the moral domain plays a potentially protective role in adolescent behavior, but rule setting in more personal domains seems to backfire more often and to increase the risk for problem behaviors. These domain-dependent effects of parental rule setting can be explained by differences in the degree to which adolescents are willing to accept and internalize parental guidelines. For instance, the degree to which parents prohibit moral misbehavior is related positively to adolescents’ internalization (i.e., self-endorsed acceptance) of rules for moral behavior (Vansteenkiste et al., 2014;Van Petegem, Vansteenkiste, et al., 2017). Because moral rules and prohibitions are considered as legitimate and as falling under parents’ jurisdiction, adolescents more easily accept parental guidelines in this domain. In contrast, the degree to which parents prohibit certain friendships relates negatively to internalization and even positively to adolescents’ oppositional defiance against parental prohibitions (Van Petegem,Vansteenkiste, et al., 2017). Because parental intervention in this domain is perceived as illegitimate, adolescents are likely to react against parents’ authority in an attempt to restore their independence and to safeguard their personal domain.This rebellious response then elicits a tendency to do the opposite of what parents expect, resulting in a heightened risk for problem behaviors. Given that adolescents are so sensitive about parental intervention in the personal domain, should the personal domain then be considered a total “no-go zone” for parents? Is any type of parental involvement in this domain doomed to yield conflict and adolescent defiance? Not necessarily. Even within a highly personal domain such as friendships, parents can set rules or introduce prohibitions in a way that does not elicit resistance. This can be achieved by adopting an autonomy-supportive style of communication (Soenens et al., 2009). Indeed, when parents take the adolescent’s perspective (i.e., asking about the adolescent’s point of view and recognizing that it may not be easy to take some distance from certain friends) and provide a meaningful rationale, adolescents may be open to consider the parent’s point of view and accept the rule or prohibition. To provide such a meaningful rationale, parents do well to highlight the moral and prudential aspects of their intervention (e.g., indicating for instance their concerns with the friends’ morally inappropriate behavior) rather than more personal aspects (such as parents’ disapproval of these friends’ lifestyle). When, instead, parents communicate the prohibition in a more pressuring fashion (e.g., threatening to withdraw privileges when a friendship is not terminated), adolescents are more likely to react against the parent’s prohibition and still affiliate with friends who are not approved of by parents (Soenens et al., 2009). Thus, although parental involvement in the personal and multifaceted domains is more risky (because there is an increased likelihood that parents’ involvement will be perceived as illegitimate and will be reacted against), even within these domains parents can still intervene in a way that supports adolescents’ autonomy and that contributes to appropriate behavior. Similarly, parents’ style of communication matters within the other social domains as well. Although adolescents are more inclined to accept parental authority and rule setting in the moral domain compared to the personal domain, when parents adopt a controlling (i.e., pressuring) style in the moral domain, adolescents are less likely to internalize parents’ rules and are more likely to defy 147

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those rules (Hardy, Padilla-Walker, and Carlo, 2008; Padilla-Walker and Carlo, 2006; Vansteenkiste et al., 2014;Van Petegem,Vansteenkiste, et al., 2017). Hence, also in the moral domain it is important for parents to take adolescents’ frame of reference and to support their autonomy rather than to impose rules in an authoritarian, threatening, or patronizing fashion. In summary, adolescents increasingly differentiate between social domains and they evaluate the legitimacy of parental authority and rule setting differently depending on the social domain involved. Parents face the challenge of adjusting their involvement in adolescents’ life to these changing conceptions of legitimate parental authority. The degree to which parents adequately and flexibly adjust their socialization efforts to adolescents’ domain-differentiated views of legitimate parental authority determines the effectiveness of parents’ rules and restrictions.

Active Information Management Another way in which adolescents demonstrate their agency in parent–child relationships is through their active management of the degree and type of information they provide to parents (Marshall, Tilton-Weaver, and Bosdet, 2005; Smetana, 2008).The importance of adolescents’ information management is underscored by the finding that most of parents’ knowledge about adolescents’ whereabouts and activities stems from adolescents’ spontaneous disclosure of information (Kerr and Stattin, 2000; Kerr, Stattin, and Berk, 2010; Stattin and Kerr, 2000; Stattin and Skoog, 2019) and to a lesser extent from active parental efforts to seek information about adolescents’ behavior (e.g., through supervision and solicitation of information; Fletcher, Steinberg, and Williams-Wheeler, 2004; Soenens,Vansteenkiste, Luyckx, and Goossens, 2006). Thus, differences between parents in terms of how much they know about their adolescent’s activities are largely a function of adolescents’ own disclosure (versus secrecy). Adolescents generally disclose less information to their parents compared to younger children, with disclosure (and corresponding parental knowledge) declining in particular in early adolescence (Keijsers, Frijns, Branje, and Meeus, 2009; Laird, Marrero, Melching, and Kuhn, 2013). In addition, adolescents become more selective in the type of information they disclose to parents and they develop a broad spectrum of specific information management strategies. In between the two extremes of full disclosure of information and full concealment and secrecy, adolescents rely on a variety of strategies, including partial disclosure (i.e., telling only part of the story or telling the truth but omitting details), telling parents only if they ask, avoiding issues (e.g., by directing the conversation away from sensitive issues), and lying (Bakken and Brown, 2010; Darling, Cumsille, Caldwell, and Dowdy, 2006). Using this differentiated arsenal of strategies, adolescents attempt to actively regulate the amount and type of information available to parents and to protect their privacy in the parent–adolescent relationship. Although there is a general decline in adolescent disclosure, on average information management strategies aimed at revealing information (i.e., through full or partial disclosure) remain more prevalent than secrecy and lying strategies aimed at concealing information (Laird et al., 2013).Yet, there are substantial individual differences between adolescents as well as within-adolescent variations (across situations and time) in the usage of these information management strategies. Adolescents actively reflect about the pragmatic value and consequences of these strategies, thereby considering for instance anticipated parental reactions to (non)disclosure of information and the legitimacy of parental knowledge in specific situations and domains (Smetana, 2008). Based on these considerations, adolescents then select information management strategies that best serve their goals, preferences, and values. One important consideration in adolescents’ selection of information management strategies is parents’ anticipated response to (disclosure) of misbehavior (Tilton-Weaver et al., 2010). Adolescents become more secretive when they expect that parents will respond negatively (i.e., in a cold, angry, 148

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and critical fashion) to misbehavior, and they are more inclined to disclose information when they expect that parents will respond more positively (i.e., attempting to understand what happened and displaying warmth). Most likely, these anticipated parental reactions are themselves a function of both adolescents’ behavior and parents’ general parenting style. Adolescents who engage more often in misbehavior and who display externalizing problems are less likely to disclose information and more likely to be secretive toward parents (Laird et al., 2013), with parents in turn having less knowledge about these adolescents’ whereabouts and activities (Laird, Pettit, Bates, and Dodge, 2003). Because these adolescents have more serious misconduct to hide, they anticipate more negative consequences when parents become aware of the misconduct. Parents’ general parenting style also plays a role. Adolescents disclose more information and are more open about their whereabouts and activities when parents are generally experienced as warm and autonomy supportive (Darling et al., 2006; Fletcher et al., 2004; Soenens et al., 2006). Within such a secure parenting climate, adolescents are probably more likely to anticipate a reasonable and appropriate parental response to disclosure of inappropriate behavior. Also, such a need-supportive parenting climate can contribute to adolescents’ perceived legitimacy of parental authority, with this perceived legitimacy in turn increasing adolescents’ willingness to disclose information. Indeed, adolescents more often disclose information to parents in response to parental attempts to obtain knowledge (e.g., through monitoring of behavior) when they perceive parents’ authority as being legitimate (Keijsers and Laird, 2014). Adolescents’ beliefs about parents’ legitimacy to be informed also depends on the social domain involved. Much like adolescents make domain-specific evaluations of the appropriateness of parental rules, they differentiate between social domains when reflecting on the need to disclose information to parents. Adolescents believe that parents have more legitimate authority to be informed about prudential issues than about personal or multifaceted issues, with moral and social-conventional issues taking an intermediate position between the two extremes (Smetana, Metzger, Gettman, and Campione-Barr, 2006). As a consequence, adolescents think it is more acceptable to manage information provided to parents (e.g., by omitting details or telling only if asked) in the personal domain compared to the prudential domain (Rote and Smetana, 2016). Parents largely share these domaindifferentiated beliefs about their right to know about adolescent activities, and parents also view adolescents as less obligated to disclose activities as they get older (Smetana et al., 2006). Still, parents generally believe (i.e., across domains) that they should be informed more than adolescents do. In summary, adolescents regulate the communication of information to parents in an active, differentiated, and sophisticated way, with various considerations and beliefs playing a role in their actual degree of disclosure or non-disclosure vis-à-vis parents. Ultimately, this degree of (non)disclosure of information has important repercussions for the quality of parent–adolescent relationships and for adolescents’ psychosocial adjustment. Low levels of disclosure forecast more troubled parent– adolescent relationships (Smetana,Villalobos,Tasopoulos-Chan, Gettman, and Campione-Barr, 2009) as well as increases in externalizing problem behaviors (Keijsers et al., 2009) and internal distress (Laird et al., 2013; Laird and Marrero, 2010). Particularly when adolescents are actively secretive (rather than merely low on disclosure), they display psychosocial problems (Finkenauer, Engels, and Meeus, 2002; Frijns et al., 2010; Frijns, Finkenauer, Vermulst, and Engels, 2005). Thus, adolescents’ information management in parent–adolescent interactions is an important indicator of the quality of the relationship as well as a reliable predictor of psychosocial adjustment.

Conflict Management Styles Conflicts between parents and adolescents are particularly prevalent in early adolescence (Laursen et al., 1998) but should not be regarded as uniformly problematic. Conflicts can be meaningful episodes providing learning opportunities for emotion regulation and constructive social interaction (Collins, Laursen, Mortensen, Luebker, and Ferreira, 1997; Granic, 2005).The extent that adolescents 149

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actually learn from these episodes depends on both parents’ and adolescents’ ways of managing conflicts (Adams and Laursen, 2007; Branje, Van Doorn, Van der Valk, and Meeus, 2009). To understand adolescents’ contribution to the resolution of conflicts with parents, research has addressed the role of four different styles of conflict management (Missotten, Luyckx,Van Leeuwen, Klimstra, and Branje, 2016; Van Doorn, Branje, and Meeus, 2008). Positive problem solving involves attempts to understand the parent’s point of view and to negotiate with the parent constructively. This constructive style of conflict management can be contrasted with three more dysfunctional styles. Conflict engagement refers to a hostile, impulsive, and overtly destructive way of dealing with conflicts, as expressed in anger, verbal abuse, and an attacking attitude. Withdrawal involves disengagement from the conflict, with the adolescent avoiding talking and becoming distant. Finally, compliance entails that the adolescent submits to the parent’s solution to the conflict, without however asserting his/her own position and without really endorsing the value of the parent’s resolution. As they grow older, adolescents become more effective in managing conflicts with parents. Indeed, while the use of constructive problem solving generally increases throughout adolescence, conflict engagement decreases (Van Doorn, Branje, and Meeus, 2011). Most likely, this development toward engagement in more mature conflict management styles is affected by other developmental processes, including increasing capacity for self-control (Duckworth and Steinberg, 2015) and abilities for perspective taking (Crone and Dahl, 2012;Van der Graaff et al., 2014). Demonstrating the importance of adolescents’ conflict management, problem solving was found to predict decreases in frequency of conflicts between parents and adolescents (Missotten, Luyckx, Branje, Hale, and Meeus, 2017; Rueter and Conger, 1995). This constructive style of conflict management prevents an escalation of conflicts, whereas the more dysfunctional styles of conflict management do not have such a preventive effect or even increase the likelihood of conflicts. Associations between conflict management styles and conflict frequency are reciprocal in nature, with these styles not only affecting the occurrence of conflicts, but with the frequency of conflicts also having an effect on the quality of adolescents’ conflict management. Indeed, in families in which conflict is highly frequent, adolescents are more likely to resort to maladaptive ways of approaching conflicts, including conflict engagement and compliance (Missotten et al., 2017). In addition to affecting the frequency of conflict, conflict management styles also affect the developmental consequences of conflict. High-frequency conflict is generally detrimental to adolescents’ development, but the conflict management styles used by adolescents determine to some extent the manifestation of developmental problems associated with high-frequency conflict (Branje et al., 2009). Adolescents who display a mixture of dysfunctional conflict management styles are particularly likely to suffer from conflicts in terms of internalizing distress, whereas adolescents who often withdraw from conflicts with parents are particularly susceptible to the effect of conflicts on externalizing problems (Branje et al., 2009). Adolescent withdrawal from conflicts is strongly associated with externalizing problems when parents at the same time engage in conflicts (Caughlin and Malis, 2004;Van Doorn et al., 2008). This so-called demand-withdraw pattern of conflict resolution is indicative of a coercive style of resolving family conflicts, resulting in a tendency for adolescents to distance themselves from the family. Ultimately, adolescents’ conflict management styles determine not only adolescents’ within-family exposure to conflict and their personal adjustment, but also their interpersonal functioning in relationships beyond the family, including relationships with peers, friends, and romantic partners (Adams and Laursen, 2001). Adolescents involved in destructive conflict management patterns at home are involved more frequently in similar patterns of conflict management while interacting with peers at school and during leisure-time activities (Trifan and Stattin, 2015). Similarly, early adolescents’ conflict management styles with parents forecast their conflict management styles with friends (Van Doorn, Branje, van der Valk, De Goede, and Meeus, 2011). In middle and late adolescence, associations between conflict management styles with parents and conflict management styles with friends 150

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become bidirectional, with conflict management styles used in both types of relationships reinforcing each other either in a positive direction in the case of constructive conflict resolution or in a negative direction in the case of dysfunctional conflict management (Van Doorn, Branje, et al., 2011). Adolescents’ conflict management with parents even translates into their conflict management with romantic partners, with positive problem solving in relationships with parents predicting problem solving in late adolescents’ romantic relationships (Staats, van der Valk, Meeus, and Branje, 2018). Overall, conflict management styles used in the home context appear to serve as a template for how conflicts are dealt with in the outside world. Given the important developmental implications of conflict management styles, research examines the sources and antecedents of adolescents’ engagement in different styles. In line with the idea that adolescents’ personality increasingly affects their interaction with parents, adolescents’ personality traits are related to their conflict management styles, with agreeableness in particular being related to more constructive (i.e., problem-solving) attempts to handle conflicts (Missotten et al., 2016). However, over and above effects of adolescent personality, parents’ rearing style also plays a role. Adolescents who generally experience parents as more need-supportive (e.g., high on responsiveness and low on psychological control) are more inclined to seek constructive ways of resolving conflicts (Missotten et al., 2016; Rueter and Conger, 1995). Several processes are likely involved in the effects of generally supportive parenting on constructive conflict management, including parents’ own demonstration of adequate conflict resolution, adolescents’ stronger valuation of a high-quality relationship with parents, and adolescents’ resources for adequate emotion regulation and social interaction. In summary, adolescents’ style of conflict management in parent–adolescent interactions substantially affects the degree to which conflicts are learning experiences or, instead, experiences that increase risk for ill-being and problematic behavior. Adolescents’ conflict management styles are rooted in a complex interplay between personal characteristics (e.g., personality) and parent-related characteristics (e.g., quality of general parenting style), and these styles are related to the frequency of conflict between parents and adolescents in a bidirectional fashion. Because of their importance in the adequate resolution of conflicts, conflict management styles play a significant role in adolescents’ psychosocial development, with constructive conflict management not only constituting a resource against personal maladjustment but also spilling over to conflict management and relationship satisfaction in relationships outside the family.

Conclusion The view that parents have a unidirectional impact on adolescent development has long been obsolete (Bornstein et al., 2012). Although models describing parent–adolescent relationships as bidirectional and reciprocal in nature were developed some time ago (Bell, 1968; Maccoby and Martin, 1983; Sameroff, 1975), systematic empirical research examining reciprocity in parent–adolescent relationships began to accumulate only relatively recently. The collection of larger, multiwave longitudinal datasets and the increased availability of easy-to-use statistical programs to analyze longitudinal data (e.g., through cross-lagged modeling and latent growth curve modeling) undoubtedly enabled a more systematic inquiry into bidirectional developmental processes. This research clearly confirmed theoretical models of bidirectional socialization, demonstrating that high-quality parenting contributes to adolescents’ psychosocial adjustment and that adolescents who are well adjusted make it easier for parents to interact with them in a supportive fashion. Unfortunately, some parents and adolescents are caught in a negative vicious cycle of dysfunctional, need-thwarting parenting and adolescent ill-being and inappropriate behavior. Reciprocity in parent–adolescent relationships manifests in bidirectional influences between parents’ and adolescents’ behavior. However, adolescents also contribute to more fundamental and qualitative changes in the nature of the parent–adolescent relationship. For instance, adolescents define 151

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more clearly the boundaries of their personal domain and privacy, become more selective in the information they provide to parents, and become increasingly proactive in their attempts to resolve conflicts in parent–adolescent relationships. A common theme in these different strategies applied by adolescents is the search for ways to reconcile their personal goals and preferences with those of their parents. As such, the transformation of parent–adolescent relationships essentially revolves around themes of identity and autonomy (Laursen and Collins, 2009; Steinberg and Silk, 2002). When these themes are dealt with constructively, the parent–adolescent relationship becomes more balanced and egalitarian. Because the empirical literature on the theme of adolescent agency is fairly new, there is a strong need for additional research. Ideally, this future research will take a dynamic and ecologically valid approach (e.g., using diary studies and observations of parent–adolescent interactions) to examine adolescents’ appraisals (e.g., perceptions and legitimacy beliefs) of and responses to parental behavior. The identification of these appraisals and responses is essential to better understand why adolescents differ in their sensitivity to the benefits of potentially growth-promoting parenting and in their vulnerability to the risks associated with potentially detrimental parenting. By examining factors that affect adolescents’ appraisals and responses (e.g., social domain considerations, personality traits, and contextual determinants), much additional knowledge can be obtained about the dynamic interplay between adolescents’ and parents’ contributions to the socialization process.

Conclusions Although one may wonder whether parents still matter in adolescence, a developmental period in which children take distance from the family and develop more independence, the research reviewed in this chapter demonstrates abundantly that parents remain key socialization figures in adolescence. This is not to say that parents’ role is straightforward. Adolescent development is highly dynamic and multidirectional. As a result, parents of adolescents face various challenges and their contribution to adolescents’ development must be considered in the context of many other sources of influence on adolescent behavior and well-being (including biological changes and peer influences). Still, parents are involved in adolescents’ development in several important ways. Both through specific practices and through the quality of their general parenting style, parents can help their adolescent to navigate through the various developmental tasks of adolescence, including coping with puberty, developing adequate emotion regulation strategies, forming their identity, and building social competence. Also, an important task for parents is to adjust adequately to their adolescent’s attempts to renegotiate the parent–child relationship. This adjustment requires flexibility and a willingness to reconsider earlier modes of relating to their child. Ultimately, this adjustment process affects parents’ own identity and involves coming to terms with a new role as a parent. There are many ways to achieve these complex goals, but it is generally important for parents to support adolescents’ needs for autonomy, competence, and relatedness. When adolescents feel that these needs are satisfied, they fare well emotionally, they are more resilient against adverse contextual influences (e.g., negative peer pressure), and they contribute to their own development in more proactive, courageous, and constructive ways. The specific ways in which parents can nurture these psychological needs depend on many factors, including the social domain involved, adolescents’ personality, and the family’s cultural background. In the end, however, it is essential for adolescents to experience their parents as creating room for authenticity, as having confidence in adolescents’ skill development, and as being involved in a caring and loving manner. To support adolescents’ needs is by no means an easy task. However, it is highly worthwhile because a high-quality parent–child relationship continues to serve as a source of resilience throughout adolescence and contributes to a successful launch into adulthood.

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5 PARENTING EMERGING ADULTS Laura M. Padilla-Walker and Larry J. Nelson

Introduction A growing body of research across a diverse number of countries and cultures suggests there is a considerable portion of young people who do not yet see themselves as adults. For example, a study of college students from numerous institutions across the United States, when asked whether they felt like they had reached adulthood, revealed that 16% of the emerging adults answered “yes,” 13% answered “no,” and 72% answered “in some ways yes, in some ways no” (Nelson et al., 2007). The parents of these emerging adults felt the same way about their children, answering in almost identical proportions to their children when asked, “Do you think that your child has reached adulthood?” Although the nature of the sample employed in this example (predominantly European American college students from privileged socioeconomic backgrounds) precludes any broad generalizations of how all young people and their parents feel about the nature of the transition to adulthood, these findings point to the growing realization that the role of parents in the lives of their children may not be finished as their children prepare to and then enter the third decade of life. It may, in fact, be the growing variance in how and when young people make the transition into adulthood that necessitates a closer examination into the role that parents may play in the lives of their 18- to 29-year-old children (“emerging adults”). The past several decades have marked numerous changes that have increased the timing, diversity, and complexity of paths out of adolescence and into adulthood. For example, as the average age of marriage has risen (29 years for males and 27 years for females in the United States; U.S. Census Bureau, 2015), and the number of jobs available to those without higher education has decreased, more and more young people are single, living at home, and financially dependent (at least partially) on parents well into their twenties. In some of these scenarios, compared to past generations, there is a greater need for many parents to remain engaged in the parenting process longer than previously expected. For others, economic and familial factors necessitate a more immediate donning of adult responsibilities and independence. For them, parents may play less of a role, or parents may play equally important but different roles than emerging adults who are less independent. Taken together, it is not surprising that this edition of the Handbook of Parenting marks the first to have a chapter devoted solely to parenting during emerging adulthood. The work reviewed in this chapter reflects the significance of examining the diverse and important ways that parents may influence the lives of their children during the third decade of life. Specifically, this chapter (1) provides a theoretical and developmental foundation for the study of parenting 168

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during the third decade of life, (2) examines specific aspects of parenting, including parenting styles, parenting dimensions, and the parent–child relationship in relation to adjustment and maladjustment during emerging adulthood, and (3) outlines directions for future work in regard to parenting of emerging adults.

Theories of Parenting in Emerging Adulthood A number of theoretical models may help us understand the importance of parent–child relationships during emerging adulthood and how these relationships are important for development during the third decade of life. The general theoretical view of socialization suggests that parents’ behaviors shape children’s psychological adjustment and interpersonal abilities (Feldman, Gowen, and Fisher, 1998) and equip them with the skills to succeed in the varied settings (e.g., school, workplace) and social interactions (e.g., peer group, romantic relationships) they encounter as they make their way toward adulthood. The centrality of parent–child relationships in this socialization process during emerging adulthood is best considered by examining both continuity (social learning theory and attachment theory) and change (family systems theory and life course perspective) in relationships over time. Finally, both dynamic systems and family systems theories emphasize the role that context has in shaping the functioning of familiar relationships and the individual development that occurs within those relationships. Social learning theory (Bandura, 1977) suggests that individuals learn by observing one another. Specifically, the learner imitates the behavior of another person who is demonstrating, or modeling, a particular behavior. In regard to the socializing role of parents in the transition to adulthood, social learning theory (Whitbeck, Hoyt, and Huck, 1994) suggests that patterns of interactions that are established and maintained during the formative years will be modeled to some degree as emerging adults leave the parental home and establish new relationships and, ultimately, families of their own (Aquilino, 2006). Indeed, parents serve as models for what it means to be an adult in domains such as family and work contexts. For example, parents hold very specific views of what is requisite to become an adult (Nelson et al., 2007) and to be ready for important role transitions such as marriage (Willoughby, Olson, Carroll, Nelson, and Miller, 2012). In a recent study examining young people’s beliefs, values, and behaviors related to marriage, Willoughby and James (2017) illuminate just how much of young people’s approaches to issues related to marriage (e.g., timing of, desire for, and readiness to marry as well as desired characteristics of potential spouses) stem from what they saw within their own parents’ marriages. In summary, it is clear that parents serve as important models that affect beliefs, values, choices, behaviors, and relationships during the third decade of life. Another way that early patterns of interaction with family members continue to impact young people during emerging adulthood is via the nature of the parent–child relationship. In particular, attachment theory suggests that early parenting behaviors shape children’s internal working models of attachment (Ainsworth and Bowlby, 1991). These internal working models in turn influence subsequent relationships, including the formation of romantic relationships (which is a key developmental milestone within the third decade of life; Arnett, 2000) by affecting children’s sense that they are worthy of another person’s love and can trust others. Although internal working models of attachment may change over time, the attachment relationship that is formed early in life will generally remain stable and in turn influence the formation of relationships during emerging adulthood (Fraley and Roisman, 2015). Indeed, research has found a moderate level of continuity in the parent–child relationship in particular over the transition to adulthood (Englund, Kuo, Puig, and Collins, 2011). Although stability in the attachment relationship is certainly not the case for all emerging adults, and a number of transitions (e.g., living away from home, marriage) may influence the quality of attachment, it is clear that attachment with parents is as an important lens through which young people navigate the relational landscape of emerging adulthood. 169

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Although continuity is likely, family theories suggest that changes in the family system or changes over time also impact development. Family systems theory suggests that it is specifically the family that provides the environment within which individual members are impacted by and impact each other as an interconnected set (or system) of relationships. In terms of change in relationships over time, a family life course perspective suggests that the trajectories of family members are interdependent and there is a consistent interplay between the individual development of the emergingadult children and other family members (Aquilino, 2006). This interplay is based on two main processes, namely that (1) family relationships change over time as a function of the development of individuals in that family and (2) life trajectories of family members are influenced by changes in family relationships over time. Like other living systems, families attempt to maintain a sense of equilibrium in their relationships so as changes occur within the family, the system (i.e., the pattern or relationships within the family) will constantly strive to establish a new state of equilibrium. As emerging adults experience different life transitions (e.g., leaving the family home, college, work, marriage), many of their relationships may change and begin a new period of development wherein emerging adults and their parents interact in new ways, which, in turn, impact the trajectory (for good or bad) of emerging-adult children. Based on the theoretical notion that changes brought about in the course of development are the impetus for restructuring parent–child interactions that in turn influence the trajectories of individuals, it is important to also consider developmental changes that might be unique to emerging adulthood. First, going beyond the pubertal changes that occurred during adolescence, the brains of emerging adults are continuing to grow. Synaptic pruning, myelination of the prefrontal cortex, and changes in the limbic system occur within the brain from early adolescence into the early twenties (Sowell, Trauner, Gamst, and Jernigan, 2002; Steinberg, 2005). Given the reorganization of the prefrontal cortex, young people are able to plan, engage in metacognition, and think increasingly well about abstract concepts. As a result, they are able to contemplate abstract notions related to identity development, including exploration of various abstract beliefs related to religion, politics, and worldviews in general. Furthermore, growth in these areas of the brain contributes to greater executive functioning (e.g., the ability to control impulses and emotions, organize, and self-monitor), which means that tasks requiring self-restraint, planning, and thinking about consequences for the future will be difficult for young people whose prefrontal cerebral cortex is not yet fully mature (Luna et al., 2001; McClure et al., 2004; Steinberg et al., 2009). Given that this part of the brain is not fully developed until approximately 25 years of age (Steinberg, 2010), there may be significant ramifications for the range and potential impact of possible choices and behaviors (e.g., pursue education or not, career decisions, participation in risk behaviors, financial choices) facing young people as they leave adolescence. Second, dynamic systems theory posits that children (including their minds and bodies) and their environments (physical and social contexts) form an integrated system that guides mastery of new skills, and this system is constantly changing (Fischer and Bidell, 2006; Thelen and Smith, 2006). It is beyond the scope of this chapter to outline the vast number of contexts and cultures within which young people are transitioning to adulthood. Instead, we provide an example of how context may interact with intrapersonal factors (brain growth) to shape development to demonstrate why parents matter in the lives of their emerging-adult children. In the United States and many other Western, industrialized nations, marriage is being postponed. Also, there has been a move away from a manufacturing economy to a service economy, and the jobs within this type of economy require postsecondary education, which delays entrance into self-sustaining careers (Arnett, 2000). Taken together, the transitions in what were traditionally seen as milestones of adulthood (marriage, parenthood, finishing education, starting a career) are being delayed until well into the third decade of life for many young people. Given this context within which many (but, again, certainly not all) young people are developing, we are now prepared to examine the role that parents may play in development. For example, if we 170

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take the changes that are occurring within individuals (brain growth) and the developmental context (delay of marriage and need for higher education resulting in an unstructured time to explore and experiment) within which those individuals live, we might see a potential problem. As discussed previously, tasks requiring self-restraint, planning, and thinking about consequences for the future may be difficult for young people for whom the prefrontal cerebral cortex is not yet fully mature (Luna, Thulborn, Munoz, Merriam, Garver, Minshew et al., 2001; McClure, Laibson, Loewenstein, and Cohen, 2004; Steinberg, Graham, O’Brien, Woolard, Cauffman, and Banich, 2009). That being said, the age of 18 brings higher levels of autonomy for young people within a context lacking structure. Young people in this context may have the means, time, and opportunities to explore and experiment without the future-thinking, regulatory, and planning skills requisite to navigate that context. Without the foundational skills provided for by development of the prefrontal cortex (e.g., the ability to control impulses and emotions, organize, plan for the future, and self-monitor), some young people may flounder as they are presented with the opportunities to engage in risky exploration and experimentation that are so common during this period of life (Ravert, 2009). Given this reality, parents could potentially provide a bridge from the more structured world of adolescence to the point in time when the prefrontal cortex has developed more fully, allowing for greater maturity in offspring decision-making and behavior. Again, it must be underscored that individual characteristics and developmental contexts vary tremendously across genders, cultures, socioeconomic conditions, and so forth. However, by providing the example of developmental context, it is our desire to show that it is at the intersection of individuals and their environment that we will better understand the roles that parents play as their children approach and then enter the third decade of life. In summary, there are a number of strong theoretical arguments for the important role of parents during emerging adulthood. Parents may directly socialize their children along the developmental path toward adulthood in ways that include serving as models for what it means to be “adult.” Parents may also indirectly impact their children’s development during the third year of life via, for example, the internal working models of relationships that have developed within the parent–child attachment relationship.Taken together, although young people may be striving for greater autonomy from their parents, even that developmental quest occurs within the context, or system, of the family as life trajectories of family members both impact and are influenced by changes in family relationships over time. Hence, to best understand young people’s development during the third decade of life, theoretically it appears essential that we understand the role of parents in the process. Reviewing literature to determine just how parents can do that best (i.e., parent in a way that leads to flourishing rather than floundering in their children) will be the focus of the next sections of the chapter. It is notable that research on parenting during the third decade of life is in its infancy compared to parenting during the formative years. That being said, there are substantive bodies of research on broad parenting styles during emerging adulthood as well as dimensions of parenting such as parental support, autonomy granting, and control. The remainder of this chapter will discuss each of these aspects of parenting in turn, while also highlighting important ideas for future research.

Parenting Styles Parenting styles are characterized as making up the broad, overarching emotional climate of the relationship between parents and children (Darling and Steinberg, 1993) and theoretically moderate the link between more specific parenting practices and children’s outcomes (Padilla-Walker and Son, in press). In other words, specific parenting strategies or practices may be more or less effective depending on the parenting style or climate of the overall relationship. Although most research on parenting styles has been conducted during the formative years of childhood and adolescence, a growing body of research also has explored parenting styles during emerging adulthood using the original characterization of parenting styles including authoritative, authoritarian, and permissive approaches. 171

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Overall, it appears that emerging-adult college students primarily perceive their parents to be authoritative (i.e., high levels of warmth and support, as well as high levels of appropriate demandingness and expectations), although there are some differences in perceptions as a function of gender and ethnicity. College students in the United States (Nelson, Padilla-Walker, Christensen, Evans, and Carroll, 2011), Australia (Conrade and Ho, 2001), South Africa (Roman, Makwakwa, and Lacante, 2016), Korea (Kim and Chung, 2003), and Israel (Alt, 2015) report authoritative parenting to be the most common. Mothers are generally reported to be more authoritative than are fathers. One study also found that young men perceived fathers to be more authoritarian and mothers to be more permissive than did young women, whereas young women perceived mothers to be more authoritative than did young men (Conrade and Ho, 2001). In a sample of South African college students, black fathers scored lower on authoritativeness than did white fathers (Roman et al., 2016). Similar to research conducted during the formative years (Grusec and Goodnow, 1994), research shows that perceptions of parenting styles during emerging adulthood vary somewhat in frequency as a function of gender and culture/ethnicity. Research on the associations between parenting styles and child outcomes during emerging adulthood reveal similarly complex patterns. More specifically, during emerging adulthood authoritative parenting has been the most consistent parenting style associated with adaptive outcomes. For example, mothers and fathers who were authoritative had children who reported lower academic amotivation (Alt, 2015), higher selfesteem (Jackson, Pratt, Hunsberger, and Pancer, 2005), better adjustment to university, and lower levels of depression, impulsiveness (Patock-Peckham, King, Morgan-Lopez, Ulloa, and Moses, 2011), and drinking behavior. However, links between parenting, impulsiveness, and drinking for young women were only significant for fathering, whereas for young men they were only significant for mothering, again highlighting the complexity of relations between parenting styles and child outcomes. Authoritative mothering (but not fathering) has been associated negatively with anxiety and depression for young women only (Barton and Kirtley, 2012), and with lower odds of drug use for young men only (in the Philippines; Hock et al., 2016). Authoritative fathering (but not mothering) has been associated with androgynous gender identity (Lin and Billingham, 2014), which was linked to better health practices and socioemotional outcomes. One study found that emerging-adult college students who reported having both an authoritative mother and father had the lowest levels of internalizing and externalizing problems, those with either an authoritative mother or father had moderate levels of problem behaviors, and those who had no parent who was authoritative were by far the most maladjusted (McKinney, Morse, and Pastuszak, 2016). In contrast to authoritative parents, authoritarian and permissive parenting are relatively less adaptive during emerging adulthood. For example, authoritarian mothering and fathering have been associated positively with maladaptive perfectionism in college students, which was then associated with test anxiety (Soysa and Weiss, 2014). Similarly, authoritarian parenting has been positively associated with extrinsic motivation (Alt, 2015), anxiety (among Chinese students; Cheung, Cheung, and Wu, 2014), and low self-reliance (among Korean American college students; Kim and Chung, 2003). One study found that authoritarian fathering was associated positively with stress, but for young men only (Barton and Kirtley, 2012). In terms of permissive parenting, research has found that permissive mothering and fathering have been associated with academic entitlement (Barton and Hirsch, 2016), stress (Barton and Kirtley, 2012), and anxiety, which in turn were associated with higher levels of depression among college students. Permissive parenting has also been associated with more impulsiveness (Patock-Peckham et al., 2011), alcohol-related problems (Whitney and Froiland, 2015), academic amotivation (Alt, 2015), and drug use (for young men; Hock et al., 2016). An interesting note regarding the research on parenting styles relates to the larger theoretical question about whether parenting looks the same during emerging adulthood as it does during the formative years. Whereas most research has used the same parenting styles during emerging adulthood as have been explored during childhood (e.g., authoritative, authoritarian, permissive), one 172

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study asked the question of whether different parenting styles were used during emerging adulthood than those that exist prior to that point. Although also based on a college student sample, Nelson and colleagues (2011) considered a variety of dimensions of parenting (e.g., control, warmth, autonomy) and used a person-centered approach to determine what parenting styles might emerge during emerging adulthood. They found that about 45% of mothers and 30% of fathers could be classified as authoritative, which was the most common style, but other styles included uninvolved (i.e., scores below the mean on all parenting dimensions), and controlling-indulgent (i.e., scores above the mean on both control and indulgence, while scoring low on warmth) also emerged. These unique styles suggest that perhaps parenting does not look the same during emerging adulthood as it does during childhood and adolescence when children are in the home, and continued research should not only consider traditional types of parenting during emerging adulthood, but also allow for unique patterns and approaches as both parents and children adjust to their changing roles. In summary, clearly research supports the adaptive nature of emerging adults who perceive their parents to be authoritative, with less adaptive outcomes for parents who are perceived as being authoritarian or permissive. These findings are relatively consistent with research during childhood and adolescence, but consider outcomes that are more appropriate for the developmental tasks of the third decade of life. It is also clear from the available literature that results vary as a function of the gender of the parent and the child, although not in any meaningfully consistent manner. These differences could be a function of the larger number of studies exploring authoritative parenting, but findings also suggest that the impact of authoritative parenting may differ somewhat more consistently as a function of these contextual variables than do authoritarian or permissive parenting. It is of note that the vast majority of studies used college student samples that were predominantly European American and an average age of 18–20 years old. The majority of studies also considered only the child’s perception of parenting, without considering the parents’ perspective or that of an outside observer. More research is needed that considers the role of parents in the lives of emerging-adult children who are not currently in school, as roles may differ widely when parents are supporting a child through college compared to when a child is working and supportive him- or herself. A notable number of studies considered parenting styles from other countries, and findings across cultures were similar, but the use of college samples from multiple cultures may result in more similarity than is really there cross-culturally (due to similarity across cultures in college student samples; Haidt, Koller, and Dias, 1993), necessitating more research with samples of varying ethnic, socioeconomic, and cultural backgrounds.

Dimensions of Parenting Throughout childhood and adolescence, three important dimensions of parenting have been identified, including support (e.g., acceptance, warmth, affection, nurturance), autonomy granting (e.g., giving choices, allowing the child input on rule making, permitting the expression of ideas, avoiding intrusive behavior), and control (e.g., limit setting, supervision, reasoning about consequences; Hart, Newell, and Olsen, 2003). Each aspect of parenting has been linked to specific child outcomes, but the unique balance, or ratio, of these features of parenting changes across development. For example, it is much more appropriate to exert higher levels of control over toddlers than adolescents or emerging adults. In addition to the developmental shift in the appropriate balance between these key aspects of parenting, the forms they take likewise change developmentally. For example, parental warmth and support toward children (e.g., assisting with homework, driving to baseball games, attending piano recitals) might look different than it would for emerging adults (e.g., listening to work- or school-related concerns). In summary, the balance among support, autonomy, and control changes across development as do the ways in which each is displayed. By the end of adolescence, it is expected that the balance will shift extensively toward the need for greater child autonomy 173

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and much less (if any) parental control. This is not meant to suggest that the beginning of emerging adulthood brings an end to the role of parents in the lives of their children, but it should signify the beginning of what may arguably be the most significant reorganization of the parent–child relationship in development, including a shift in the balance and form of the dimensions of parenting. Thus, a closer look at the dimensions of parenting in emerging adulthood is necessary to understand the roles that parents play in the lives of their children during the third decade of life.

Parental Support Research on parental support during emerging adulthood exists in many forms, with little attempt at connection across literatures. In this section, we synthesize a broad literature and suggest that perhaps the most commonly studied aspect of parenting during emerging adulthood is overall support. In some studies support is conceptualized as social support, in others warmth or attachment, and in yet others the overall quality of the parent–child relationship. Although coming from somewhat different perspectives, we argue that all of these studies tap into the same underlying aspect of parenting that is considered during the formative years (e.g., warmth/support), but that the ways in which it is measured and the types of support may be somewhat different during emerging adulthood than they were during childhood or adolescence. Theories of social support suggest that a supportive parent–child relationship may be important for emerging adults, and that parental support (compared to support from other sources) may be especially important in meeting certain needs such as chronic stress or financial problems (Messeri, Silverstein, and Litwak, 1993). Similarly, functional specificity models of relationships suggest that relationships are not only a matter of preference and need, but also may serve very distinct functions in the lives of emerging adults (Simons, 1983). This model purports that the basic needs of security, intimacy, and self-esteem are met by relationships and that different relationships meet these needs in unique ways. For example, parent–child relationships may be especially important for feelings of security during the transition to adulthood, but may not be as central for intimacy or self-esteem needs compared to other sources of social support. That being said, there is ample evidence that parental support is key to a variety of healthy developmental outcomes during the third decade of life. More specifically, both mothers and fathers are important sources of social support for emergingadult children across a variety of cultures. For example, parental social support has been associated concurrently with less depression and loneliness for both European and African American college students (Mounts, 2004). Parental social support has also been associated with lower levels of risky sexual behavior (Simons, Burt, and Tambling, 2013), open parent–child communication about sex, and higher sexual self-esteem among college students (maternal support; Riggio, Galaz, Garcia, and Matthies, 2014). Longitudinally, parental social support has been associated with lower levels of self-criticism and higher levels of goal attainment in Israeli college students (Dickson and Shulman, 2016), better psychological adjustment (well-being, distress) from ages 18–20 for European American college students (Holahan, Valentiner, and Moos, 1994), and better academic and social adjustment over a 3-year time span for Croatian college students (Smojver-Ažić, Dorčić, and Juretić, 2015). One study found that a sample of diverse emerging adults (not a college student sample) who reported intense levels of support from parents (several times a week, financial, advice, emotional support) reported better psychological adjustment and higher life satisfaction than those who did not report intense support (Fingerman et al., 2012). Given research and popular media attention suggesting that parents are increasingly overinvolved in their college students’ lives, this study was novel in claiming that not only support, but also high levels of support, can be adaptive during emerging adulthood. It is likely that intense emotional and financial support can be adaptive, while similar behaviors that are used in a controlling manner (e.g., helicopter parenting) are less adaptive. Thus, it is important to take into account parental motivation and specific parenting practices (as opposed to 174

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broad dimensions and styles). Relatedly, the majority of studies suggest social support is a strength, but one study found that perceived parental support among Finnish emerging adults was associated with lower levels of volunteerism 2 years later, suggesting that perhaps emerging adults who are overly close with their family may be less willing to reach out and help strangers (Pavlova, Silbereisen, Ranta, and Salmela-Aro, 2016). In other words, the maintenance of close family relationships during the transition to adulthood could impact emerging adults’ willingness to reach out and build relationships with others. However, this study was the only one that linked social support to a less than optimal outcome, and whereas it is an intriguing finding, it is certainly in need of replication. Taken together, the majority of research on the role of parental support suggests that parents continue to play a key role in helping their children during the transition to adulthood, especially in terms of positive psychological adjustment. Similar to general measures of support, specific aspects of the parent–child relationship indicative of support have also been linked to positive outcomes during emerging adulthood. For example, parent–child attachment in college student samples has been associated with higher levels of self-esteem, especially for young women (60% Latino/a; Laible, Carlo, and Roesch, 2004), and paternal (but not maternal) acceptance was associated with psychological adjustment (Poland; Filus and Roszak, 2014) and lower levels of anxiety (Reitman and Asseff, 2010). In one study, maternal warmth was associated with less production of cortisol (healthy cortisol levels peak in the morning and then decrease throughout the day) and also moderated relations between stress and cortisol production among college students (50% Asian American; Lucas-Thompson, 2014). Maternal warmth/responsiveness has also been associated with lower levels of drug use among European American (but not Asian American) college students (Luk, Patock-Peckham, and King, 2015), higher academic achievement via perceived teacher social support among Argentinean college students (mother and father responsiveness; de la Iglesia, Hoffmann, and Liporace, 2014), and higher levels of self-regulation and social competence among Turkish emerging adults (non-college student sample; Moilanen and Manuel, 2017). Parental warmth and attachment have also been consistently linked with romantic relationship quality during emerging adulthood. More specifically, paternal warmth/attachment was associated with romantic relationship quality in European American college students (Karre, 2015) and intimate relationship satisfaction among college students from Mozambique (Cruz, 2014). In a sample of Italian emerging adults (non-college student sample), attachment to the father was directly and positively related to life satisfaction, whereas attachment to the mother was negatively associated with insecure romantic attachment, which was in turn associated with life satisfaction (Guarnieri, Smorti, and Tani, 2015). In summary, it is clear that the research on warmth and attachment is consistent with the research on support in suggesting that emerging adults who feel they have a supportive, loving, trusting relationship with parents, also report positive psychological and relationship outcomes. Finally, research on parent–child relationship quality is also consistent with research on social support suggesting that, overall, a positive parent–child relationship is beneficial during the transition to adulthood. Child-reported mother-child relationship quality (support, companionship, intimacy, aid) was associated positively with prosocial values, religious faith (Barry, Padilla-Walker, and Nelson, 2012), and prosocial behavior (Barry, Padilla-Walker, Madsen, and Nelson, 2008) among college students. Positive parent–child relationship quality (intimacy, conflict, relative power) has also been associated with higher levels of well-being when making the university-to-work transition (German college students; Buhl, 2007), lower levels of anxiety and higher academic self-efficacy and GPA (Cutrona, Cole, Colangelo, Assouline, and Russell, 1994), and higher overall happiness for emergingadult college students (40% European American, 40% African American; Demir, 2010). Relationship quality protects against problem behaviors such as risky drinking (Serido, Lawry, Li, Conger, and Russell, 2014) and nonmedical prescription opioid use (non-college sample; Cerda et al., 2014). Thus, the body of research assessing relationship quality adds to the social support literature in suggesting that emerging adults who report having a positive relationship with their parents not only 175

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report lower levels of risk behaviors, but also higher levels of both academic and moral outcomes, as well as general well-being and happiness. Whether parental support is operationalized as general support, parental warmth, attachment, or relationship quality, it appears that parents continue to be important in the lives of their emerging-adult children, especially in terms of providing support during the transition to adulthood. This body of research tells us little about specificity in parenting practices, but it does suggest that the foundation of a positive relationship with parents is widely studied and consistently associated with a variety of healthy child outcomes.

Parental Autonomy Support Another aspect of support during emerging adulthood, autonomy support, is characterized by parents who support their child in making his or her own decisions. Given the developmental importance of an increase in autonomy during the transition to adulthood (see Grolnick, Deci, and Ryan, 1997), there are surprisingly relatively few studies that consider the impact of parental autonomy support on the parent–child relationship and child outcomes during this time period. Certainly, as will be discussed below, a relatively larger body of research considers the role of parental control, but a lack of control does not necessarily mean a promotion of autonomy. A number of studies considered both autonomy support and other aspects of parenting during emerging adulthood, and autonomy support was not always significantly associated with child outcomes once other parenting was taken into account (Fulton and Turner, 2008). Given the challenge many parents face in balancing involvement and autonomy support when their children leave the family home, parental autonomy support will be an important area for continued research. Research that has explored the role of perceived parental autonomy support during the emergingadult years has generally found that it is associated with positive outcomes. For example, parental autonomy support has been associated with subjective well-being among college students (Ratelle, Simard, and Guay, 2013), and parental denial of autonomy has been associated with alcohol problems for European American (but not Asian American) college students (Luk et al., 2015). Parental autonomy support has also been associated with feelings of autonomy and relatedness (which were in turn negatively associated with anxiety) in both U.S. and Italian college student samples (Inguglia et al., 2016) and protective self-regulatory processes (which were in turn negatively associated with depression) among non-college African American emerging adults (Kogan and Brody, 2010). Another study found that for Latino immigrant college students, parental facilitation of autonomy was important to success in school, although sometimes this felt like a mixed blessing because it was often due to parents’ inability to help (Ceballo, 2004). This study suggests that the impact of autonomy support may be different depending on the parental motivation or the child’s perception of why the support is being given. It seems clear that research is consistent with theory suggesting the importance of parental autonomy support during the transition to adulthood, especially as it relates to psychological well-being. However, additional research is clearly needed to explore how autonomy support might impact additional child outcomes and how it interacts with other aspects of parenting (e.g., control, involvement) and child characteristics (e.g., temperament) to influence child outcomes.

Parental Control Similar to research conducted during the formative years, the growing body of work examining controlling and intrusive forms of parenting in emerging adulthood shows that, when parents attempt to exercise negative control aimed at limiting their children’s behavioral autonomy (i.e., harsh, threatening, authoritarian behaviors) or psychological and emotional autonomy (i.e., psychological control), the outcomes tend to be negative. In this section we discuss three forms of control, namely behavioral control, psychological control, and helicopter parenting. These three forms are related 176

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but unique types of control and are linked to a variety of mostly negative outcomes in the lives of emerging-adult children.

Behavioral Control Given the developmental appropriateness of granting greater levels of autonomy to young people as they leave adolescence, parental behavioral control should diminish significantly in emerging adulthood even for those living at home. However, many parents still try to control the behavior of their emerging-adult children. Obviously, behavioral control in emerging adulthood will look different than it did in childhood and adolescence when it took the form of time-outs, grounding, revoking television/computer/video game privileges, or corporal punishment (e.g., spanking, slapping). In emerging adulthood, some parents still attempt to maintain control over the behavior of their emerging-adult children by setting rules about how they spend their money, trying to control what classes they take or jobs they pursue, or controlling what they do with their free time. Not surprisingly, the increasing amount of evidence on the effects of parental behavioral control during emerging adulthood reveals that it is correlated both concurrently and longitudinally with numerous negative outcomes. For example, maternal self-reports of behavioral control have been linked to college students’ lower emotional control (Manzeske and Stright, 2009), and parents who use high levels of punishment and hostility have emerging-adult children with higher levels of depression, anxiety, and impulsivity and lower levels of social competence, self-worth, and kindness (Nelson et al., 2011). Although these studies suggest that control is linked to negative outcomes, the picture may be a little more complex than imagined at first glance, as research has found variability in emerging adults’ perceptions of parents’ legitimate authority to control their behavior. More specifically, in a study of university students in the United States, Padilla-Walker, Nelson, and Knapp (2014) examined the extent to which young people felt their parents had legitimate authority in social conventional (e.g., socially acceptable behavior), moral (e.g., lying, cheating), personal (e.g., free time), and prudential (e.g., personal safety) domains of their lives. The majority of emerging adults (66%) perceived their parents to have moderate legitimate control in some areas (e.g., moral), but not others (personal), whereas a smaller group (11%) consisted of emerging adults who perceived their parents to have legitimate authority in all four domains and a third group (24%) consisted of emerging adults who did not perceive their parents as having legitimate control in any domain. Emerging-adult children who felt their parents had legitimate authority over most issues in their lives tended to feel less like adults, reported parents who were financially involved in their lives, and reported high levels of behavioral control and helicopter parenting (Padilla-Walker et al., 2014). In summary, factors such as perceptions of legitimate authority may determine just how quickly parents begin granting greater autonomy for their children. Notably, if parents are financially involved in the lives of their emerging-adult children, the children see parents as having some legitimate authority in decisions (Padilla-Walker et al., 2014), although parents may then use this financial advantage as a means to control emerging-adult children inappropriately to the detriment of their children’s wellbeing (Nelson et al., 2011). Behavioral control appears to take on different forms and be used less frequently in emerging adulthood, but when it is used, it is linked to rather negative outcomes in the third decade of life.

Psychological Control Compared to behavioral control, there is a larger body of work examining psychologically controlling forms of parenting in emerging adulthood, possibly because psychological control is a more common form of control in emerging adulthood due to the fact that it is difficult to behaviorally control children at this age (often due to not being in physical proximity). Psychological control is a 177

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parent’s attempt to control his or her child’s thoughts and psychological world (see Barber, 1996; Barber and Harmon, 2002) and includes parents inducing guilt if the child does not do what is desired (“After everything I’ve done for you, this is all that you’re going to do for me?”), ignoring the child if behavior is seen as unacceptable (referred to as love withdrawal), and trying to change how the child thinks or feels through manipulation. Emerging-adult children with psychologically controlling parents report problems in numerous domains of development. In particular, maternal psychological control has been associated with anxiety among college students, especially young women (Reitman and Asseff, 2010). Parental psychological control has also been linked to depression (Reed, Ferraro, Lucier-Greer, and Barber, 2015), lower levels of autonomy (Zimmer-Gembeck, Madsen, and Hanisch, 2011), lower levels of emotional regulation (Manzeske and Stright, 2009), and difficulties in coping with interpersonal stress (Abaied and Emond, 2013). Psychological control has been found to be indirectly associated with lower levels of same-sex peer competence and romantic partner social competence (Moilanen and Manuel, 2017), eating disorder symptoms and exercise dependence symptoms (Costa, Hausenblas, Oliva, Cuzzocrea, and Larcan, 2016), and participation in risk behaviors (e.g., getting drunk, use of illegal drugs, driving drunk; Urry, Nelson, Padilla-Walker, 2011). Emerging adulthood is a time during which young people explore their identity in regard to work, love, and worldviews (Arnett, 2000) and is also a key time for gaining an education, starting a career, and establishing more stable and intimate romantic relationships. Psychological control is detrimental in all three of these areas. More specifically, one longitudinal study with university freshman in Flanders, Belgium, found stable associations between psychological control and identity (i.e., negative associations with both commitment dimensions and a positive association with exploration in breadth; Luyckx, Soenens, Vansteenkiste, Goossens, and Berzonsky, 2007). Another longitudinal study found that lower initial levels of and decreases in paternal psychological control were associated with higher levels of education completed, and, for young men, higher perceived educational abilities (Desjardins and Leadbeater, 2017). Also for young men, decreases in maternal psychological control were associated with higher perceived educational abilities. Finally, in a study conducted in the United States with slightly older university students who were mainly female and European American, Karre (2015) found that less paternal psychological control was linked to greater levels of support in romantic relationships for young men, and higher levels of paternal psychological control was linked to more conflict in the relationship for both young men and women.Thus, psychological control seems to be detrimental to developmental tasks that are central to emerging adulthood. There is also a body of work examining factors that mediate the links between psychologically controlling parenting and emerging adults’ adjustment. For example, in a study of American and Italian emerging adults, researchers found that links between psychological control and emerging adults’ anxiety and depressive symptoms were mediated by lower levels of perceived autonomy and relatedness (Inguglia et al., 2016). Similarly, research has found that links between psychological control and educational abilities were mediated by emerging adults’ depression (Desjardins and Leadbeater, 2017), such that decreases in psychological control were related to lower levels of depression, which were in turn associated with higher levels of educational outcomes. Other mediators between psychological control and emerging-adult outcomes include lower levels of self-regulation (Moilanen and Manuel, 2017), maladaptive perfectionism (Costa et al., 2016), and emerging adults’ willingness to disclose to their parents (Urry et al., 2011). In summary, a growing body of evidence suggests that psychological control appears to foster problems of an internalizing nature, hinder developmentally important markers of growth (e.g., educational and occupational attainment, identity development), and negatively impact emerging adults’ relationships with others including parents, peers, and romantic partners.

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Helicopter Parenting A final way that parents sometimes attempt to control their children during emerging adulthood is via helicopter parenting. This form of intrusive parenting consists of parents “hovering” over their emerging-adult children and making important decisions for them such as where they should live, whom they should date, and what classes they should take. The term “helicopter” parenting first emerged via media and popular culture (Gabriel, 2010; Marano, 2010) and caught on and persisted without any empirical evidence supporting the claim that it was a unique form of controlling parenting during emerging adulthood. It should be noted, though, that similar constructs such as overprotective and over-solicitous parenting have been studied extensively for years with younger children and have been consistently linked with maladaptive outcomes (Rubin, Hastings, Stewart, Henderson, and Chen, 1997). Helicopter parenting has since been distinguished from behavioral control and psychological control (Padilla-Walker and Nelson, 2012) as well as other forms of parenting such as autonomy support (Reed, Duncan, Lucier-Greer, Fixelle, and Ferraro, 2016). The work that has emerged examining helicopter parenting suggests that it may not be as harmful as behavioral or psychological control but is linked nevertheless to less than optimal outcomes. This developmentally inappropriate parenting practice appears to be linked to various indices of maladjustment within the educational setting in particular. For example, helicopter parenting has been found to be associated with low self-efficacy (Bradley-Geist and Olson-Buchanan, 2014), alienation from peers, and lack of trust among peers (van Ingen et al., 2015) for European American university students. Helicopter parenting has also been negatively related to indices of adjustment, such as school engagement (Padilla-Walker and Nelson, 2012), school functioning (Luebbe et al., 2016), coping skills (Abaied and Emond, 2013; Odenweller, Booth-Butterfield, and Weber, 2014; Segrin, Woszidlo, Givertz, and Montgomery, 2013), and decision-making skills (Luebbe et al., 2016). Research has also found that students whose parents engaged in higher levels of overparenting produced more maladaptive responses to potential workplace scenarios (e.g., blaming others, lying, getting others to solve problems for them; Bradley-Geist and Olson-Buchanan, 2014). Taken together, these findings are disconcerting given that educational and early career successes are significant milestones for many individuals during the third decade of life. Educational contexts are not the only settings wherein children of helicopter parents appear to struggle. Numerous studies have revealed a link between helicopter parenting and indices of anxiety and depressive symptoms (Luebbe et al., 2016; LeMoyne and Buchanan, 2011; Rousseau and Scharf, 2015; Schiffrin et al., 2014), negative internal locus of control (Kwon,Yoo, and Bingham, 2016), and lower levels of well-being (for young women, Kouros, Pruitt, Ekas, Kiriaki, and Sunderland, 2017). This latter study by Kouros and colleagues is particularly noteworthy because it is one of the few studies on helicopter parenting to explore ethnic differences, but results did not find that ethnicity played a role in the association between helicopter parenting and indices of well-being. Finally, another important developmental milestone of the third decade of life is forming more stable and intimate romantic relationships including, for many, marriage (Arnett, 2000). Albeit very limited, emerging work suggests that helicopter parenting may take a toll in this domain as well, as it has been found to influence emerging adults’ attitudes and beliefs, including negative marital attitudes (Willoughby, Hersh, Padilla-Walker, and Nelson, 2015). Just as with other forms of controlling parenting, there may be factors that mediate and moderate the effects that helicopter parenting has on young people in the third decade of life. Selfefficacy (Bradley-Geist and Olson-Buchanan, 2014), attachment anxiety (Jewish-Israeli emerging adults; Rousseau and Scharf, 2015), and perceptions of psychological control may mediate relations between helicopter parenting and maladaptive outcomes. Similarly, links between helicopter parenting and child outcomes may be moderated by other aspects of parenting, the most notable of which is parental warmth. Indeed, some of the media depictions of hovering parents suggest that it is a form

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of control that might be driven by excessive warmth and care on the part of the parents as they want to prevent their children from making mistakes or experiencing failure. However, research does not seem to reflect the notion that helicopter parenting is even significantly associated with parental warmth, positively or negatively (Padilla-Walker and Nelson, 2012). One study found that helicopter parenting was associated with lower levels of self-worth and higher levels of risk behaviors for those emerging adults who reported low levels of warmth from their parents (especially their mothers), but not for those with high levels of warmth. These results suggest that warmth in conjunction with helicopter parenting does not lead to positive child outcomes, but the lack of warmth in the context of helicopter parenting is particularly harmful. The exploration of warmth in relation to helicopter parenting also raises the question of parental motivation. Are helicopter parents loving and protective, albeit misguided, or are they trying to control their children? One study examined the extent to which parents’ having a prevention focus (e.g.,“Not being careful enough has gotten me into trouble at times.”) versus a promotion focus (e.g., “I feel like I have made progress toward being successful in my life.”) predicted their use of helicopter parenting (Jewish and Arab families; Rousseau and Scharf, 2017). Analyses revealed that higher levels of prevention focus (for mothers and fathers) were associated with higher levels of helicopter parenting, which led the authors to speculate that parents with higher levels of prevention focus may use helicopter parenting as a tactic for preventing their children from making mistakes. These results, along with attempts to examine the role of warmth (Nelson et al., 2015), point toward the need to better understand the motivations that parents have for engaging in helicopter parenting. Taken together, research shows that helicopter parenting is a unique and measurable form of control in emerging adulthood. Furthermore, it is becoming increasingly clear that helicopter parenting in and of itself is not inherently warm and is not facilitative of emerging adults’ development. In fact, it appears to be linked to negative outcomes in educational pursuits and to be associated with problems reflective of both internalizing problems and externalizing problems, especially when helicopter parenting occurs in the context of low parental warmth. It is of note that behavioral and psychological control are generally more detrimental to child outcomes than is helicopter parenting, but in summary it is clear that all forms of control appear to be far from adaptive during the third decade of life.

Future Directions in Parenting During Emerging Adulthood Given that research on emerging adulthood is in its infancy, it is impressive to review the wealth of research that has considered the role of parents in the lives of their emerging-adult children. Although existing research clearly highlights the continued importance of parents during the transition to adulthood, much still needs to be done to increase our understanding and provide parents and educators with information that will help families and young people. In this section, we discuss a few directions that research should consider as the field moves forward. First and foremost, research needs to consider the diversity of individuals who make the transition to adulthood (college versus non-college, culture, ethnicity, age, gender, and so forth) and explore how different aspects of parenting might be differentially important for some compared to others. Second, research should consider the bidirectional nature of the parent–child relationship, especially given findings that parenting may become less directly associated with child outcomes as children get older (Padilla-Walker, 2014). Third, research on parenting during emerging adulthood would benefit from greater specificity and exploration of multidimensionality in both parenting and child outcomes (Bornstein, 2015). Fourth, future research should explore how emerging adults who have their own children in the third decade of life adjust to the transition to parenting compared to those who have children in their 30s or 40s. Finally, research on parenting during emerging adulthood should consider how parents of emerging adults navigate this time in their child’s life, as parents of emerging-adult children are also experiencing numerous transitions. 180

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A Need for Diversity Not surprisingly, the majority of research on parenting during emerging adulthood relies on U.S. college student samples. In addition, most of these samples are convenience samples, and researchers often do not consider the developmental issues that might be unique to emerging adulthood and to college students. Indeed, we know little about whether parenting during emerging adulthood is distinct from parenting during adolescence, and how parenting might vary meaningfully for university, college, and non-college emerging adults. Although nearly 70% of U.S. American adolescents attend college, this group is overrepresented by European American and high-income individuals (Arnett, 2016a). Furthermore, only half of this 70% attend 4-year universities, with the remainder attending 2-year colleges, so data using primarily university samples, at best, only represent about a third of emerging adults in the United States, not to mention those who are underrepresented by using university samples in other countries. The majority of university samples also consist of emerging adults in the first few years of the third decade of life. Given that emerging adulthood is purported to span the years 18–29, continued research should explore how parenting might change from early to late emerging adulthood, both in terms of parenting behavior and children’s needs. Indeed, a child who is making her first transition from the family home to college life or to work is likely quite different in terms of the need for parenting and parental support than is a child in his late 20s who already has a family and has been working for 5 years. There is also still a great deal of debate regarding whether the theory of emerging adulthood (Arnett, 2000) applies across different social classes and cultures. Arnett (2016b) argued that there are similarities across social class (Arnett, 2016b), whereas others continue to argue convincingly that there are meaningful differences and more research is needed (du Bois-Reymond, 2016; Furstenberg, 2016). Beyond culture, ethnicity, and social class there is mounting evidence that emerging adulthood is largely a “his” and “hers” reality, with young men and young women experiencing this time period differently, with young men reporting higher levels of floundering overall (Nelson and PadillaWalker, 2013). Given these findings, we know relatively little about how the role of parents may differ for young men and young women. Although some studies certainly found differences, taken together these differences did not approach a meaningful pattern of results, and continued research is needed in this area. In short, there is a great need to expand our study of parenting during the third decade of life to include diversity in a variety of ways to understand more clearly the variability that exists in the transition to adulthood.

Bidirectionality of the Parent–Child Relationship Parenting research during the formative years has long called for additional research considering the active role of the child in shaping parent–child interactions (Grusec and Goodnow, 1994), and researchers have been increasingly responsive. However, there is a relative dearth of research considering the active role of the child during the third decade of life, perhaps because of the paucity of longitudinal studies during this period. Given parenting research suggesting that the goal of Western socialization is to rear children who are independent and autonomous and who internalize parental and societal values, it is logical that, as children age, parenting should be less directly associated with child outcomes and more indirectly related (Grusec and Goodnow, 1994; Padilla-Walker, 2014). The direct impact of parenting may decrease as children age, but research during late adolescence has found that children continue to shape parenting (Maggs and Galambos, 1993; Padilla-Walker, Carlo, Christensen and Yorgason, 2012), and additional research is needed during emerging adulthood. One study found support for the active role of the child, but suggested that it depends on the aspect of the child’s behavior that is considered. More specifically, the authors found that emergingadult college students’ rule-breaking behavior was associated with parenting, while aggression and 181

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ADHD were not (McClelland and McKinney, 2016). Whereas this study provides initial support for the idea that child characteristics impact parenting during emerging adulthood, these data were cross-sectional and so could not accurately assess direction of effects. Another study found that emerging-adult college students’ personality was more strongly associated with adjustment than was parenting style, although relations between the child’s personality and parenting were not explored (Schnuck and Handal, 2011). However, this study suggested that, although direct paths between parenting and child outcomes are present during emerging adulthood, they are weak and somewhat inconsistent compared to child characteristics (which are notably shaped by parenting during the formative years). We are also aware of one study that explored bidirectional longitudinal associations between parenting (involvement, autonomy support, warmth, and control) and emerging-adult college students’ prosocial behavior, and found that children’s prosocial behavior at Time 1 was a consistent predictor of parenting 1 year later, but parenting was not longitudinally associated with prosocial behavior (Padilla-Walker, Nelson, Fu, and Barry, 2017). More specifically, emerging adults who were more prosocial at Time 1 reported mothers who had higher levels of warmth and autonomy support and lower levels of behavioral control 1 year later, suggesting that children’s behavior was shaping parenting rather than the other way around.Taken together, we can determine little that is conclusive from these studies, but it is clear from theory and research during the formative years that children are active participants in the parent–child relationship, so certainly more research should consider how children influence their parents (and vice versa) during the transition to adulthood.

Specificity and Multidimensionality It became clear in reviewing the literature on parenting during emerging adulthood that the aspects of parenting and the types of child outcomes that have been explored are relatively limited.The largest body of research by far is that exploring the role of general social support and the broad parent– child relationship. Whereas it is fruitful to understand that having a positive relationship with one’s child is important during the transition to adulthood, this broad information leaves relatively little detail to provide parents with specific answers to how one might go about maintaining or building this relationship. In other words, we know that parents are important during emerging adulthood, but know much less about parenting during emerging adulthood. The specificity principle (applied to parental cognitions in particular, but related to many aspects of parenting) suggests that “specific cognitions and practices on the part of the specific parents at specific times exert specific effects over specific children in specific ways” (Bornstein, 2015, p. 77). This principle also supports the idea that effective parenting at one stage of life might not be effective at another and helps to highlight the need for a more nuanced approach to parenting during emerging adulthood. For example, we know that a parent should support his or her child and should not be controlling, but what type of support is the most helpful (e.g., financial, emotional, social) and how much support is optimal (see Bornstein and Manian, 2013)? A positive relationship is associated with adaptive outcomes, but how can parents best maintain a positive relationship with their children when the child no longer resides with the parent or when the parent–child relationship was strained during the formative years? If a child is struggling in work or in school, what specific strategies might parents use to encourage and support their child? Is supportive parenting associated positively with some child outcomes, while inhibiting other outcomes such as autonomy or independence? Are there aspects of parenting (e.g., helicopter parenting) that might be unique to emerging adulthood and that therefore need to be explored with greater specificity? As noted earlier, it will be essential for future research to not just look at parenting during emerging adulthood as more of the same, but to critically examine how parenting might look different during this period, or how it ought to look different given the age of the child. Both parenting and child outcomes are multifaceted, and recent edited volumes have argued for a need to

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explore diverse dimensions of parenting to more fully capture its influence across the lifespan (Laible, Carlo, and Padilla-Walker, in press). In addition to more specificity needed in how to measure and think about parenting, the research during emerging adulthood generally has focused on child outcomes that are somewhat risk based to the exclusion of indicators of flourishing beyond general life satisfaction (see Padilla-Walker and Nelson, 2017). Thus, continued research should explore not only how diverse aspects of parenting impact a variety of risk behaviors, but also how parenting promotes or detracts from positive child outcomes during emerging adulthood, such as civic and political engagement, moral development, self-esteem, and prosocial behavior, as well as positive relationship formation and other aspects of flourishing. In short, the existing research on parenting during emerging adulthood is an impressive start given the relative infancy of the field, but overall next steps should include specificity and multidimensionality.

Emerging Adults Who Are Parents There is a significant literature on the transition to parenthood, but few studies make a distinction between those who transition to parenthood during emerging adulthood and those who transition later. Given that the average age of first parenthood in the U.S. is during emerging adulthood (26.3 years for women, 27.4 for men; Mathews and Hamilton, 2016), a significant portion of emerging adults are becoming parents, but we know little about how this impacts their development differently than it might those who become parents later in life. Or perhaps more importantly, we know little about how becoming a parent in one’s early 20s is related to developmental outcomes compared to becoming a parent in one’s late 20s or early 30s. The age of first parenthood is lower than the age of first marriage in the U.S., highlighting that the context for becoming a parent is changing, with many emerging adults having children within cohabiting relationships (Holmes, Brown, Shafer, and Stoddard, 2017). This recent chapter by Holmes and colleagues highlights the transition to parenthood for emerging adults, but acknowledges that the majority of existing research does not focus on this developmental period specifically when considering mental and physical health outcomes for parents. Thus, we know little about whether becoming a parent is uniquely challenging (or beneficial) during early-emerging adulthood when one is potentially also balancing school or a new job, so future research should consider these questions.

Parents of Emerging Adults Whereas research has focused with increased regularity on how parents are involved in the lives of their emerging-adult children and how this impacts the child, there is less research considering how parenting an emerging-adult child impacts the parent. Although media depictions would lead one to believe that most parents of emerging-adult children are either fed up with their child or are engaging in extreme helicopter parenting, the research that has been done suggests that parents are generally satisfied with their child and are experiencing positive mental health. Research from a national survey of over 1,000 parents of emerging adults in the U.S. (Arnett and Schwab, 2013) suggested that a vast majority of parents reported that their relationship with their emerging-adult child was a primary source of enjoyment for them (in addition to hobbies, media, and relationship with their spouse) and that the relationship with their child had become more enjoyable and respectful now that the child was an emerging adult. About 45% of U.S. parents reported helping their children frequently or regularly with financial support, although very few parents reported being helped financially by their parents when they were emerging adults (Arnett and Schwab, 2013).The majority of Australian parents in a large longitudinal

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study of families reported not only providing financial help, but also providing emotional help in the form of listening, assistance with problems, and providing advice (Vassallo, Smart, and PriceRobertson, 2009). About half of parents of emerging adults ages 18–21 in the U.S. reported that their emerging-adult child still lived in the family home, but the majority of parents also reported that residing with their adult child was related to feelings of companionship and help with household responsibilities (Arnett and Schwab, 2013). It is also of note that findings highlighted important differences in the parents of emerging-adult children as a function of ethnicity, with African American and Latino parents, as well as parents with less education, feeling strongly (compared to European American and college-educated parents) that their emerging-adult children would have more opportunities and a better life than they did. Although parents of emerging adults generally report they are doing well, findings from the national survey also suggest that a majority feel like this time of their life is stressful and full of changes, and a small group report increased conflict with their child. Research has also found that some parents struggle with separation anxiety when their children leave the home (Kins, Soenens, and Beyers, 2013) or with empty nest syndrome (Bouchard, 2014), though these struggles are not shared by the majority of parents of emerging adults. Taken together, although few empirical studies have focused on the well-being of parents of emerging-adult children, initial evidence exists that by and large parents are doing well, though some certainly struggle with letting go and allowing their children autonomy in decision-making (Kloep and Hendry, 2010). This is an area of research that is ripe for study, as parents’ successful later years may be, in part, a function of how they adjust to the empty nest (see Bouchard, 2014) generally, but well-being in later life could also specifically be influenced (positively or negatively) by how the quality of the relationship with their children emerges from this time of change.

Conclusions This is the first chapter in the Handbook of Parenting to consider the role that parents play in the lives of their emerging-adult children. Although a number of studies explore continuity in parenting from adolescence through the transition to adulthood, in this chapter we have chosen to focus on how parenting might be important during the third decade of life and how it might meaningfully differ from parenting (in either frequency or practice) during the formative years. A number of theoretical foundations provide support for the continued importance of parents as well as theories suggesting that developmental changes during the transition to adulthood (especially due to historical changes in context for many young people) may result in changes to the family system and to the individual that necessitate change in the parent–child relationship. Research on parenting during emerging adulthood is sparse compared to childhood and adolescence, but there is a growing body of research particularly focused on parental support and parental control. Research summarized in this chapter provides ample evidence, for example, that authoritative parenting and parental support are importantly related to developmentally appropriate outcomes during the third decade of life, while parental control (e.g., behavioral and psychological control) is even more harmful when used during emerging adulthood than it might be earlier in development. There was also initial evidence that parents of emerging-adult children may provide support (e.g., financial) and engage in controlling strategies (e.g., helicopter parenting) in different ways than support or control that is used during childhood and adolescence. We noted throughout this chapter that there is wide variability in how emerging adults and parents from different cultures, contexts, and socioeconomic backgrounds experience this time of life, but overall findings in regard to parenting were relatively consistent across the groups studied in the existing body of research. We encourage researchers to explore the wealth of topics relating to parenting during emerging adulthood, first and foremost the need to explore variability and diversity as well as bidirectionality and multidimensionality. The field would also benefit from a greater understanding of 184

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emerging adults who are parents, as well as the effect of the transition to adulthood for the parents of emerging-adult children. Finally, the field would benefit from a clearer focus on parenting that might be unique to the third decade of life, rather than merely measuring the same parenting constructs from childhood and adolescence to assess adaptive parenting during a time of life that may be unique in meaningful ways. Despite limitations in the existing body of research, this chapter makes a strong case for the continued need for parents to be involved in the lives of their children as they transition to adulthood. Continued research should aim to provide education for both parents and children who seek counsel on how to best navigate this variable and somewhat unstable time of life, and parents and children should optimistically seek ways to engage in meaningful relationships with one another.

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Laura M. Padilla-Walker and Larry J. Nelson van Ingen, D. J., Freiheit, S. R., Steinfeldt, J. A., Moore, L. L., Wimer, D. J., Knutt, A. D., . . . Roberts, A. (2015). Helicopter parenting: The effect of an overbearing caregiving style on peer attachment and self-efficacy. Journal of College Counseling, 18(1), 7–20. Vassallo, S., Smart, D., and Price-Robertson, R. (2009).The roles that parents play in the lives of their young adult children. Family Matters, 82, 8–14. Whitbeck, L., Hoyt, D. R., and Huck, S. M. (1994). Early family relationships, intergenerational solidarity, and support provided to parents by their adult children. Journal of Gerontology, 49(2), S85-S94. Whitney, N., and Froiland, J. M. (2015). Parenting style, gender, beer drinking and drinking problems of college students. International Journal of Psychology: A Biopsychosocial Approach, (16), 93–109. Willoughby, B. J., Hersh, J. N., Padilla-Walker, L. M., and Nelson, L. J. (2015). “Back off ”!: Helicopter parenting and a retreat from marriage among emerging adults. Journal of Family Issues, 36(5), 669–692. Willoughby, B. J., and James, S. L. (2017). The marriage paradox: Why emerging adults love marriage yet push it aside. Oxford:Oxford University Press. Willoughby, B. J., Olson, C. D., Carroll, J. S., Nelson, L. J., and Miller, R. B. (2012). Sooner or later? The marital horizons of parents and their emerging adult children. Journal of Social and Personal Relationships, 29(7), 967–981. Zimmer-Gembeck, M. J., Madsen, S. D., and Hanisch, M. (2011). Connecting the intrapersonal to the interpersonal: Autonomy, voice, parents, and romantic relationships in emerging adulthood. European Journal of Developmental Psychology, 8(5), 509–525.

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6 PARENT–CHILD RELATIONSHIPS IN ADULTHOOD AND OLD AGE Karen L. Fingerman, Steven H. Zarit, and Kira S. Birditt

Introduction Parent–child relationships span the entire life course. Rather than ceasing when children are launched from the family, these relationships endure, characterized by complex patterns of interaction, support, and assistance that wax and wane around key transitions and major events in the adult years. Indeed, family issues, such as intergenerational conflict, mutual assistance, and inheritance, have a timeless feel to them. Several trends in contemporary society, however, have modified and made these issues more complicated. Changes in mortality (death rates) and morbidity (disease rates) have resulted in more people living longer, often with disabilities in later life. As a result, older people are likely to depend on family for help, sometimes for a long period of time. Altered patterns of marriage and divorce have also meant more individuals entering old age without the support of a spouse and with more complex relationships with children. At the same time, other trends, such as slow growth in jobs and wages along with lower rates of savings and accumulation of wealth, have diminished the economic prospects of younger generations and magnified the importance of tangible help and emotional support that adult children receive from their parents. In this chapter, we review the most recent research on the nature of relationships between aging parents and their adult children. Reflecting the basic premises of a life course perspective, we postulate that ties between aging parents and their adult children are a two-way street; that is, not only do children provide support and care to parents, but parents continue to support their children long after they have been launched into adulthood. We examine the circumstances when adult children provide assistance to disabled elderly parents, and, conversely, when older parents continue giving help to their adult children. These everyday interactions between aging parents and their children and grandchildren provide a richness to life but also can be a stage on which long-standing tensions in families continue to play out. The aspect of family relationships in later life that has received the most attention from research and the media has been the care provided to disabled parents or other relatives. The need for, and provision of, care to an aging parent is a momentous event in later life that affects not just children who provide care, but also children who are not directly involved in caregiving (Amirkhanyan and Wolf, 2003, 2006). With ever-increasing costs of medical and long-term care, assistance by family members is often essential to the security and well-being of an older parent. Unfortunately, for many families this involvement is stressful. Assisting a severely disabled parent may interfere with children’s

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own employment, family life, and/or well-being or reawaken long-standing conflicts with parents or siblings (Aneshensel, Pearlin, Mullan, Zarit, and Whitlatch, 1995; Zarit and Heid, 2015). We have included in this chapter this dual focus on everyday interactions and support between children and parents and caregiving, because an emphasis only on caregiving does not capture the reciprocal, contingent nature of parent–child ties across the lifespan. Even when children are assisting a disabled parent, the parent may still be returning some support as well. Moreover, older adults typically require care for a relatively brief period of a few years at the end of life; for decades before that, relatively healthy parents interact with and often assist their grown children in many different ways. From a life course perspective, caregiving is only one part of this long history of interactions and exchanges between parents and children. We believe that examination of these complementary patterns of exchange contributes a fuller understanding of intergenerational relationships in later life than would a focus on caregiving the aged alone, because most relationships of parent and adult child do not involve caregiving, and when care is needed, it develops in the context of long-standing relationships with their unique histories of exchange, affection, conflict, and values. We begin this chapter with an examination of the demographic changes that have dramatically altered the structure of the family and family relationships over the adult years. Based on these trends, critical issues in intergenerational relationships are identified. We then present theoretical perspectives that illuminate the exploration of family relationships in adulthood. Turning to research, we identify patterns of assistance from older parents to their adult children and the assistance given from children to parents. We next review the extensive literature on care of a disabled parent, including who provides care, stressors associated with caregiving, determinants and mediators of caregiving stressors, and interventions that can lower stress on caregivers. We end with a discussion of future trends of ties between the generations. As we look ahead, we ponder whether we should be optimistic or pessimistic about the ability of families to support and care for each other across generational lines.

How Demographic and Social Changes Have Affected Family Ties The demographic revolution in the twentieth century changed family structure in substantial ways. Increased life expectancy and decreased family size resulted in an aging of the population and of the family. Having an older relative in the family had once been a relatively rare occurrence; now, it is usual and expected. In the United States in 1900, life expectancy at birth was 49 years for women and 46.4 years for men. Currently, women have an expected lifespan of 81.2 years and men 76.4 years (National Center for Health Statistics, 2015). Life expectancy at age 65, which adjusts for mortality earlier in life, yields higher figures—85.5 years for women and 82.9 years for men. The increased rate of survival into old age means that relationships between parents and children endure for longer periods than in the past, as do relationships of grandparents and their grandchildren (Smith and Wild, 2019). Increased survival to advanced ages also means that adult children are likely to provide care to one or both parents at some point in their lives. Similar trends are found throughout much of the world, particularly in developed nations. Most older people are healthy and live independently, but rates of cognitive and functional disability increase with age (National Center for Health Statistics, 2015). For example, difficulties performing daily activities among women rose from 9.4% of the population aged 65–74 to 45% at ages 85 and older; for men the comparable figures were 6.4% and 26.2%. As would be expected, the proportions of individuals living in nursing homes or other residential settings rise with advanced age (Kinsella and Velkoff, 2001). Several characteristics of the older population have implications for family relationships. Given the gender difference in life expectancy, women constitute a greater proportion of the population over 65 (56.4%). This gender gap increases with advancing age. Among people 85 and older, 66.6% 192

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are women (Ortman,Velkoff, and Hogan, 2014).The preponderance of women is one of the defining features of the social world of late life. Gender differences in survivorship, combined with the fact that women tend to marry men 2 or more years older than themselves, means that older women are much more likely to be widowed (34% of women over age 65 compared to 11% of men; Mather, Jacobsen, and Pollard, 2015). Furthermore, older men who are widowed are more likely to remarry than older women. As a result, 72% of men aged 65 and older are married, whereas 48% of older women are married. These differences in marital status are why older women are much more likely to live alone, become institutionalized at earlier ages, have incomes below the poverty line, and to be more likely to need support from family (Kinsella and Velkoff, 2001). Another factor affecting the intergenerational experiences of aging people is the high rate of marital dissolution (Brown and Lin, 2013). Children of divorced parents may have ambivalent feelings toward one or both of their biological parents and may be reluctant to provide support and assistance. Conversely, when their children divorce, older adults may find themselves providing help ranging from caring for grandchildren to financial assistance. The economic status of older adults in the United States is probably better than at any time in history. The poverty rate for persons aged 65 years and over was 10% in 2014 (Mather, Jacobsen, and Pollard, 2015). This amount is considerably less than for children (21%), and slightly lower than among working age adults (14%). The economic circumstances of older people vary widely, however. Persons who are 75 and older have poverty rates that are more than one-third higher than the young-old (aged 65–74). Poverty rates are also higher for single, divorced, and widowed women and ethnic minorities, groups that have increasingly characterized the older population. Moreover, a sizable proportion of older adults are “near poor” or just above poverty.The Social Security program has played a major role in reducing poverty among older people (Mather, Jacobsen, and Pollard, 2015), but concern about its rising cost and political opposition to government programs could lead to substantial changes in that program. Moreover, 21% of married adults and 43% of unmarried older adults who rely solely on Social Security for 90% of their income and circumstances are already in tight economic circumstances (Social Security Administration, 2017). In sum, demographic changes underlie many of the changes in intergenerational ties that have occurred over the past 50 years. In particular, increased longevity has resulted in a great number of generations living at the same time. Other demographic changes such as marital patterns have also contributed to variability in these ties.

Critical Issues in Parent–Child Relationships To understand these long-enduring relationships between adults and their parents, this chapter addresses several critical questions that permeate the literature on intergenerational ties: 1. How do qualities of relationships between adults and parents vary over time and within families? 2. What are typical patterns of intergenerational support and exchanges between parents and their adult offspring, and how do these patterns contribute to health and emotional well-being? 3. To what extent do families serve as a safety net, providing help both upward toward older generations and downward from the older to younger generations? 4. How do qualities of parent–child relationships contribute to helping patterns? 5. How does the emergence of caregiving to an older adult affect exchanges of support within families? 6. What are the major stressors associated with caregiving for middle-aged adults and strategies that can maintain the challenges of caregiving at manageable levels? 193

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These questions convey a story about adult development and parent–child relationships. In early adulthood, as young adults traverse an increasingly complex transition into adult roles, parents typically remain invested in the child (more so than the reverse). Over time, the relationship progresses toward increased reciprocity. Toward the end of life, as aging parents accumulate physical and cognitive declines and losses, midlife adults increasingly find themselves in positions of caregiving. This progression has yielded research addressing each of the questions posed above.

Theoretical Approaches to Parent–Child Relationships in Adulthood The parent–child tie in adulthood involves multiple ties and is not solely a dyadic phenomenon. Given changes in longevity, multi-generational families have become increasingly the norm. As such, many individuals spend decades of adulthood in which they are simultaneously a grown child and a parent. Moreover, most parents have more than one child, and many grown children have more than one parent who is alive. Grown children may also have ties to stepparents and in-laws (for children who are married).Thus, the critical issues described above become more complex from a theoretical perspective in considering how any given dyad fits into the array of family relationships. Furthermore, life course scholars have long noted the structural and contextual factors that shape relationships between adults and parents. But structural factors alone do not account for how parents and children feel about one another and what they are willing to do for one another. Rather, psychological issues, such as their affection for one another and their beliefs about their relationships, shape the nature of the tie. We have developed the multidimensional intergenerational support model (MISM) to provide a framework for the factors that influence ties between parents and grown children (Fingerman, 2017; Fingerman, Sechrist, and Birditt, 2013; see Figure 6.1). This framework considers structural factors, such as the historical context and socioeconomic position of the parents and grown children, that shape the resources parents have to share and the demands grown children place on those resources. During historical periods or in circumstances where grown children struggle to gain a foothold

Time 1

Resources and Demands

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Determinants of Exchange Contingencies - Everyday needs - Crises or problems Relationship quality Potential achievement Support provided

Determinants of Exchange Contingencies - Everyday needs - Crises or problems Relationship quality Potential achievement Support provided

Support Exchange - Type of support - Appraisals

Support Exchange - Type of support - Appraisals

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Figure 6.1  The multidimensional intergenerational support model

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in a well-paying job, parents are more likely to fill in with financial support and housing (Fingerman, 2017; Newman, 2012). Family context also matters. For example, researchers have repeatedly shown that parents’ marital status (e.g., two biological parents married versus stepparent and biological parents) influences the likelihood that parents will provide financial support to grown children (Henretta, Wolf, van Voorhis, and Soldo, 2012). Moreover, experiences in the parent–child tie vary depending on whether the party is a child or a parent in that relationship. Finally, qualities of the relationship (e.g., affection) and individual beliefs are also key factors in determining the nature of the tie, the frequency of contact, and the types of support the parties provide.

Intergenerational Relationship Qualities The positive and negative qualities of the relationship between parents and their adult children have ongoing implications for well-being and health across the adult years. Positive aspects of the tie include the extent to which parents love and care for one another and understand one another (Bengtson, Giarrusso, Mabry, and Silverstein, 2002). Negative qualities include the extent to which parents and children get on one another’s nerves and make too many demands on one another (Umberson, 1992). These qualities vary by gender, age, and generation. Mothers and daughters typically report both more intense positive and negative ties than do fathers and sons (Birditt Tighe, Fingerman, and Zarit, 2012). Indeed, research shows that mothers tend to report better quality ties (i.e., favoritism), as well as conflict, with daughters than sons (Suitor et al., 2016). Parent–child ties tend to become both more positive and less negative as parents age (Tighe, Birditt, and Antonucci, 2016). In addition, the literature shows that parent–child ties consistently vary by generation between parents and children in dyads and within person by the generation of the interaction partner (i.e., whether the partner is a parent or a child). Parents typically report greater investment, positivity, and lower negative quality with children than do their children regarding the relationship (Aquilino, 1999; Giarrusso, Silverstein, Gans, and Bengtson, 2005; Shapiro, 2004). This is referred to in the literature as the “intergenerational stake” (Bengtson and Kuypers, 1971). Parents view their children as continuations of themselves and are highly invested in their achievements and successes. Based on this theory, we developed what we refer to as the intraindividual stake hypothesis (Birditt, Hartnett, Zarit, Fingerman, and Antonucci, 2015). According to this hypothesis, individuals are more invested in their own children than in their parents.We have examined this theory in different ways and found support for the hypothesis. Middle-aged individuals report greater investment as well as greater negative relationship quality with their children than with their parents (Birditt et al., 2015).

Parent–Child Daily Interactions in Adulthood In contrast to the vast literature regarding parent–child interactions in childhood and adolescence (Bornstein, 2019; Chapters 3 and 4 in this volume), only scant research literature has examined qualities of interactions between adults and their aging parents. On an everyday basis, parents report frequent enjoyable interactions with their grown children. In diary studies, parents reported the majority of their daily encounters with grown children were enjoyable and they frequently shared laughter (Fingerman, Kim, Birditt, and Zarit, 2016). Yet, stressful encounters also occur on a regular though less frequent basis. Moreover, parents and grown children experience tensions with the each other, without ever confronting the other person (Birditt, Rott, and Fingerman, 2009). Parents report more intense tensions than do adult children particularly with regards to individual issues (e.g., finances, health) but not problems with the relationship in general (Birditt et al., 2009). Daily interactions and their effects on parents’ well-being also vary depending on whether adult children are experiencing life problems such as drug and alcohol addiction, financial crises, divorce, 195

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or serious health issues. Birditt, Kim, Zarit, Fingerman, and Loving (2016) found that parents were more likely to report negative daily interactions with adult children who suffered from such life problems. Furthermore, interactions with children who had problems were associated with parent’s diurnal cortisol rhythms, which is a physiological marker of stress. Interactions with adult children who had lifestyle–behavioral problems had more delayed or next-day associations with cortisol.

Conflict Strategies Most parents and grown children find successful ways to navigate tensions in their relationships in adulthood without disbanding their ties. Estrangement between grown children and parents is relatively uncommon and primarily attributable to extraneous factors such as perpetual non-involvement of a father, parental incarceration, or death (Hartnett, Fingerman, and Burditt, 2017). Rather, parents and grown children engage in conflict behaviors that maximize positive feelings in the tie and minimize dissent (Birdit et al., 2009). In particularly positive relationships, parents and grown children cope with interpersonal tensions in the tie in ways that sustain strong ties. First, a parent or child may cognitively frame the other party’s negative behaviors in terms of a flaw in the other party, rather than as a personal affront. For example, a midlife daughter might view her mother’s intermittent phone calls throughout the day as a sign of the mother’s loneliness rather than as the mother’s intruding on the daughter’s time. Second, such parents and grown children are unlikely to confront the other party, but instead accept the problem and find ways to deal with it (Fingerman, 2001). These behaviors also vary by context and by generational stations. Birditt et al. (2017b) found that middle-aged individuals were more likely to report active strategies with adult children (e.g., discussing problems), whereas they were more likely to use passive strategies (e.g., avoidance) with aging parents. Conversely, middle-aged individuals who did use passive strategies with adult children reported greater depressive symptoms. Research also shows that daily interpersonal interactions vary by generation. Birditt, Manalel, Kim, Zarit, and Fingerman (2017a) found that middle-aged individuals reported having more frequent contact with their adult children than their aging parents, but more negative interactions with their aging parents than adult children. Furthermore, they found that daily interactions with adult children were more consistently associated with daily negative affect and diurnal cortisol than interactions with aging parents. Daily negative interactions with adult children may be more salient because tensions with adult children occur less frequently than tensions with parents. The qualities of parents’ and children’s relationships are important for each party’s well-being. But in addition to emotional bonds, ties between adults and parents are resource rich; that is, these relationships often involve exchanges of tangible and nontangible support.

Exchanges of Support Across Generations The first critical question posed at the start of this chapter—regarding typical patterns of intergenerational support and exchanges between parents and their adult offspring—has received considerable research attention across cultures. Around the world, in childhood, parents are expected to support and care for their children’s material and nonmaterial needs. But in adulthood, expectations on family vary by culture and type of government (e.g., social welfare state vs. conservative government).

Parental Support of Grown Children Despite some variability, across Western cultures family support usually flows downstream from older generations to their progeny, at least until parents incur health problems in late life (Kohli, Albertini, and Künemund, 2010). Parents typically provide both intangible and tangible support to grown 196

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children. Tangible support includes financial assistance as well as help with practical tasks that have financial value, such as helping with childcare and chores. Intangible support involves emotional support, companionship, and discussing recent events. Parents are most likely to provide intangible forms of support, such as emotional support, followed by practical and financial support. Parents provide intangible support at least once a week or even every day, and tangible support weekly, once a month, or several times a year (Fingerman, Kim, Davis Tennant, Birditt, and Zarit, 2015; Fingerman, Miller, Birditt, and Zarit, 2009).Yet, parents typically give 10% of their income to grown children each year, regardless of their own financial circumstances (Kornrich and Furstenberg, 2013). The frequency with which parents provide different types of support to grown children varies based on structural factors associated with needs and resources. For example, age of offspring is one of the strongest predictors of parental support, with younger adult offspring receiving more frequent support of all types than older offspring (Hartnett, Furstenberg, Fingerman, and Birditt, 2013). This age association is linked to offspring needs; younger adults are more likely to be transitioning into adulthood and, as such, to be unmarried, a student, or employed in low-wage jobs that necessitate support from parents. Indeed, across cultures, parents provide more support (particularly financial support) to students than to non-students (Henretta et al., 2012; Johnson, 2013; McGarry and Schoeni, 1995, 1997). Parental resources play a key role in support with regard to both intangible resources (e.g., having a spouse) and tangible resources. Children in lower SES families receive less frequent support of all types (Fingerman et al., 2015). Upper SES parents are more likely to be able to pay for their children’s education, a key form of support in the U.S. where secondary education requires private resources (as opposed to many European countries where the government underwrites college tuition; Henretta, Wolf, van Voorhis, and Soldo, 2012; Johnson, 2013). Nevertheless, parents in all SES circumstances in the U.S. attempt to assist their grown children; even lower SES parents give 10% of their income to their children (Fingerman et al., 2015; Kornrich and Furstenberg, 2013). Part of the SES disparity reflects the constellation of other factors associated with parents’ upper and lower SES status. For example, parents who are better off financially are also more likely to be college educated, to be married to the grown child’s other parent, to have fewer children, and to be in better health, facilitating their ability to support their grown children (Henretta et al., 2012; McGarry and Schoeni, 1995, 1997). Other structural factors, such as gender and geographic proximity, play a role in parental support. Parents are more likely to provide practical support and emotional support to daughters and children who live closer to them (Suitor, Pillemer, and Sechrist, 2006). Studies examining daily reports of support have confirmed these findings showing that parents provide more daily support to children with greater needs (children with more problems, who were unmarried, younger, daughters, students, coresident children, and those with children; Fingerman et al., 2015; Fingerman, Huo, Kim, and Birditt, in press). Qualities of the relationship also determine who gets support. Parents provide more support to grown children whom they view as successful (Fingerman et al., 2009). Consistent with the developmental stake hypothesis, parents remain invested in the parental role, and watching their children succeed is partially a reflection of their own success as parents (Cichy, Lefkowitz, Davis, and Fingerman, 2013). When parents and grown children have more affectionate bonds, parents also provide more to grown children (Fingerman et al., 2011). Furthermore, parents provide more support to offspring who provide more support to them (Suitor et al., 2006). This pattern of reciprocity raises the question of life course patterns—when and why do grown children start to support aging parents?

Offspring Provision of Support to Parents In young adulthood, grown children may not provide much support to midlife parents. A majority of grown children do report offering their parents emotional support at least once a month (Cheng, 197

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Lam, Kwok, Ng, and Fung, 2013), but this is an infrequent rate of emotional support given that most grown children report talking with their parents nearly every day (Arnett and Schwab, 2012; Fingerman et al., in press). Furthermore, consistent with the typical flow of support in Western countries and the premise of the intergenerational stake, young adults typically only provide practical support to parents in extreme circumstances, such as when a midlife parent incurs severe physical illness (Pakenham and Cox, 2012). Some cultural variability is evident in these patterns. For example, Latino families may harbor an expectation that young people will contribute to the overall family well-being via caregiving and financial contributions, beginning in adolescence (Kuperminc, Wilkins, Jurkovic and Perilla, 2013). Although cultural brokering in childhood has been widely studied in immigrant populations (Weisskirch et al., 2011), and there is a belief that Latino young adults are involved in supporting their parents, research on this topic is all but absent. Although offspring only support parents under limited circumstances when parents are in midlife, they increase that support over time.The question then arises as to what factors contribute to midlife adults’ support of aging parents. Offspring support their parents due to need; as parental needs increase (particularly disabilities) offspring support increases (Eggebeen and Davey, 1998; Fingerman et al., 2011; Silverstein, Gans, and Yang, 2006; Silverstein, Parrott, and Bengtson, 1995). Structural and relationship factors also play a role in how much assistance offspring give to parents. For example, grown children who live near parents provide more support than their more distant siblings (Fingerman et al., 2011; Pillemer and Suitor, 2013). Offspring are more likely to support parents when they feel closer to the parent, they value the relationship, and they spent time together in the past (Fingerman et al., 2011; Silverstein et al., 2002). A great deal is known about relationship qualities and exchanges of support between adults and parents due to a vast array of survey data.Yet, as discussed below, the focus and patterns of such measurement has changed over the past few decades.

Measurement of Parent–Child Relationships in Adulthood Research addressing parent–child relationships in adulthood has primarily relied on survey methodologies. Adults are proficient at reporting on themselves and their relationships. Often, parents and grown children reside at a distance and bringing both parties into the lab is not feasible. As such, a large literature built up derived from adults’ self-reports of ties to parents or grown children. In the twentieth century, much of the research on relationships between adults and parents focused on a single member of the family—a parent or a grown child—and that individual answered questions about intergenerational ties (Eggebeen and Davey, 1998; Rossi and Rossi, 1990; Silverstein et al., 1995; Willson, Shuey, and Elder, 2003). Indeed, it was only in the 1990s that some researchers collected data aimed at dyadic processes in parent–child ties in adulthood, by interviewing pairs including a parent and a grown child (Cohen and Pollack, 2005; Fingerman, 2001; Lyons, Zarit, Sayer, and Whitlatch, 2002). These types of analyses revealed patterns in which grown children affected their parents’ well-being and vice versa. This research and subsequent studies confirmed parental sensitivity to their grown children’s problems (Fingerman, Cheng, Birditt, and Zarit, 2012), as well as grown children’s susceptibility to parental distress, particularly when the parents suffered health problems (Cohen and Pollack, 2005; Fingerman, Hay, Kamp Dush, Cichy, and Hosterman, 2007). Dyadic studies also revealed findings consistent with the developmental stake hypothesis; parents were typically more positive about their relationships with the grown child than the reverse (Cichy, Lefkowitz, Davis, et al., 2013; Fingerman, 2001). The most recent studies of intergenerational ties have focused on patterns of within-family differences (Suitor et al., 2018). That is, most people who become parents have more than one child. As such, parents appear to have distinct relationships with different children, favoring children who 198

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share their values or who are successful (Fingerman et al., 2009; Suitor et al., 2006). Grown children seem to be aware of such patterns and to suffer when they perceive their parents as favoring a sibling (Jensen, Whiteman, Fingerman, and Birditt, 2013). Some studies have included parents’ dyadic discrepancies with different grown children, combining the dyadic and within-family methodologies (Kim, Zarit, Eggebeen, Birditt, and Fingerman, 2011), showing when and how discrepancies arise between parents and a specific child’s perception of the relationship. Researchers have also expanded studies to ask about more than two generations of adults by examining young adults, midlife parents, and aging grandparents. Examination of three generations of adults reflects current demographic trends that families typically have three, four, or even five generations alive simultaneously (Bengtson, 2001). One study focusing on three generations found that the two younger generations (midlife parents and young adult children) had more emotionally intense relationships than the midlife generation had with the aging grandparents (Birditt et al., 2015). Research has shown that midlife adults typically provide more support to grown children than to parents, but reverse that pattern when parents incur health declines (Fingerman et al., 2011). Another study focused on patterns of physical problems and psychological problems across three generations. In a majority of families, few members of any generation suffered such problems, but in other families either the young adults incurred life problems and physical problems, or the grandparents suffered disabilities. That study of three generations suggested that families may evolve through a life sequence of coping with different types of problems as their members grow older (Fingerman, Huo, Graham, Kim, and Birditt, in press). Notably, the literature examining adult’s intergenerational ties is not completely constrained to self-report surveys. A few studies have used observational methods with dyads of parents and grown children (Cichy, Lefkowitz, and Fingerman, 2013). Some studies have also relied on daily reports of encounters with parents and grown children, including measures of salivary hormones mentioned previously (Birditt et al., 2016; Birditt et al., 2017a; Fingerman, Huo, Kim, and Birditt, 2017; Fingerman, Kim, Tennant, Birditt, and Zarit, 2016). Although the research regarding intergenerational ties is rich, there are also several topics or areas of study absent from the literature. For example, despite many studies of SES disparities in raising children, there is a surprising dearth of research focusing on socioeconomic disparities in intergenerational relationships after the children reach adulthood. Similarly, some research has examined ethnic differences in parent–child ties, particularly with regard to support and caregiving (Fingerman, Vanderdrift, Dotterer, Birditt, and Zarit, 2011; Gallagher et al., 2003; Suitor, Sechrist, and Pillemer, 2007). But the literature is much richer with regard to ethnic difference in parents’ ties to children earlier in life. Finally, the literatures regarding intergenerational ties broadly and caregiving in late life are distinct. A few studies have attempted to examine the transition period from everyday support patterns to more intensive caregiving (Kim et al., 2016; Suitor, Gilligan, Johnson, and Pillemer, 2012; Suitor, Gilligan, and Pillemer, 2013), but for the most part, the literature examining parents with disabilities is separate, as though the disabilities arose in new relationships that lacked a prior history. As such, additional research is needed to examine continuity and discontinuity in intergenerational relationships from earlier to later adulthood when caregiving and health problems become increasingly likely. We address the literature regarding parental disabilities in the next section.

Older Parents With Disabilities Patterns of everyday support provided by adult children to their aging parents may eventually shift toward “caregiving,” where they are giving more intensive assistance with activities of daily living (ADL) as well as helping in other ways. Caring for an aging parent with cognitive, emotional, and/ or physical disabilities is one of the most challenging tasks during the adult years. Brody (1985) 199

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characterized caregiving as normative but stressful. Caregiving is normative in the sense that long life carries with it the likelihood of experiencing disability for a period at the end of life and for one’s children to be involved in varying degrees in providing care. A survey by the National Alliance for Caregiving and the American Association of Retired Persons (2015) estimated that 14.3% of adults in the United States are assisting a person 50 years of age or older who needs help with daily functioning (e.g., cooking, cleaning, shopping) and/or personal care (e.g., bathing, dressing). Nearly half of all the care goes to persons 75 years of age or older. Unlike other normative life events, however, caregiving is often stressful (Brodaty, Woodward, Boundy, Ames, and Balshaw, 2014; Joling et al., 2015). Caring for a parent or other relative who is experiencing a major decline in health and functioning is often physically and emotionally demanding and time consuming. Caregiving can also be rewarding. Caregivers can have positive experiences in their interactions with their parent and may gain a sense also of fulfilling an obligation (Cheng, Mak, Lau, Ng, and Lam, 2016; Goodman, Steiner, and Zarit, 1997). The belief that families are responsible for the care of their elderly relatives has long been a central tenet in most cultures (Habib, Sundström, and Windmiller, 1993). With the emergence of modern nuclear families, there has been a concern that families will pull back from their traditional obligation to care for parents and instead turn over their care to formal institutions. Most people, however, endorse attitudes of filial obligation, indicating that children should be involved in their parents’ lives and provide assistance when needed (Brody, Johnsen, and Fulcomer,1983; Stein et al., 1998; Youn, Knight, Jeong, and Benton, 1999). Furthermore, although historical trends can be difficult to estimate, it appears that families remain highly involved, even in countries such as Sweden where extensive formal services are available (Habib et al., 1993; Shea et al., 2003). Indeed, given the increased probability of becoming a caregiver and assisting someone for a long period, adult children may be providing more help to older parents than ever before. Helping patterns between children and their aged parents are characterized by considerable heterogeneity. Children may be helping parents with different types of problems, including acute and chronic health concerns, functional and/or cognitive disabilities, and emotional difficulties such as depression and anger.The amount and type of help needed and assistance provided range from minimal to extensive, around-the-clock responsibilities. At any single point in time, most older people need little or no regular assistance, so the amount of help being provided by children will be minimal. On occasions, however, even these minimal involvements can be very stressful, with children perceiving that their parents are making excessive demands on them or where the need for assistance rekindles long-standing family conflict with a parent or siblings. An additional source of heterogeneity involves who helps an aging parent. Much of the literature has focused on a single caregiver, but it is common for multiple family members to provide assistance, with one person serving as primary caregiver who coordinates care and has the greatest involvement (Koehly, Ashida, Schafer, and Ludden, 2015; National Alliance for Caregiving and the American Association of Retired Persons Policy Institute, 2015). Patterns of multiple family caregivers and multiple care recipients are found in many Mexican American families (Evans, Coon, Belyea, and Ume, 2017). Family members sometimes provide assistance to a parent on a short-term basis, for example, following a hospitalization or other event that temporarily limits the older person’s ability to perform daily activities (National Alliance for Caregiving and the American Association of Retired Persons Policy Institute, 2015). More commonly, caregiving involves assisting a parent suffering from chronic and often deteriorating conditions, such as dementia, that may persist over several years and ultimately lead to death. In these situations, caregiving is an evolving role that changes over time in response to the care receiver’s needs and how the caregiver adapts to the situation. To capture the dynamic changes in caregiving, we use a framework developed by Pearlin and Aneshensel (1994) that views caregiving as a career with three primary phases: acquisition, enactment, and role disengagement.

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Becoming a Caregiving: Acquisition of the Role Caregiving sometimes is initiated following a major event, such as an acute illness or injury, but more often it develops gradually, growing out of the pattern of mutual support between aging parents and their adult children. Children begin providing more assistance with everyday tasks in response to a parent’s needs. As an example, assistance that a child previously gave that was discretionary, such as taking a parent to the grocery store, becomes necessary due to the parent’s increasing difficulty with driving or mobility. Children may have a growing awareness that a parent needs help, or may worry that minor difficulties will become worse. Often it takes an event such as a parent getting lost or having difficulty transitioning home following a hospitalization that crystallizes awareness of caregiving. Cultural norms influence which family member steps forward to provide care (Cantor, 1983; Stein et al., 1998; Wolff and Kasper, 2006;Youn et al., 1999). If a parent is married, a spouse is most likely to take on responsibilities for care. Couples, however, who married in later life may have less commitment to giving care to one another, especially when high levels are needed, such as with dementia (Sherman, Webster, and Antonucci, 2013). Sometimes both parents have health or mental health problems that limit their ability to help one another. Typically, children play a supporting role when one parent is caring for the other. Children may, however, encounter resistance when trying to intervene to improve the parents’ living situation or health habits or to bring in paid help (Heid, Zarit, and Fingerman, 2016). When an older person is not married, or when both parents are disabled, then a daughter is more likely to assume the primary caregiving role (Pillemer and Suitor, 2006). Sons and daughters-in-law become primary caregivers when there are no daughters, or if daughters are unwilling or unavailable to help (Wolff and Kasper, 2006; Williamson and Schulz, 1990). In the absence of any living adult children or when adult children are unable to take on primary caregiving responsibilities, then other relatives or, in some instances, friends or acquaintances may do so. Who becomes the primary caregiver is also influenced by geographic propinquity (Pillemer and suitor, 2006). The child or other relative who is local is likely to become caregiver. When there is no one in the local area, children living at a distance face the problem of obtaining reliable information about the parent’s situation, identifying and assessing local resources which might help the parent, and deciding when to intervene. Because social services in the United States can vary so much from one region to another, finding out quickly what services are available and which agencies provide better quality home care can present a formidable and time-consuming task. Care managers for the elderly are increasingly available and can provide care coordination for an elder whose children live at some distance. Parents, however, may refuse help that a child arranges and insist that they can manage on their own (Heid, Zarit, and Fingerman, 2016). Refusing help is fairly common and often becomes a source of worry and frustration for children. When it is difficult to arrange for or monitor services at a long distance, children may consider moving a parent closer to them or into their house. In weighing this decision, children are painfully cognizant of the problems the parent is having in daily functioning, but they often are unaware of the pitfalls associated with a move. On the positive side, a move can address children’s concerns about their parent’s safety.They can more directly monitor their parent and any paid help hired to assist the parent. A move will also cut down children’s travel time, and they will be more accessible to a parent in the event of an emergency. On the downside, moving parents from a community in which they have lived for many years can disrupt their familiar routines and sever ties with old friends and neighbors. Children may unrealistically expect the parents to recreate their social life after a move, but the unfamiliarity of a new place and new routine can overwhelm an older person whose functioning is already compromised. The result may be greater dependency on children than they anticipated. Another aspect of the emergence of care is that parents have their own preferences about who among their children should be their caregiver. A study of older mothers found they preferred

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daughters who lived closer to them as caregivers, but they also took into account children’s personality and which child would likely be a good caregiver (Suitor et al., 2013). Not getting the caregiver they preferred was associated with greater parent depression over time. Caregiving varies among social and ethnic groups and can differ within groups. As an example, in the African American community, the amount and type of help that the primary caregiver receives from family and friends can vary considerably (Dilworth-Anderson, Williams, and Cooper, 1999). Another trend found in some inner-city African American families is compression between generations, such that grandparents, who may be in their 30s and 40s, raise their grandchildren and also assist their own elderly parents and grandparents (Burton and Sörensen, 1993).These types of variations in family care are important to consider when assessing a family or planning interventions. The transition to caregiving changes existing patterns of support to parents. Kim, Bangerter, Polenick, Zarit, and Fingerman (2016) used longitudinal data to show that as parents became disabled, their children responded by increasing practical assistance but not nontangible support, such as socializing or emotional support. A parent’s increasing disability was also associated with decreases in children’s rating of the quality of their relationship with the parent, but not with changes in children’s emotional well-being. Other research, however, has found that the transition to caregiving is associated with increased depressive symptoms (Dunkle et al., 2014; Rafnsson, Shankar, and Steptoe, 2015).

Enactment of the Caregiving Role Caring for a parent or other older relative is a uniquely challenging experience. Caregivers in highstress situations, such as assisting someone with dementia or chronic mental illness, experience high levels of burden, emotional distress, and risk of health problems (Brodaty et al., 2014; Clyburn, Stones, Hadjistavropoulos, and Tuokko, 2000; Dassel and Carr, 2016; Joling et al., 2015; Klein et al., 2016; Liu, Kim, and Zarit, 2015). Depressive symptoms tend to be greater among daughters caring for a parent than sons, especially over time (Bookwala, 2009). Even children who are not providing direct care to a disabled parent may report increased stress and depression (Wolf, Raissian, and Grundy, 2015). In the following sections, we examine stressors that affect caregiver’s physical and emotional well-being and factors that modify or buffer the stress process.

Caregiving Stressors Caregiving stress is not a single process, but rather multiple factors that contribute to a buildup of distress or burden. Stressors can be divided into two broad groups: (1) primary stressors, which are activities directly related to providing care, and (2) secondary stressors, which represent the spillover of caregiving activities into other areas of the caregiver’s life (Aneshensel et al., 1995).

Primary Stressors Among the various care-related stressors, cognitive, behavioral, and/or emotional problems have the greatest impact on caregivers (Brodaty et al., 2014; Clyburn et al., 2000; Koerner and Kenyon, 2007). In dementia care, although memory problems occur more frequently than other problems, caregivers experience disruptive and depressive behaviors as the most stressful (Fauth and Gibbons, 2014; Teri et al., 1992). Providing help with daily activities can also be stressful (Clyburn et al., 2000), especially when it involves a physically demanding task such as transferring a parent from bed to chair, or when helping with personal activities like bathing and toileting that can be embarrassing for both caregiver and care recipient. Stress is also greater if the care-recipient resists or struggles when the caregiver tries to help with these tasks (Fauth, Femia, and Zarit, 2016).

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In addition to the strain involved in managing specific tasks and problems, caregivers experience stress as a result of the time, effort, and energy it takes to assist a parent (Aneshensel et al., 1995). Caregivers of persons with dementia, for example, often find themselves continually involved in providing care. Not surprisingly, they report high levels of overload, that is, feeling exhausted because they have more to do than they can manage (Aneshensel et al., 1995). Another primary stressor is caregivers’ perspective on the effects the illness has on the care recipient. Pearlin, Mullan, Semple, and Skaff, (1990; see also Aneshensel et al., 1995) proposed that diseases such as Alzheimer’s alter personality and behavior so fundamentally that they erode closeness and intimate exchanges between patient and caregiving. Along the same line, Monin and Schulz (2010) suggested that caregivers’ perception that the care recipient is suffering is a major source of emotional distress. Much of the focus in the caregiving literature falls on the effects of chronic illness and disability. An overlooked aspect of caregiving is the burden placed on families when a parent is hospitalized due to an acute illness or injury.Whether or not the parent had been receiving care prior to the problem, there is often pressure to make a quick decision about whether the parent can return home, go to an in-patient facility offering rehabilitation, or move to a nursing home. Caregivers may have little information about the choices available in their community (for example, home care services to help the parent return home), and they may not know what their parent might want. Hospitals, in turn, may have only minimal social work staff to help the family with discharge planning. Furthermore, hospital stays have become increasingly briefer. It is not uncommon for patients to be discharged within 24 hours of major surgery. Families who take a parent home are often expected to perform medical tasks, such as wound care, injections, and administering intravenous fluids, and to operate medical equipment, such as ventilators and tube feeding (Reinhard, Levine, and Samis, 2012). Families, however, report that they received little training for these tasks and often feel overwhelmed.

Secondary Stressors The buildup of primary stressors centered on care activities can proliferate into other areas of the adult child’s life, leading to what have been called “secondary stressors” (Aneshensel et al., 1995). Theses stressors are not secondary in the sense of having less impact, but rather because the time and strain associated with providing care spill over and interfere with other areas of a person’s life. Caregivers, for example, report decreases in social and leisure activities (Mausbach, Patterson, and Grant, 2008). They may have less time meeting other family obligations or just spending time with a spouse or children. Balancing caregiving and employment is a frequent challenge faced by middleaged adults caring for a parent. Some caregivers leave the workforce when taking on responsibility for care of a parent (National Alliance for Caregiving, and the American Association of Retired Persons Public Policy Institute, 2015). Among those caregivers who continue in the workforce, it is not uncommon to have increased absences, reduce work hours, or experience other disruptions of work that result from caregiving (National Alliance for Caregiving, and the American Association of Retired Persons Public Policy Institute, 2015). Having a child at home under the age of 18 adds to this pressure (Scharlach and Boyd, 1989). A study by Stephens and her colleagues illustrates how caregiving may impact on other roles (Stephens, Townsend, Martire, and Druley, 2001). The sample included women who were caring for a parent or parent-in-law and who simultaneously held roles as parent, wife, and employee. Sixty-two percent of the sample reported some difficulty balancing between caregiving and their other roles. Among daughters reporting conflict between caregiving and other roles, 34% indicated they had the most difficulty caring for their own children, 28% said they had the most trouble balancing time with their husband, and 38% had the most difficulty with their work role. Not surprisingly, greater role

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conflict was associated with poorer psychological well-being. Employment, however, appeared to buffer the stresses associated with caregiving (see also Edwards, Zarit, Stephens, and Townsend, 2002). Another type of secondary stressor is disagreements between the primary caregiver and other family members over caregiving. Family members may argue with the caregiver about the parent’s medical diagnosis, treatment, or how the caregiver is providing help (Aneshensel et al., 1995; Semple, 1992). In a study that assessed stress over multiple days, Koerner and Kenyon (2007) found that disagreements between caregivers and other family members were associated with increased depressive symptoms, burden, and health symptoms. Siblings, in particular, may disagree over who should provide care, how much care they should each provide, and who should make decisions about care. Perceived closeness with and favoritism shown by a parent as well as past inequality in help given by parents are associated with greater tensions among siblings (Lashewicz and Keating, 2009; Suitor et al., 2012). Money issues and anticipated inheritance are also a frequent source of contention among siblings (Lashewicz and Keating, 2009). The loss of valued activities and roles can threaten caregivers’ psychological sense of self (Pearlin et al., 1990). Caregivers may feel trapped or engulfed by caregiving or feel that restrictions of other roles and activities are eroding their identity (Aneshensel et al., 1995; Johnson and Catalano, 1983; Skaff and Pearlin, 1992). These feelings have been found to be the strongest predictors of placing a disabled elder into a nursing home (Aneshensel, Pearlin, and Schuler,1993). Although the stress process model posits that secondary stressors emerge due to the spillover of care into other areas of the caregiver’s life, it is also possible that there could have been stressors and conflict prior to the onset of caregiving in employment, family relationships, finances, health, and other areas of life. According to Pearlin, Schieman, Fazio, and Meersman (2005), early life adversities and their resulting economic strain and discrimination experiences make enactment of caregiving and other transitions in middle and later life more difficult by adding to these existing strains as well as to the erosion of psychological and social resources that result from ongoing hardships. When planning clinical interventions, the origins of these problems may be important. Most research interventions have assumed that treatment of the core sources of stress associated with care tasks will be sufficient in helping caregivers. The converse may be true in some cases that it is more productive to help caregivers to address secondary stressors initially or as part of the overall course of treatment. As an example, a caregiver who is experiencing an acute health problem or a flare up of chronic pain may only be able to make changes in caregiving once those issues are managed better.

Moderating or Buffering Caregiving Stressors One of the early and enduring themes in the caregiving literature is that there is considerable heterogeneity in how people adapt to the caregiving role (Zarit, Reever, and Bach-Peterson, 1980; Zarit and Zarit, 1982, 2007).Two people may be caring for parents who have similar disabilities. One person reports high levels of burden and the other states that she experiences relatively little stress. Social, psychological, and economic resources can help caregivers manage primary stressors associated with care more effectively and reduce the spillover of those stressors into other areas of their lives (Aneshensel et al., 1995). Social support, either from family or paid help (Chappell and Funk, 2011), is a critical resource for caregivers. Larger support networks are generally associated with lower stress and burden, especially when care tasks are shared across multiple people and when there are fewer disagreements between the primary caregiver and other helpers (Cheng, Lam, Kwok, Ng, and Fung, 2013; Tolkacheva, Van Groenou, de Boer, and Van Tilburg, 2011). Siblings typically assist each other in caring for parents (Brody et al., 1989; Suitor and Pillemer, 1993), although there may also be conflict over this help. Friends may also be an important source of emotional support (Suitor and Pillemer, 1993). Spouses

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of caregivers helping a parent can be a valuable source of support (Brody, Litvin, Hoffman, and Kleban, 1992). How caregivers cope with daily stressors and challenges also affects their emotional well-being. It has generally been suggested that people with better problem-solving skills, who can distance themselves somewhat from problems and think about alternative courses of action, will function better than caregivers who respond emotionally to their situation (Hepburn, Tornatore, Center, and Ostwald, 2001; Okabayashi et al., 2008; Pruchno and Resch, 1989;Vitaliano, Becker, Russo, MaganaAmato, and Maiuro, 1988–89). A greater sense of mastery or self-efficacy may contribute to more effective coping and lower burden (Cheng, Lam, Kwok, Ng, and Fung, 2012; Mausbach, et al., 2011). As an example, Li, Seltzer, and Greenberg (1999) found that daughters who were higher in mastery used more problem-focused coping strategies in caring for a parent and that led to less depression over an 18-month period. When coping with Alzheimer’s disease or other long-term degenerative conditions, cognitive coping strategies, such as finding meaning in the situation, or seeking comfort in one’s religious beliefs can be very helpful (Pruchno and Resch, 1989).

Caregiving Transitions and Disengagement From the Role Caregiving activities may span several years, shifting in intensity in response to changes in the parent’s condition and other circumstances in the caregiver’s. Caregivers can follow different trajectories, with some showing increased problems and stress-related symptoms, but others improving, even as the elder’s condition worsens (Aneshensel et al., 1995; Joling et al., 2015; Schulz,Williamson, Moryca, and Beigel, 1993; Townsend, Noelker, Deimling, and Bass, 1989; Zarit, Todd, and Zarit, 1986). Two major transitions, placement of a parent in a care setting and death of the parent, substantially restructure the caregiving role. Each of these transitions is associated with its own stressors and challenges.

Placement of a Parent Into a Care Setting Placement is often considered as ending the care role, but it is best viewed as a restructuring of that role in a way that minimizes some stressors but may increase some problems and introduce new challenges (Aneshensel et al., 1995; Gaugler, Zarit, and Pearlin, 2003). Placing a parent remains a last choice for many people. Children may feel guilty and depressed about the prospects of placement. They also encounter realistic problems, including poor quality of care in some facilities and specifically in the United States the cost of long-term care, which is not covered by Medicare. As an alternative to traditional nursing homes, new types of care facilities, often grouped under the umbrella term “assisted living,” have been developed to offer elders more autonomy and a better quality of life than available in nursing homes (Zarit and Reamy, 2013). Rather than operating on the medical model as nursing homes do, assisted living emphasizes the social aspects of daily life and tries to help people maintain their involvement in ordinary activities. The best of these facilities are an excellent housing option for older people, but many are plagued with the same problems as nursing homes, such as staff shortages and turnover, inadequately trained staff, and unimaginative activities for residents. Placement does not mean the end of a caregiver’s involvement. Children typically remain involved, visiting their parent frequently, in some cases assisting their parent with daily activities such as feeding or dressing, and interacting with staff to assure good care (Gaugler et al., 2003). Although placement relieves some features of emotional distress associated with caregiving, many caregivers continue to experience high levels of depression and other problems after institutionalization (Zarit and Whitlatch, 1992). For many caregivers, this is a critical period when they may feel guilty and

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question their decision. They can benefit from support but often family members or friends view the problem of caring for a parent as resolved or they may be openly critical of the decision. Perhaps not surprisingly, feelings of depression that emerge around placement may persist for years (Zarit and Whitlatch, 1993).

Death and Bereavement Death of a parent is a major milestone for children. They grieve for the loss of a mother or father, and also experience a shift to being the oldest generation in the family. After a prolonged period of caregiving, responses to death of a parent can vary (Aneshensel, Botticello, and Yamamoto-Mitani, 2004; Aneshensel et al., 1995). For some people, grief can be intense and last 6 months or more. Spouse caregivers are more likely to experience distress than adult children (Ott, Sanders, and Kelber, 2007). Some caregivers of persons with chronic conditions such as dementia experience a sense of loss as they deal with their parent’s ongoing decline and so they view death as a release from suffering (Aneshensel et al., 1995). There may also be stress around such issues as closing a parent’s home or apartment and inheritance, both of which can become contentious among siblings. These varied responses underscore that there is no typical or normative pattern of bereavement and that expressing empathy and understanding for how each individual is coping with death of a parent may be the most useful response. Supportive services as well as treatment for complicated grief are also available (Bergman, Haley, and Small, 2011; Rosner, Pfoh, Kotoucova, and Hagl, 2014).

Managing the Stress and Burden of Caregiving A growing clinical and research literature proposes strategies for helping lower distress and emotional burden of family caregivers. Intervention approaches are based typically on stress management and family systems models. Stress management interventions target increasing personal resources that may buffer the experience of care-related stressors. Interventions at the family level are designed to improve support received by the primary caregiver and decrease conflict. Another approach is to give caregivers regular breaks from caregiving through the use of respite services. Some programs combine all these elements. Two caveats need to be considered about current intervention research. First, most of the research has been conducted on caregivers of persons with dementia, although a growing body of work now addresses programs for other types of disorders, such as stroke or cancer, as well as serious mental health problems (Baucom, Porter, Kirby, and Hudepohl, 2012; Martire, Schulz, Helgeson, Small, and Saghafi, 2010). Second, much of the research lumps all caregivers together, and does not consider how well an intervention might work for adult children caring for a parent, compared to other caregiving situations.

Psychoeducational Programs for Caregivers The typical psychoeducational program provides education about the care receiver’s disease and possible treatments, training for the caregiver in behavioral problem solving skills to manage challenges related to the care receiver’s behavior and other care-related stressors, and sometimes also addresses family issues (for a review, see Zarit and Heid, 2015). Many interventions have used fixed manualized interventions, which administer the same treatment to each individual. By contrast, the REACH II program (Belle et al., 2006) use an innovative approach that tailors goals and treatment specifically to problems that most concerned caregivers. This program has been widely adopted in the United States. Burgio et al. (2009) have shown that REACH II can be administered with fidelity in community as opposed to research settings. 206

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Support groups have long been popular among caregivers and have the advantage of providing a setting where caregivers can learn from one another. Group interventions that introduce problem solving and cognitive behavioral skills have shown some promise. Gallagher-Thompson and her colleagues (Coon et al., 2003; Gallagher-Thompson, 2003) have shown that training caregivers of persons with dementia in a group setting with cognitive behavioral and other skills can diminish feelings of anger and depression. Likewise, Hepburn and colleagues (Hepburn, Tornatore, Center, and Ostwald, 2001; Hepburn et al., 2007) used a group setting to help caregivers gain emotional distance and perspective so that they would be able to utilize problem-solving approaches more effectively. Their research showed sustained improvement in depressive feelings and subjective burden and increased self-efficacy among caregivers in treatment groups compared to those in a control condition.

Family Systems Interventions Couples or family systems interventions, which have the potential of building support for the primary caregiver and reducing conflict in the family, have shown considerable promise with dementia caregivers (Mittelman, Roth, Coon, and Haley, 2004; Qualls and Noecker, 2009). Building on early treatment models that included family meetings (Whitlatch et al., 1991; Zarit, Orr, and Zarit, 1985), Mittelman and colleagues showed benefits of an intervention that combined training in skills for managing behavioral support and involvement of multiple family members in the treatment sessions. Their trial, however, only included spouse caregivers. Gaugler, Reese, and Mittelman (2015) tested an adaptation of the Mittelman model with adult child caregivers and found reductions in depressive symptoms in adult children. About half the treatment sample, however, did not follow the protocol and did not actually involve other family members in sessions. In interventions for caregivers of persons with dementia, the care recipient’s cognitive problems often preclude participation in treatment, except when symptoms are early and mild (Whitlatch, Judge, Zarit, and Femia, 2006). Couples based interventions have been developed for other types of disorder such as diabetes, osteoarthritis, cancer, and chronic mental health disorders (Baucom et al., 2012). Although studies often recruit married couples, treatments could also be adapted for adult child-parent dyads.

Respite Respite programs, such as adult day services (ADS), in-home helpers, and overnight care can directly address fundamental dilemmas facing most caregivers—how to balance the time needed for care with other responsibilities and reduce daily stress. Respite provides caregivers with a block of time that allows them to engage in other activities, including employment for many children caring for a parent (Aneshensel et al., 1995; Zarit et al., 2011). It also has the effect of lowering exposure to care-related stressors. One study, for example, found that caregivers had a reduction of 43% in the time they dealt with care-related stressors on days their parent or spouse attended an ADS program compared to days when they provided all the care (Zarit et al., 2011). By lowering stressor exposure, ADS and other types of respite lead to improved well-being and may have protective effects for caregivers’ health. Studies of caregivers of persons with dementia using ADS have demonstrated improvements in affect as well as in physiological markers of the stress process on days their relative attends an ADS program compared to days when they provide all the care (Klein et al., 2016; Zarit, Kim, Femia, Almeida, and Klein, 2014; Zarit, Whetzel, et al., 2014). Caregivers’ health outcomes after 1 year were associated with amount of respite used. Receiving more days of respite was associated with stability in functional health over a 1-year period, whereas caregivers using fewer days were more likely to decline (Liu, Kim, and Zarit, 2015). 207

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Although caregivers can seek relief from caregiving demands by using paid help for respite or other purposes, rates of unmet needs are fairly high while amount of service use is fairly low (Aneshensel et al., 1995; National Alliance for Caregiving, 2015). Factors affecting utilization include difficulties in finding appropriate and good quality services, reluctance by family caregivers to turn responsibilities over to someone else, and resistance of a parent to using paid help (Heid, Zarit, and Fingerman, 2016; Malone Beach, Zarit, and Spore, 1992; Mullan, 1993). Caregivers’ emotional state may also affect service use. Caregivers who are depressed and may have the most need for assistance use formal services the least (Mullan, 1993). Their depression and concomitant feelings of helplessness and hopelessness may act as barriers to obtaining assistance. Cost of services is a major reason for low use of paid help. Alone among economically advanced countries, the United States does not have public insurance for most long-term care services, including nursing homes. Although paid in-home care is part of many private long-term care insurance, numbers of people who buy those policies remain low.

Future Trends in Intergenerational Ties It was not long ago that family scholars were predicting the demise of the extended family, and gerontologists focused on whether older people were becoming socially isolated. Instead, as we have described, social and economic trends over the past 30 years have led to strengthened intergenerational ties that under optimal circumstances function to the benefit of younger and older generations. Families potentially support one another in normal circumstances and when there are hardships. Older parents can be a continuing source of emotional, practical, and financial support for children struggling with dual-career issues, childcare, the cost of their children’s college and a myriad other issues. In turn, adult children provide emotional and practical support to aging parents in everyday interactions as well as in response to declining health and functioning. This pattern of exchanges between older parents and their children may become the basis of a new social compact. Feelings of obligation, reciprocity, and affection toward parents, which have always been part of most cultures, may strengthen, and generations will rely on one another for assistance, although in some instances with reluctance. The multi-generational family, with all its tensions and limitations, may take on a paramount role in buffering each generation from social and economic strains of the modern world. We need to consider, however, how well families are prepared for these tasks. This role likely plays out best in families with adequate social, psychological, and economic resources who will find constructive ways of managing the added burdens. But for the many families with limited resources and who are too divided by conflict, intergenerational pressures may be just another source of the widening gap between haves and have-nots in society. For some tasks, such as care of an adult child with a severe developmental or mental health problem or care of an aging parent with dementia or other debilitating disorders, even families with extensive resources may be overwhelmed by the demands associated with care. A central question, then, is what role should government play is supporting families in care and in relieving pressures in other areas, such as the costs of childcare or advanced education. Policies developed in the Nordic countries and as well as in some European countries have specifically been designed to support young adults with stipends that help them continue their education. Programs also support young adults with extensive family leave programs following birth of a child as well as low-cost and high-quality childcare (Lee, Duvander, and Zarit, 2016). Likewise, universal health care and publically supported coverage of the cost of long-term care of older adults reduce pressures on families. These programs are also critical for supporting older people who cannot rely on or do not have close family members (Shea et al., 2003). Aging populations place pressures on these programs, but thus far governments have maintained their commitment to extensive welfare state policies 208

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(Davey, Malmberg, and Sundström, 2014). It is hard to be optimistic, however, that these types of programs will be adopted in the United States. Indeed, cornerstone programs such as Medicare, Medicaid, and Social Security have been under attack, and their survival as effective programs is not guaranteed despite their popularity. As a result, the continued growth of the older population will likely place new burdens on children and grandchildren. As we look to the future, the critical questions are whether countries with extensive social, educational, and health programs can continue to provide this level of support and whether countries with more rudimentary program can find a better balance to meet the needs of young and old. At a fundamental level, communities need to ask if they benefit as a whole when everyone has an opportunity for high quality childcare and education and when there are supports for persons of any age with severe disabilities that supplement the care given by families, or if they believe that each person should take on these responsibilities, no matter if they have the resources and abilities to do so.

Conclusions Relationships between parents and their children remain for most people a fundamental focus of their lives across the life course. We do not cease being parents when children have left the house, and we do not cease being children until parents are deceased. These lifelong ties are characterized by patterns of reciprocity of support, even when parents have disabilities or other limitations. How these connections play out, as well as the rewards and stressors associated with ongoing parent–child ties are likely to vary widely both within as well as between families. Such factors as cultural beliefs, family history, social and economic resources, and current life problems and health are likely to affect the tone and substance of intergenerational relationships in families. Caregiving will often be the final act of this drama. The challenge is to find a path that supports the older person’s dignity and preferences without overwhelming the resources of their children.

Acknowledgments We acknowledge support by grants from the National Institute on Aging which contributed to some of the research discussed in this chapter—award number R01AG027769, “The Family Exchanges Study II” (Karen L. Fingerman, Principal Investigator) and award number R01 AG031758, “Daily Stress and Health Study” (Steven H. Zarit, Principal Investigator).

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PART II

Parenting Children of Varying Status

7 PARENTING SIBLINGS Mark E. Feinberg, Susan M. McHale, and Shawn D. Whiteman

Introduction To discuss parenting in the context of sibling relationships situates the sometimes abstract notion of parenting within a family context rich with intersecting relationships, alliances, and rivalries. As any parent of more than one child recognizes, parenting becomes substantially more complex and sometimes fraught in the sibling context. Similarly, for parenting scholars, insights gleaned from singlechild research designs must be re-conceptualized and assessed with the incorporation of additional sibling-related dimensions. Such work requires the development of new theory, research questions, and, sometimes, more complex methods. Although difficult to pursue at times, sibling-focused parenting research has the potential to inform the parenting field about factors that are relevant—but not recognized—in single-child family research. Managing sibling relationships presents some of the most difficult and stressful childrearing challenges parents face (Perlman and Ross, 1997). Indeed, the most frequent source of disagreements and arguments between parents and young adolescents is how siblings are getting along (McHale and Crouter, 1996). By leading to increased parental stress and even depression, sibling conflict may compromise the parenting of many otherwise positive and competent parents. In addition to providing further insight into parenting, incorporation of sibling dynamics into parenting research is directly relevant to over 80% of U.S. children who have a sibling. In fact, in 2010 more children in the United States were growing up with a sibling than with a father in the home (McHale, Updegraff, and Whiteman, 2012). For this majority of children with siblings, the sibling’s characteristics and the quality of the sibling relationships are non-trivial influences on children’s long-term developmental outcomes and trajectories in domains such as mental health, academic and career success, and peer and romantic relationships. Although much less well studied, sibling relationships factors frequently predict unique variability in adjustment after accounting for other factors such as parenting, parent, and sibling adjustment, peer relationships, and/or genetic factors; and sibling effects are robust across ethnic and cultural groups examined to date (Feinberg, Solmeyer, Hostetler, et al., 2012; Feinberg, Solmeyer, and McHale, 2012; Updegraff, McHale, Killoren, and Rodríguez, 2011). The influence of sibling relationships starts very early and persists over long time periods; for example, studies show that sibling warmth and negativity as early as the preschool years influence children’s adjustment and maladjustment at least into pre-adolescence (Dunn, Slomkowski, Bcardsall, and Rende, 1994); and sibling relationships in childhood predict internalizing problems 30 years later

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(Waldinger,Vaillant, and Orav, 2007). The importance of sibling relationships may also be due to the duration of the bond—sibships are often the longest lasting relationships individuals experience, and thus carry influence across the lifespan.The salience of sibling relationships for well-being continues: The quality of sibling relationships is one of the most important long-term predictors of mental health in old age (Vaillant and Vaillant, 1990). The salience of siblings for each other’s development is likely due to several factors. First, siblings spend more out-of-school time with each other on average than with parents or friends (McHale and Crouter, 1996; Updegraff, McHale, Whiteman, Thayer, and Delgado, 2005). Second, the sibling context allows children—from the earliest months of life—to learn about, experiment with, and refine a repertoire of relational behaviors with a family member who has a more similar status and role than parents (i.e., horizontal relations rather than vertical relations). Third, shared time with siblings is often emotionally intense as many sibling relationships are composed of high levels of both affection/support and hostility/aggression. It is likely that these factors help explain the influence that siblings and their relationships have on each other’s development and lifelong adjustment. For example, in early childhood, those children with a sibling—especially of a roughly similar age range—demonstrate relatively more advanced competencies and cognitions related to theory of mind and executive functioning—and the more siblings the better (McAlister and Peterson, 2006; McAlister and Peterson, 2013). Warmth and affection between siblings have unique positive implications for development, as demonstrated in three studies in different Western countries examining links between warm sibling relationships and prosocial behavior, disruptive behavior, and/or internalizing problems—demonstrated cross-sectionally (Padilla-Walker, Harper, and Jensen, 2010); controlling for parent–youth relationship qualities and sibling negativity (Pike, Coldwell, and Dunn, 2005); and controlling for support received from parents and friends (Branje, van Lieshout, van Aken, and Haselager, 2004). In addition to promoting cognitive, social, and mental health development, warm sibling relationships can also serve as a unique protective shield, buffering the negative impacts of stressful life events and conditions—as Gass, Jenkins, and Dunn (2007) found in predicting internalizing problems while controlling for prior adjustment and parent–child relationships. However, sibling relationships are not always beneficial and promotive. Siblings can serve as partners in crime, and a sibling’s delinquent, antisocial, and health-risking behaviors, such as substance use, may be contagious (Feinberg, Solmeyer, and McHale, 2012). Furthermore, elevated levels of sibling conflict and violence predict poorer developmental outcomes across a broad range of mental health, social, and academic competencies and life domains. Sibling conflicts—which have been observed to occur many times an hour (Berndt and Bulleit, 1985; Dunn and Munn, 1986)—can be stressful for parents, leading to problems like depression and interparental conflict—and thereby compromising sensitive, warm, and consistent parenting (Feinberg, Solmeyer, and McHale, 2012) Perhaps the greatest common denominator across sibling investigations over the past decades has been the complaint that scholars, service providers, and policymakers have neglected the large and critical role that sibling relationships play in children’s development and lifelong well-being, patterns of family stress and conflict, and parenting self-efficacy and competence. For example, the four major family research journals together published an annual average of only about 10 articles focused on sibling relationships over the two decade period 1990–2011—with almost two-thirds of those reports coming from one journal (McHale et al., 2012). The lack of research and attention to sibling relationships generally, and parenting of siblings in particular, is in stark contrast to the substantial influence of sibling relationships on children’s long-term development. Apart from other sibling dynamics, sibling conflict and aggression should be a general source of concern given that, on average, the sibling relationships frequently involves aggression and violence; according to the only representative sample with such data, about one-third of all children and adolescents (and 45% of children ages 2–10) were victims of sibling aggression (physical, property, or psychological) in the 220

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previous year (Tucker, Finkelhor, Shattuck, and Turner, 2013). High levels of sibling aggression and sibling rivalry may be facilitated by societal and family tolerance of physical fighting and conflict among siblings; in non-Western societies, prohibitions against sibling aggression are associated with lower levels of such conflict, although some societies sanction older-siblings’ physical punishment of younger siblings as part of the older siblings’ caregiving role (Weisner, 1993). To prompt increased research on and understanding of parenting in the context of more than one child, we focus here on the insights the field has generated to date regarding: (1) the influence of parenting toward individual children on sibling relationships; (2) parenting directed toward siblings, and the consequent impact on children’s development; and (3) the influence of sibling relationships on parents and their parenting.Together, these topics capture sibling-related family systems dynamics.

Historical Considerations of Parenting Siblings Ironically, given the general neglect of the salience of sibling relationships, the founding moral document in Western civilization—the Bible—over and over again depicted sibling rivalry as the driving force behind the course of individual lives and even nations. The fates of Cain and Abel, Jacob and Esau, and Joseph and his family all turn on life-threatening conflicts between siblings. In each case, sibling rivalry over parental affection and rewards were the driving force behind the conflicts (that is, if we can put their God in the role of a parental figure in the Cain and Abel story). The increasing ability of siblings to repair conflicts across these stories is followed by the more optimistic story of Moses, whose sister and brother save Moses’ life and facilitate his leadership of the Jewish rebellion and exodus. The first application of empirical research methods to the topic of sibling relationships dates to the nineteenth century: Galton held that the predominance of firstborns in science and other fields was a result of their greater ambitions and leadership ability derived from their prerogatives and experience as the older sibling in the family. Birth order effects have fascinated scholars and the public since, but together this research suggests that simple birth-order effects on most personality traits and developmental outcomes in Western societies are small—if present at all (Rohrer, Egloff, and Schmukle, 2015) rather, children’s everyday experiences in their sibling relationships better account for “sibling influences” (Buhrmester and Furman, 1990). In addition to birth order, researchers beginning in the 1950s examined the effects of other “structural” sibling characteristics: For example, Brim (1958) and Koch (1960) initiated the examination of how the gender constellation of sibling dyads may influence the affective quality of the sibling relationships, social learning processes in the sibling pair, development of stereotypically gendered interests and activities, and social and romantic competence. Again, findings were not systematic and thus directed attention from structural factors to the social processes underlying sibling influences. In addition to birth order and gender constellation, research beginning in the 1960s examined sibship size in an effort to understand how a larger number of siblings in a family may “dilute” parents’ personal and/or financial resources that can be devoted to any single child, and thereby diminish children’s achievement in school and career (Blake, 1981; Blau and Duncan, 1966). However, the theorized mediating processes—perhaps most importantly family relationships—have not been carefully studied. In contrast to this work on structural characteristics, Adler’s theoretical work in the first half of the twentieth century (Ansbacher and Ansbacher, 1956) focused on the emotional dynamics between siblings in the family context. His theoretical work still represents the strongest statement of the centrality of sibling relationships for individual development and well-being in the field of psychology. Adler’s theory put siblings at the center of development: He viewed sibling rivalry—shaped partly by birth order, but more strongly by individual’s defense against feelings of inferiority— for resources, such as parental attention and affection, as a critical driver of family dynamics and 221

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children’s psychological and personality development. Confronted by the strain of persistent sibling rivalry for parental recognition, siblings become enmeshed in social comparisons and struggles for power. As Schachter later hypothesized and studied, sibling pairs can learn to develop separate family “niches” to avoid direct conflict (Schachter, Shore, Feldman-Rotman, Marquis, and Campbell, 1976). Nonetheless, Adler’s sibling-focused approach is typically given perfunctory review in introductory psychology classes, and the issue of sibling dynamics typically then forgotten throughout psychologists’ clinical or research careers. In the 1970s, as society moved to de-stigmatize mental and physical “handicaps”—and instead view children and adults with disabilities as requiring accommodation and support to engage more fully in their families and in the larger society—researchers began examining individual development and sibling relationships when one sibling has a physical, psychiatric, or developmental disability.This work examined a range of issues including the ways in which siblings were called on to help with the care of their sister or brother, the quality of the sibling relationships, and the consequences for youth development of having a disabled sibling (Farber, 1963). Focused and ongoing lines of research examining the quality and dynamics of sibling relationships emerged in the late 1970s and 1980s. Much of this work targeted childhood and adolescence. Focused on very young children, Dunn’s sibling research, beginning in the1980s, represents one of the earliest and most prominent lines of study (Dunn, 1983; Dunn and Kendrick, 1980). With careful observations of family interaction, Dunn and colleagues broke new ground in describing the ways that young sibling pairs interacted with each other, how mothers behaved with the children, and the ways that these family dynamics influenced the development of children’s interpersonal and social-cognitive abilities (Dunn, Brown, and Beardsall, 1991). Her work highlighted the important and unique ways that early sibling relationships provide opportunities for social development from infancy onward, about triadic dynamics involving siblings and their mothers, such as competition for maternal affection and attention, striving for fairness, and complex cooperation and conflict processes. Dunn and her colleagues also examined how dimensions of the parent–sibling triad— including but not limited to parenting behaviors—were linked to later development. Additionally, she investigated how the quality of the pre-existing relationships between the mother and firstborn child influenced the development of sibling and triadic relationships after the birth of the next child (a topic to which we will return) with consequences for developmental outcomes such as social and emotional competence and sibling relationship qualities. A noteworthy exception to researchers’ general focus on childhood and adolescence is the life-course-oriented work by Cicirelli, who also examined sibling relationships in early and later adulthood (Cicirelli, 1980; Cicirelli, 1995). The topic of sibling differentiation (e.g., niche picking) was revived in the 1980s. This interest followed from surprising behavioral genetics findings that pointed to the importance of non-genetic, environmental influences that led to divergent sibling outcomes (Plomin and Daniels, 1987; Rowe and Plomin, 1981).These findings countered scholars’ general assumptions that similar home, school, and community environments should generally lead to similar sibling outcomes. Researchers became increasingly interested in examining how parenting toward siblings (e.g., favoritism, differential treatment) as well as sibling relationship experiences, another component of the nonshared family environment, could be responsible for the ways siblings turned out differently. Although researchers have documented how parental practices—especially parents’ differential treatment of siblings (PDT)— lead in many cases to sibling differentiation, the magnitude of PDT effects are not large enough to account for more than a small portion of sibling differentiation (Reiss, Hetherington, Plomin, and Howe, 1995; Turkheimer and Waldron, 2000). The Behavior genetic (BG) research also led to the development of large sibling datasets given the reliance of most BG research on sibling designs with large enough samples to reliably assess differences in sibling similarity (typically, intraclass correlations) across types of siblings, including monozygotic (MZ) and dizygotic (DZ) twins, and full biological, step-sibling, and adoptive sibling pairs.This 222

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work brought into question study-design assumptions about sibling development and experiences, such as the assumption that identical and fraternal twins have equivalent parenting and family experiences; that is, that MZ and DZ twins experience similar kinds of common and differentiated microenvironments (Kendler, Neale, Kessler, and Heath, 1993). Furthermore, the accumulation of sibling samples for BG analysis allowed family and developmental scholars to address questions surrounding sibling relationships and family system dynamics with larger samples than they could amass themselves (Feinberg and Hetherington, 2001; Feinberg and Hetherington, 2000; Feinberg, Neiderhiser, Reiss, Hetherington, and Simmens, 2000). As research on siblings has continued to evolve, some family scholars have begun applying existing empirically based knowledge to programs designed to improve parenting of siblings as well as directly enhance sibling relationships. Although only a handful of high-quality, empirical evaluations of such programs exist (see Practical Considerations, below), results have been promising and suggest that the field is capable of developing robust tools to address what has long-been—to use an analogy from modern astrophysics—the neglected, somewhat invisible, but highly salient “dark energy” of family life.

Central Issues in Parenting Siblings In this chapter, our discussion of the parenting of siblings is informed by a general framework of the constituent dimensions of parenting developed by Parke and Buriel (1998). This framework categorizes parenting behaviors into three domains. The first domain, the focus of most research on parenting, consists of the actual interactions that parents have with children, including the qualities of those interactions. Most social learning theories, which implicitly inform considerable parental socialization research, focus on processes such as modeling social behaviors and reinforcing behaviors of children. Parenting behaviors in this domain are often assessed in terms of dimensions that have been shown to be predictive of future child development and well-being, such as warmth, sensitivity, hostility, and control. A second domain consists of the ways that parents actively and directly try to teach children, such as through instruction, coaching, or advice giving. Finally, parents organize children’s experiences; this domain is referred to as orchestration or engineering children’s experiences. For parenting of siblings, such orchestration could include attempts to engage siblings in similar and shared versus different activities and settings and attempts to influence the choice and social contexts of sibling’s activities together when they are not with parents. Orchestration also influences the situations and contexts in which hands-on, direct parenting interactions take place—which can be assessed with the framework of family time use (i.e., considering the activities parents engage in with children as well as where, for how long, and with which other people present). All three domains of parenting can come into play in the ways parents shape a single aspect of children’s development. For example, children’s conflict resolution capacities can be influenced directly through parent modeling in the context of parent–sibling interactions, through coaching and advising the siblings, or through planning siblings’ activities and daily routines, such as family meals and shared leisure activities or enrolling siblings together in activities such as team sports. Although we do not articulate all the possibilities here, it is a worthwhile exercise to consider each of the three categories of parenting when contemplating, for example, the ways that each theoretical framework described below conceptualizes how parents promote their children’s development. We also focus on several pathways between parenting and sibling relationships. First, we are interested in “parental socialization,” that is parenting behaviors directed toward and/or that influence sibling relationships, which consequently affect each child: parentingsibling relationshipschild. For example, higher levels of parental negativity and conflict are associated with higher levels of sibling conflict (Kim, McHale, Osgood, and Crouter, 2006;Volling and Belsky, 1992), which is in turn linked to diminished levels of children’s emotional well-being, relational competence, self-regulation, and academic and occupational attainment (Feinberg, Solmeyer, and McHale, 2012). 223

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Second, we are interested in how sibling relationships affect parents and parenting; that is, sibling relationshipsparenting. A handful of studies has found that sibling relationship qualities—especially rivalry and conflict—are linked to parental well-being (i.e., depression) and parenting competence (Brody, Kim, Murry, and Brown, 2003; Dishion, Nelson, and Bullock, 2004; Patterson, Dishion, and Bank, 1984). Moreover, siblings can actively collude to counter parents’ goals (see below). A third pathway highlights the ways that parenting influences each child’s personality and adjustment, with consequent influence on the sibling relationship. For example, children’s individual characteristics such as their conduct problems and social competencies—which are susceptible to influence by parents over development—may lead to more conflictual or more positive sibling relationships (Patterson, 1984).This pathway can be expressed as: parentingchildsibling relationships. Given its main focus on the development of individual children, however, we pay most attention to the first two pathways. Together, these paths suggest a conceptual model of family systems processes in parenting of siblings that describes the scope of our interest here, depicted in Figure 7.1. The three domains of parenting we address may all come into play around certain sibling relationship dynamics. For example, one of the largest areas of research on sibling relationships has concerned description and analysis of parent differential treatment (PDT), the ways and extent to which parents treat their children differently—or more pejoratively, parental favoritism. As we elaborate below, scholars have found that the extent of PDT is linked with more negative and less positive sibling relationships, and that, as expected, the less favored sibling often demonstrates lower well-being (Shanahan, McHale, Crouter, and Osgood, 2008). As an example, consider how PDT can be shaped through the three dimensions of parenting and two pathways described: First, parents can demonstrate—or children can interpret—PDT through their direct interactions with children, for example, when a parent shouts at one child more than the other. A parent may also spend more time providing instruction and support to one sibling—which could be due to, or perceived as due to, a parent behaving in a more positive, helpful way to one child or as based on a parent’s perception that one child is less capable and needs more help than the other. Parents can orchestrate children’s experiences in ways that are deemed to favor one child, such as providing more of a family’s resources to support that child activities (e.g., sports)

Figure. Parenng, sibling relaons, and child adjustment pathways Pathway 1: ParenngSibling relaonschild adjustment Pathway 2: Sibling relaonsParenng Pathway 3: ParenngChild adjustmentSibling relaons

Figure 7.1  Parenting, sibling relations, and child adjustment pathways

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or needs (e.g., health care). Furthermore, PDT can be involved in both parent-socialization and child effects pathways: PDT can lead to more rivalry and conflict in sibling relationships; at the same time it is possible that the stress a parent experiences from exposure to frequent sibling conflict leads to compromised emotional regulation and angry outbursts in which one child is blamed for the conflicts (e.g., the older child should have been behaving his age; the younger child should stop instigating and irritating the older one; the brother should stop being physical with his sister). Together, these parenting domains and directional pathways of influence serve as a framework for organizing the range of theorized mechanisms that can inform research on parenting of siblings.

Theory in Parenting Siblings Although there has been relatively limited theoretical development within the study of the parenting of siblings per se, sibling scholars have made use of existing developmental and family theories to guide such research. As we noted at the outset, however, theories focused on parenting—including those that capture influences on parenting (Belsky, 1984)—describe what parents do (Darling and Steinberg, 1993; Parke and Buriel, 1998) and their effects on individual children, and thus require re-assessment when applied to the parenting of siblings. That is, most theories around parenting have not been tested in ways that capture the most common family context of parenting siblings.

Attachment Security The critical building block of attachment security in early childhood develops through direct experience with reliable parental figures. Although the attachment security construct was largely developed and studied in the context of parent–child relationships, scholars have theorized that siblings may serve as secondary attachment figures for each other—across the life course (Ainsworth, 1989). A secondary attachment figure framework may be useful for understanding sibling relationships as they develop over time, particularly relationships in families or cultures where older sibling caregiving of younger children is prominent. Attachment security may also provide a useful lens for understanding variability in sibling rivalry and conflict in that insecurely attached children may feel more threatened by a sibling competitor for parental affection (Teti and Ablard, 1989). Research in the sibling context or with sibling designs has contributed to our understanding of attachment security, demonstrating how including siblings into parenting and family research can lead to new insights.Thus, several studies point to the conclusion that, unlike temperamental reactivity, personality, intelligence, and many other child characteristics, children’s attachment security is not directly influenced by children’s genetic factors (although genetic factors may moderate the influence of parenting on attachment security) (Bakermans-Kranenburg and van IJzendoorn, 2007; Bokhorst, Bakermans-kranenburg, Fonagy, and Schuengel, 2003; van IJzendoorn et al., 2000). Instead, such attachment security with parents is influenced by “environmental” factors, such as parents, peers, school, and neighborhood. Further explorations of environmental influences on attachment security suggest that these influences primarily lead siblings to be similar (shared environmental influence) rather than different (Caspers,Yucuis,Troutman, Arndt, and Langbehn, 2007; Fearon et al., 2006).The implication of this research is that attachment security is primarily driven by certain dimensions of parenting, such as sensitive responding, which are manifest (or at least exert influence) in a somewhat consistent manner across siblings (although see Bakermans-Kranenburg, van IJzendoorn, Bokhorst, and Schuengel, 2004).

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Social Comparison A social psychological framework for understanding the effects of parenting on sibling relationships is social comparison theory, generated by Festinger in the 1950s. Festinger proposed that individuals’ self-esteem is influenced by ongoing assessment of one’s own capabilities or attributes in comparison to that of others—especially others who are perceived as like oneself (Festinger, 1954; Suls, Martin, and Wheeler, 2002). This theory bears similarities to Adler’s focus on sibling competition as a source of feelings of inferiority and superiority. In social comparison theory, upward and downward comparisons are focused on others who are higher or lower, respectively, in status, skills, or other salient attributes. Upward comparisons are often associated with low self-esteem, but can also drive motivation to improve and thus lead to greater gains in skills, status, and ultimately self-esteem (and the reverse for downward comparison). Upward and downward social comparison have clear relevance for siblings given the importance of birth order as a marker of status and determinant of capacity or skill in childhood relationships although this aspect of the theory has not been much deployed in the sibling context. Schachter, building on Adlerian notions of sibling rivalry and the links to esteem, developed the construct of sibling de-identification as a way that some siblings manage rivalry over sources of self-esteem, such as parental attention and affection (Schachter, Gilutz, Shore, and Adler, 1978). By developing alternative areas of interest and competence—and thus de-identifying with each other— siblings reduce social comparison with each other and build sources of esteem and parental recognition in non-overlapping areas. In this framework, siblings are able to “bask” in the reflected glory of each other’s accomplishments, and thus sibling pairs who de-identify and reduce their similarity may not only reduce rivalry but also achieve higher levels of mutual support and affection (Feinberg et al., 2000; Schachter et al., 1978). Feinberg proposed the use in research of a broader term—sibling differentiation—to incorporate processes through which parents, extended family, teachers, and others fostered the individuation of siblings. Note that PDT and parenting-influenced differentiation are not the same thing, as PDT has typically referred in the research literature to better versus worse parental treatment rather than parenting that fosters differentiation of sibling identities and abilities without an implication of better and worse.

Social Learning Theory Social learning theory is a general framework explaining the learning of behavior through either observation of or reinforcement in interactions with others (Bandura, 1977).Young children are keen observers of parents and older siblings and learn many positive and negative relational behaviors from such observation, some of which they deploy in the sibling relationship context. Siblings also actively shape their own relationships through their social exchanges, reciprocally reinforcing positive or negative behaviors (Bullock and Dishion, 2002) and by observing and imitating one another. The work of Patterson and colleagues offers a social learning framework for understanding some types of sibling conflict. Patterson (1982) observed certain types of family conflicts through the lens of behavioral reinforcement, crystallized in the notion of coercive processes. The central idea is that hostile family conflicts can represent struggles between individuals to achieve conflicting goals, with each relationship partner displaying increasingly aversive and hostile expressions to overcome the resistance of the other. If a parent “gives in” allowing the child to “win” a conflict, such positive reinforcement strengthens the child’s tendency to use the same tactic in the future. Coercive processes in the parent–child relationships can lead children to use similar strategies with siblings. Such conflictual and coercive family interaction patterns can become a “training ground” for the child’s development of a generalized aggressive and coercive interpersonal style (Patterson, 1984, 1982). Patterson found that a particularly detrimental combination consisted of disruptions in parental discipline alongside 226

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the child’s engagement in conflicts with family members. Because the sibling relationship is a more equal, horizontal relationship than the vertical child-parent relationship, it is possible that sibling coercion has unique implications for other egalitarian relationships such as future peer and romantic relationships (Natsuaki, Ge, Reiss, and Neiderhiser, 2009). Although the finding was relatively neglected, Patterson identified the sibling relationship as playing a pivotal role in the development of antisocial behavior problems (Patterson et al., 1984).

Family Systems Theory Finally, family systems theory is an overarching perspective that encompasses processes targeted by several of the above theories, and provides a general framework for many sibling researchers. Fundamentally, family systems theory holds that all individuals and relationships in a family are part of an integrated system in which individual components are responsive to and reciprocally influence others. For example, an ecological systems framework (Cox and Paley, 2003) holds that sibling relationships reciprocally influence and are influenced by family subsystems including parent–child relationships and couple/marital relationships. This general framework is supported by research documenting links between the quality of sibling and parent–child relationship (Brody, Stoneman, and McCoy, 1994; Brody, et al., 1992; Furman and Giberson, 1995; Stocker and McHale, 1992), and a smaller set of studies links sibling and couple/marital relationships (Cummings and Smith, 1993; Deal, 1996; Brody, Stoneman, and MacKinnon, 1986; McHale, Crouter, McGuire, and Updegraff, 1995; Stocker and Youngblade, 1999). Some studies have gone beyond correlational data to examine longitudinal paths, allowing for stronger inferences about direction of effect (Bank, Burraston, and Snyder, 2004; Bank, Patterson, and Reid, 1996; Brody et al., 2003; Feinberg, McHale, Crouter, and Cumsille, 2003; Lam, Solmeyer, and McHale, 2012). Some versions of family systems theory posit that family dynamics tend toward an equilibrium— that is, disruptions in individual behavior or the usual pattern of relationships triggers feedback mechanisms and actions that tend to return the system to the prior pattern of functioning (Minuchin, 1985).This principle highlights the idea that families can be viewed as resisting changes at individual and relational levels that challenge ongoing, customary processes embedded in a network of dynamics. Although typically discussed in the context of clinical intervention, this principle may also be applied to parenting behaviors intended to modify individual children’s adjustment or the quality of sibling relationships. For example, a parent who attempts to improve a child’s self-esteem, as by increased warmth and attention, may trigger a reaction from a sibling striving to maintain a position of equal or favored status.

Classical and Modern Research in Parenting Siblings In presenting the main themes and findings of sibling research in this section, we adopt a life course perspective and describe the research from the birth of the second child (transition to siblinghood) through childhood and adolescence to parenting issues involving adult siblings. We include birth order and gender-composition issues where relevant, and provide brief overviews of areas of family context research that have been the focus of some investigation: the cultural contexts of parenting siblings and parenting when one sibling has a disability.

Parenting at the Transition to Siblinghood As noted, most children grow up with siblings, making the transition to parenthood of siblings a normative event in the lives of mothers and fathers, and the development of sibling relationships a normative event for children. Indeed, the ubiquity and significance of this family transition is evident 227

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in the popular press, where “how to” guides for new parents often include chapters on managing parents’ own transition experiences as well as their children’s transition to becoming siblings. In a review of advice to parents in the popular press literature, Kramer and Ramsburg (2002) identified 47 books and book chapters that included a focus on children’s transition to having a sibling. Nor is the popular press literature limited to parenting advice: Our recent search on Amazon.com found over 100 books written for children, published since 2000, on how to have a positive sibling relationship. The most common topic by far was helping children across the transition to siblinghood. Consistent with the relative neglect of sibling relationships in the research literature, popular press publications on the transition to siblinghood appear to outweigh the empirical literature on this topic—raising concerns that advice tendered to parents lacks an evidence base. Kramer and Ramsburg (2002) identified seven topics of parental concern evident in popular press accounts: (1) optimal timing of having a second child, (2) preparing children for the sibling’s birth; (3) managing children’s feelings of jealousy or displacement, (4) children’s regressive behavior following the siblings’ birth, (5) managing children’s negative behaviors toward the sibling, (6) involving children in care for their sibling, and (7) promoting positive sibling relationships. The advice provided to parents in these popular press outlets and, indeed, the limited empirical literature on parenting around the transition to siblinghood can be viewed in terms of the three domains of parenting we described, namely parents’ behaviors in their direct, interactive relationships with their children, their coaching, and their orchestration efforts. Beginning with parental interaction behaviors, parental warmth and involvement, both before and after the sibling’s birth have been linked to more positive reactions to a new sibling and to child adjustment more generally (Dunn and Kendrick, 1982; Gottlieb and Mendelson, 1990; Volling and Belsky, 1992). One early study emphasized the significance of father involvement with the older child (Legg, Sherick, and Wadland, 1974), and most research on the sibling transition documents fathers’ coparenting role as active and cooperative partners in dealing with the transition to a second child (Kolak and Volling, 2013; Song and Volling, 2015)—a family dynamic not unlike coparenting across the first transition to parenthood (Feinberg, 2003). Beyond relationship quality, parents’ direct instruction may be particularly effective during the sibling transition. Another early study found that the children of mothers who talked to them prior to the siblings’ birth about their baby sister’s or brother’s feelings and well-being exhibited more positive and fewer negative reactions across the transition to siblinghood (Dunn, Kendrick, and MacNamee, 1981). As we elaborate in our discussion of childhood-aged siblings, parents also can coach their children in social problem solving and prosocial play behavior as a means of promoting positive sibling relationships (Feinberg, Sakuma, Hostetler, and McHale, 2013; Kramer and Radey, 1997). For example, praising children for their efforts and supervising their joint involvement appears to promote positive engagement by preschool-aged children with their new siblings (Kramer and Washo, 1990). Coaching children’s involvement in sibling care also may have positive implications for the sibling relationship, including by promoting children’s social understanding (Stewart and Marvin, 1984). Finally, parents may consider preparing their children for becoming a sibling through direct instruction by involving their children in sibling preparation classes. A review of community- and health care-based sibling preparation classes, however, found little evidence of the effectiveness of these interventions (Beyers-Carlson and Volling, 2017). Finally, parents can orchestrate more positive reactions to a sibling by maintaining the older child’s routines such as bedtime, meal, and daycare schedules, and minimizing other simultaneous transitions (e.g., move to a new bedroom or home) around the time of the transition (Legg et al., 1974). Preparing children for the siblings’ birth with information about who will care for them when their parents are at the hospital and arranging hospital visits with the mother and new sister or brother also was described by mothers as having positive implications (Legg et al., 1974). One study found that support from a close friend during the transition was linked to more positive adjustment by young 228

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children who had experienced the birth of a sibling, suggesting that developing extrafamilial sources of friendship and esteem may be another important focus of parents’ efforts to orchestrate the older child’s daily routine (Kramer and Gottman, 1992). As we elaborate below, parents also can support their children’s adjustment by their timing of the sibling’s birth. Kramer and Ramsburg’s (2002) conclusion about the mismatch between popular interest and science-based knowledge was echoed in Volling’s (2012) review of the literature on changes in firstborns’ adjustment following a sibling’s birth. The authors of both reviews noted that prevailing ideas about the transition to siblinghood as a period of family crises and stress are grounded largely in psychodynamic theories and have limited scientific support. Highlighted in this theoretical framework are issues of sibling rivalry and jealousy that stem from a firstborn’s “dethronement” following the birth of a sibling (Adler, 1959). Consistent with this perspective, the transition to siblinghood has most often been described as a stressful and disruptive life event, likely to give rise to adjustment problems in children and their families (Volling, 2012).Yet,Volling’s review of the empirical literature yielded a quite different conclusion, namely that there is substantial variability in children’s responses to becoming a sibling, including in children’s conduct problems, emotional well-being, learning and achievement, and health behaviors (e.g., sleeping and eating, where there are concerns about regression). Indeed, in a report of a longitudinal study of the sibling transition,Volling et al. (2017) identified distinct trajectories of change characterized by patterns of emotional and behavioral problems and adaptations. Moving away from a psychodynamic perspective that posits universalistic and biologically embedded responses, and adopting a developmental ecological perspective,Volling highlighted the significance of personal, social, and contextual factors in children’s adjustment to the sibling transition.This is a welcome orientation for intervention-focused scholars, as these factors are generally somewhat malleable. For instance, children who are younger at the time of a sibling’s birth and those with smaller age-spacing between them and their older siblings also may respond more poorly (Baydar, Greek, and Brooks-Gunn, 1997; Dunn and Kendrick, 1980; Kramer and Gottman, 1992; Teti, Sakin, Kucera, and Corns, 1996). Rather than simply better or poorer reactions, there is also some evidence that younger and older children exhibit different kinds of negative reactions to their sibling’s birth (Teti et al., 1996). Findings regarding the role of family dynamics in children’s adjustment are more consistent than studies of child characteristics in showing a diminution of positive interactions with mothers and an increase in maternal control (Baydar et al., 1997). Father involvement and marital and coparenting relationship quality also may be challenged by the birth of a sibling, but maintaining positive family dynamics in these domains has significant implications for children’s adjustment and for the quality of the developing sibling relationship (Kolak and Volling, 2013; Song and Volling, 2015). Child temperament characteristics also play a role.Volling et al. (2017) found that higher negativity and lower positivity in sibling relationships at 1 year following the younger sibling’s birth were predicted by the older sibling’s emotion reactivity, attention problems, and aggression. It is important for parents to recognize, however, that children’s reactions are not monolithic: Instead, the same children may exhibit both positive and negative responses, which can change over time. For example, one study based on a nationally representative sample revealed that children who had experienced the birth of a sibling showed greater increases in verbal development, but also greater increases in peer problems compared to those who did not become siblings (Baydar et al., 1997). Parents and policymakers should also attend to the wider context, as some research suggests that children from single-parent and economically disadvantaged families are at greater risk for adjustment and learning problems following the birth of a sibling (Baydar et al., 1997). Beyond these domains of parenting, the transition to siblinghood may also be influenced by the new sibling’s temperament and capacities. Researchers have developed new assessment methods over the past 20 years that have pushed back the age at which infants are able to track and influence social relationships, including triadic family relationships, to the first months of life. For example, 229

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Fivaz-Depeursinge and colleagues developed a triadic observation paradigm for infants and two parents, which included tracking family members’ eye gaze and head and body orientations (FivazDepeursinge, 2008).Their research found individual differences in infants’ triadic engagement ability (operationalized as the frequency of rapid multishift gaze transitions between parents) by 3 and 4 months of age that were linked with coparenting dynamics (Fivaz-Depeursinge, Favez, Lavanchy, De Noni, and Frascarolo, 2005; McHale, Fivaz-Depeursinge, Dickstein, Robertson, and Daley, 2008).We can extrapolate from these findings that infants as early as 3 or 4 months are participating in and even influencing triadic exchanges, including parent–sibling interactions. Also important to the sibling transition is a developmental transition that occurs in the second half of the first year, according to Ziv and Sommerville (2016), in which infants begin to register violations of the fair distribution of resources. This capacity in the first year of life implies that mutual sibling dynamics with respect to fairness may begin developing during the first year of the younger sibling’s life. The presence of siblings predicted the degree of an infant’s concern over fairness after this developmental transition, suggesting that a potentially competitive context at home affects young children’s general sensitivity to fair and unfair situations. This developmental research helps us understand the capacities of young children that underlie findings in the work of Dunn (see below) who described children as young as 18 months as “vigilant” observers of how mothers treat them versus their older sibling (Dunn, 1983). These capacities and interests in fairness may also link early parent–child attachment security with sibling relationships: In a laboratory study, Teti and colleagues examined whether children’s individual secure attachments with their mother were associated with more positive observed sibling interaction (Teti and Ablard, 1989). The results supported the hypothesis that securely attached children may be less threatened by and respond more positively to their siblings. Notably, the mother’s presence played a role as well: The infant’s attachment security predicted his/her positive behaviors toward the older sibling in the presence of the mother, whereas the older sibling’s attachment security, perhaps by now internalized, predicted his/her positive behaviors toward the infant in the mother’s absence.

Parenting Siblings During Childhood and Adolescence Developmental Trajectories The early childhood developmental period is one of rapid change in siblings’ cognitive, self-regulatory, and social capacities. Perhaps such rapid change accounts for Dunn and Plomin’s finding of little stability in parenting from child age 2–3 years (Dunn and Plomin, 1986).To the extent that parenting is a key influence, we may also expect substantial change in sibling relationships during this period. However, Dunn and Plomin found that a degree of consistency in parenting across siblings emerged when each child in a sibling dyad was 3 years old.These results suggest a great deal of fluctuation and variability in parenting in early childhood, with parent- or family-driven consistency in parenting emerging as children develop a degree of self-regulatory and verbal communication capacity in the third year of life. Researchers have also found fairly strong rank-order stability in sibling relationships qualities such as warmth and negativity beginning in early childhood and extending through adolescence (Dunn, 1983; Dunn, Slomkowski, Bcardsall, et al., 1994;Volling, 2003). In particular, stability is relatively strong for older siblings’ feelings and behavior about their younger siblings (Dunn, Slomkowski, Bcardsall, et al., 1994; Howe, Fiorentino, and Gariépy, 2003; McGuire, McHale, and Updegraff, 1996), including displays of aggression (Martin and Ross, 1995;Volling, 2003). Despite a fair degree of rank-order stability, however, the characteristics of sibling dynamics that parents are called on to manage change from middle childhood through adolescence. One longerterm longitudinal study of sibling relationship trajectories focused on European American siblings, beginning when the younger siblings in each dyad were about 9 years old and following families for 230

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up to 10 years, until older siblings were about 17 years of age (Kim et al., 2006). This study showed that sibling conflict increased during middle childhood and peaked for both siblings at firstborns’ transition to adolescence and then declined. This pattern may suggest that firstborns’ transition to adolescence is a period of perturbation for the family as a whole. In contrast to the pattern for conflict, analyses of the development of sibling intimacy revealed effects of sibling gender constellation: Among same-sex siblings, intimacy was generally constant across the study period, although sister-sister pairs reported significantly more intimacy than brother-brother pairs. Among mixed-sex dyads, however, a U-shaped pattern of change emerged such that intimacy decreased slightly from middle childhood through early adolescence, but then increased substantially across adolescence.The authors suggested that the marked rise of brother-sister intimacy in mid-adolescence may be due in part to a greater involvement and interest in the opposite sex that develops during this period (Kim et al., 2006). Findings that the onset of adolescence marked changes in sibling relationships may not be surprising. Adolescence is a period of dramatic change for both youth and their parents. Coupled with biological, physiological, and cognitive development, youth undergo rapid transformations in their social relationships (Brown and Larson, 2009; East, 2009; Laursen and Collins, 2009). Navigating these transitions is challenging for both youth and parents alike. Indeed, parents rate adolescence as the most difficult period of rearing offspring (Buchanan et al., 1990). Against this background, it is notable that the challenges presented to parents by sibling rivalry and conflict appear to decline following the older siblings’ transition to adolescence. Accordingly, family scholars and interventionists may consider how parents’ could actively leverage an improving sibling relationship during adolescence to promote youth well-being.

Parenting Siblings in Childhood and Adolescence As at the transition to siblinghood, warm, sensitive, attentive, and supportive parenting of children is related to more positive and cohesive sibling relationships in middle childhood and adolescence (Kim et al., 2006; Teti and Ablard, 1989), and negative, harsh, or disengaged parenting, to more difficult, negative, and conflictual sibling relationships (Brody, Stoneman, and McCoy, 1994; Gass et al., 2007; Houston, Pfefferbaum, Sherman, Melson, and Brand, 2013; Jenkins, 1992; Kim et al., 2006; Pike et al., 2005). Grounded in a family systems perspective, evidence also supports the notion that negative feedback loops may exist among problematic family relationships, including sibling relationships, and children’s adjustment problems. For example, in one study, hostile sibling conflict and rejecting parenting predicted—both independently and jointly—6-year-old children’s externalizing problems as reported by mothers and teachers (Bryant and Crockenberg, 1980). As children’s difficult temperament and behavior elicits higher levels of conflict with siblings (Brody, Stoneman, and Burke, 1987; Brody et al., 1994; Lytton, 1990) as well as compromised parenting (Lytton, 1990), we might expect that higher levels of child externalizing would both be a consequence of and then exacerbate hostile sibling conflict and negative parenting. Across development, research has found positive evidence for parents’ efforts to reduce sibling conflict and rivalry by establishing social norms, fostering problem solving, and discussions of perspective taking (Dunn and Munn, 1986; Felson and Russo, 1988; Ihinger, 1975; Kendrick and Dunn, 1983; Perlman and Ross, 1997; Ross, Martin, Perlman, Smith, et al., 1996). The best opportunities for parents to influence sibling relationships (and consequently children’s development) may come in early and middle childhood as basic prosocial capacities are rapidly developing. Several scholars have noted that young children’s social cognitive abilities—such as perspective taking, articulation of internal states and emotions, and conflict resolution capacities—are shaped in early family interactions, particularly those with their siblings (Dunn, 1983). Moreover, some have suggested that young children display such understandings within early family interactions before being able to 231

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demonstrate such understanding within formal assessment paradigms (Carpendale and Lewis, 2006; Rosnay and Hughes, 2006). In the sibling-focused literature, parents’ discussions and references to internal states, such as emotions, intentions, and goals, have been conceptualized as a critical socializing process in the early development of sibling relationships (Dunn and Brown, 1991). Dunn and colleagues in the early 1980s utilized detailed observations of family interaction to describe the ways that young sibling pairs interacted with each other, how mothers behaved with the children, and the ways that these family dynamics influenced the development of children’s interpersonal and social-cognitive abilities (Dunn et al., 1991). Much of this work concerned various parenting behaviors, including discussion of internal states. Although internal-state referencing by parents is often considered as taking place during or after a conflict, (Dunn, 1988a; Dunn, 1988b) noted that internal-state referencing may also occur as a form of anticipatory management—talking about problems before they arise—as parents coach their children’s views of their sibling and sibling relationship. Dunn’s work demonstrated links between internal-state discussion and sibling relationships: Dunn and Kendrick (1982) found that mother’s discussion of the younger sibling’s needs and feelings with the older sibling predicted the older sibling’s friendliness to the younger sibling over the next year. If introduced and reinforced by parents, children may incorporate such internal-state discourse into sibling and peer interactions. Children’s own use of such discourse with siblings and peers, in the absence of parents, is positively related to cooperative sibling and peer interactions (Brown, DonelanMcCall, and Dunn, 1996; Howe, 1991). However, internal-state referencing has been linked to positive sibling relationships, and to some negative outcomes. For example, Dunn and Munn (1986) found that mothers’ (and older siblings’) references to social rules and feelings when younger siblings were only 18 months old predicted, 6 months later, the younger siblings’ use of “relatively mature behavior in sibling interactions such as conciliation, teasing, reference to social rules and justification for prohibition”—as well as, unexpectedly, hitting. Howe and Ross (1990) reported that maternal references about the younger child’s internal states to the older sibling were associated with friendly sibling relationships, but the older sibling’s references to the mother about the younger sibling’s internal states were associated with both more sibling play as well as more conflictual sibling behavior. One interpretation of these results is that discussion of internal states helps siblings to have more positive relationships, which leads to increased engagement and interaction; an increase in conflict incidents may arise as a byproduct of the amount of increased time and engaged sibling interaction. As part of a broader examination of parenting influences, McHale, Updegraff, Jackson Newsom, Tucker, and Crouter (2000) posited that, while spending time with sibling dyads, parents may model effective strategies for getting along, mitigate conflicts before they arise or escalate, and ultimately facilitate family cohesion and sibling harmony. Consistent with these expectations, they found that parents’ temporal involvement with siblings was associated with more positive sibling relationship qualities. Parents’ involvement was often divided on gendered lines. With the exception of brother-brother dyads, mothers spent more time in the company of sibling dyads than did fathers. This difference may reflect the responsibility that fathers feel to socialize sons (Harris and Morgan, 1991). Youth inability to get along with their siblings represents parents’ most frequently reported child management problem (Ross, Martin, Perlman, and Smith, 1996) and source of their own conflict with their children (McHale and Crouter, 1996). As such, parents’ efforts to manage and potentially improve the quality of youth sibling relationships may represent a critical pathway to improving family cohesion and support. Parents may influence sibling relationships through coaching, advice, and instruction; and we include in this dimension the distinct parental strategies for intervening in siblings’ conflict. Although some intervention strategies may not take advantage of sibling conflict as a teaching opportunity, some strategies clearly are intended in that manner. 232

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Consistent with the negative implications of an authoritarian parenting style found in the general parenting literature (Parke and Buriel, 1998), authoritarian-type parental responses to sibling conflict—such as dictating a solution to the conflict at hand, or administering a negative consequence to the children—have been linked with less intimate and more negative sibling relationships (Brody et al., 1987; Felson and Russo, 1988; McHale et al., 2002). What is yet unclear is whether an authoritarian response to sibling conflict is detrimental due to the parents’ emotionally laden response (e.g., angry, aggressive) versus the actual parental intervention (e.g., adjudicating the conflict on the spot, administering a negative consequence). Moreover, managing sibling relationships may require different rearing strategies across development. For example, it is possible that higher levels of structuring and intervention in sibling disputes is more effective in childhood than in adolescence, when youth developing cognitive abilities and greater desire for autonomy may make such parental strategies counter-effective. McHale, Updegraff, Tucker, and Crouter (2000) examined three different parental strategies for responding to sibling conflict during mid-adolescence: (1) intervention (e.g., directly step into the conflict, punish siblings for the conflict); (2) coaching (e.g., aiding perspective taking, providing advice); and (3) non-involvement (e.g., ignore the problem, let the siblings work out the issue). Consistent with findings from earlier research (Felson and Russo, 1988), parents’ direct interventions into sibling conflicts were negatively related to sibling intimacy and positively related to sibling negativity. Together, such findings counter a perspective that, at least by adolescence, siblings fight to attract parental attention, and thus, that parental intervention serves only to promote sibling conflict (Dreikurs, 1964a, 1964b). One reason that parent intervention in sibling interaction may be associated with negative sibling relationships (at least cross-sectionally) may have to do with the reasons for parent intervention. For example, parent engagement in sibling interaction may come as a result of a parent attempting to manage frequent or intense sibling conflict, compensate for conflict resolution deficits in the children, or assuage the parent’s own high level anxiety about family conflict. Parental engagement for these reasons may prove to predict greater conflict over time (Howe et al., 2003) not because the parental intervention strategy itself has a causal impact on sibling conflict, but because these factors may independently lead to greater sibling conflict. In other words, parental intervention may serve as a marker of difficulties that will lead to increased sibling conflict over time. At the end of the day, experimental trials remain the best way to tease out causal influence from selection and other confounds. An important issue is how parenting strategies may be more or less effective depending on the characteristics of the children and their sibling relationships. That is, a parenting strategy such as non-involvement may be beneficial for siblings with warm relationships and who individually have self-regulation and problem-solving skills,We are aware of only one study (Recchia and Howe, 2009) that examined the match between parenting and sibling relationship qualities: In that study, directive parental intervention with high-conflict sibling pairs, as well as non-directive intervention with lowconflict pairs, predicted more cooperative sibling relationships 2 years later. However, where there was a mismatch between sibling relationships and parenting—such as non-directive intervention with high-conflict siblings—siblings’ cooperation declined. Finally, there is much yet to be learned about the factors that influence the strategies parents utilize in parenting siblings. For example, McHale, Updegraff, Tucker, et al. (2000) explored the ways that parents’ values and beliefs influenced their decisions around intervening in sibling interactions. Parents’ who valued fostering autonomy in their children were less likely to intervene in sibling conflicts. Future research into the roots of parents’ strategies for influencing sibling relationships could be linked to parents’ broader experiences and understanding of what will promote their children’s success in life; for example, values around conformity and autonomy may stem in part from parents’ roles at work related to following directives versus autonomous decision-making (Kohn, 1976). 233

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Family Systems Processes: Parents’ Differential Treatment of Siblings In line with a family systems orientation, parents shape their children’s relational and individual adjustment through differences in their treatment of and relationships with each child. (As we mentioned above, PDT can be expressed through various dimensions of parenting—including direct interaction, instruction, and orchestration.) Although parents in egalitarian Western societies typically strive to be even-handed in their parenting, research shows that parents often treat siblings differently for a variety of reasons—including the children’s temperament or needs, parents’ emotional connection with each child, or simply sibling gender and age differences. For example, one study found that in early childhood, younger children were just as likely as their older sibling to be physically aggressive, tease, or start a quarrel (Dunn and Munn, 1986).Yet mothers were observed to be twice as likely to issue prohibitions toward the older sibling and distract the younger than vice versa. A body of research across childhood and adolescence highlights that parents’ differential treatment (PDT) of offspring in both childhood and adolescence is generally related to poorer sibling relationship qualities (Brody, Stoneman, and McCoy, 1992; Kowal and Kramer, 1997; Shanahan et al., 2008) and individual maladjustment (Feinberg and Hetherington, 2001; Richmond, Stocker, and Rienks, 2005; Scholte, Engels, de Kemp, Harakeh, and Overbeek, 2007). A meta-analysis found that PDT was significantly linked with both internalizing and externalizing problems among siblings, although the effect size was small (Buist, Deković, and Prinzie, 2013). The small effect size found in the Buist et al. (2013) meta-analysis may be the result of larger PDT effects in some families and the absence of such effects in other families. For example, most research on PDT is rooted in Adlerian (Ansbacher and Ansbacher, 1956) and social comparison (Festinger, 1954) perspectives, which suggest that youth self-esteem is especially sensitive to differences between their own and their siblings’ relationships with parents. This theoretical framework may explain why the association between differential treatment and adjustment is weak for children whose parents exhibit warm and supportive parenting, even when their siblings receive even warmer and more positive treatment (Feinberg and Hetherington, 2001). A second moderator of PDT effects appears to be children’s interpretation of differential parenting as fair or not (Kowal and Kramer, 1997; Kowal, Kramer, Krull, and Crick, 2002; McHale, Updegraff, Jackson Newsom, et al., 2000).Youth who perceive differential parenting as justified based on explanations, such as the sibling’s different needs or behavior, are less susceptible to the negative impacts of PDT. In one study, youth perceptions about the fairness of parents’ differential treatment moderated the association between PDT and children’s adjustment via jealousy; the indirect pathway from PDT to adjustment through jealousy was only significant when children perceived the differential parenting as moderately or highly unfair (Loeser, Whiteman, and McHale, 2016). These findings suggest that it is critical for parents to communicate with their children about the reasons for discrepancies in treatment, as well as for youth to express their concerns about potential differences. With adolescents, such discussions may be especially appropriate and effective as their increasing cognitive skills allow for more nuanced understanding of complicated issues and greater perspective taking. As developmental changes in cognition and perspective taking are associated with youth increased utilization of comparisons for self-evaluation (Eccles, Midgley, and Adler, 1984; Ruble, Boggiano, Feldman, and Loebl, 1980), one might expect the implications of PDT would be especially salient during adolescence. However, the Buist et al. (2013) meta-analysis found that developmental period moderated the findings for internalizing such that the influence of PDT was larger for children’s than adolescents’ internalizing. It may be that as adolescents invest more time and emotion into peer relationships and withdraw their engagement from the family (Steinberg and Monahan, 2007), that the salience of PDT for well-being diminishes. A developmental exploration of these issues might examine developmental changes in social cognition and time spent with the family to examine whether these factors influence the salience of PDT over development. 234

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In addition to development and age, gender differences may moderate the salience of differential treatment. Maccoby (1998) suggested that girls become more relationship oriented during adolescence and engage in social comparisons (at least in terms of relationships) more often than boys. Consistent with this idea, gender and dyad gender constellation moderation have also been found in associations between PDT and adjustment, with girls and same-gender dyads documenting stronger linkages between PDT and adjustment (McHale, Updegraff, Tucker, et al., 2000; Shanahan et al., 2008; Tamrouti-Makkink, Dubas, Gerris, and van Aken, 2004). Most research on parents’ differential treatment focuses on differences in maternal (and less often paternal) affection and conflict. Yet, Tucker and colleagues (2003) found that PDT was evident in other domains of parenting. For example, the majority of parents (mothers and fathers) in their study allocated more privileges to firstborns. Although a majority of parents allocated chores equally, when differential treatment was displayed, firstborns were almost three times more likely to be assigned more chores than secondborns. Gender differences emerged with respect to parents’ temporal involvement with adolescent siblings. Although a majority of mothers and fathers reported spending equal amounts of time with both of their offspring, for about one-quarter of the sample, a complementary pattern of shared time emerged. For these families, mothers reported spending more time with one child, and fathers reported spending more time with the other. About 75% of these families included mixed-gender siblings, suggesting that parents may be taking responsibility for socializing offspring of the same-gender (i.e., mothers and daughters, fathers, and sons). This pattern may be especially likely during adolescence, as anthropological work highlights that, across cultures, gender role expectations become more pronounced as parents attempt to prepare their adolescent offspring for adult roles (Whiting and Edwards, 1988). Although the connections between PDT and youth individual and relational adjustment have been well established, the mechanisms connecting them are often implied as opposed to tested. For example, consistent with social comparison principles that upward comparisons (i.e., comparisons with those who are viewed as better off) are associated with challenges to one’s self-worth, perceived disfavored treatment from parents is linked to maladjustment in adolescents (Feinberg and Hetherington, 2001; Richmond et al., 2005; Scholte et al., 2007). However, sibling jealousy may mediate the association between disfavored treatment and youth adjustment. Loeser et al. (2016) found that the direct links between PDT and youth depression, self-worth, and risky behaviors operated indirectly through siblings’ self-reported jealousy. That is, PDT was related to greater jealousy, which in turn, was related to youth adjustment. Although research on the implications of within-family differences in parenting is well established, challenges remain. First, most studies on PDT utilize a vertical or top-down perspective regarding parenting and parent–offspring relationships. That is, most work assumes that parents enact differential treatment toward their offspring and are not reacting to potential differences between siblings.Yet, research and theory demonstrates that with age, youth become more capable and skilled at evoking specific types of treatment from parents (Scarr and McCartney, 1983). As such, the direction of effects (i.e., parent to child) may be reciprocal, especially during adolescence (but see Lam et al., 2012). Additionally, most research on differential treatment (and siblings more generally) focuses on a single dyad. U.S. census (2015) data, however, indicate that about 50% of families with multiple children have more three or more offspring. Although practical challenges may exist for collecting data from all members of a family, methodological advances make the analysis of data from multiple family members less problematic. Work from Jenkins and colleagues (Browne, Meunier, O’Connor, and Jenkins, 2012; Jenkins, Rasbash, and O’Connor, 2003; Meunier et al., 2012) highlights how multi-level modeling strategies can be adapted to analyze the implications of parental differential treatment for all siblings in a family. One study utilizing several children per family found that parent agreeable personality was inversely related with the extent of differential negativity, whereas openness to experience was linked with greater differences in parenting negativity (Browne et al., 2012). 235

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Family Systems Influences: Parent and Relationship Characteristics Clearly, parents’ traits and behaviors influence children in many ways when they are not intentionally engaged in “parenting.” For example, maternal depression has long been known as a detrimental influence on children (Dix, Moed, and Anderson, 2014), and maternal mood has been found to influence sibling relationship qualities (Dunn, Slomkowski, Bcardsall, et al., 1994). Moreover, a father’s tendency to drink and become drunk is an influence on both less and more severe sibling violence (Eriksen and Jensen, 2009; Feinberg, 2003). Sibling relationships can serve to mediate the negative influence of such parent or family risk factors, including structural risk factors, such as single parenthood, on children’s development (East and Khoo, 2005). We include research on parent and family relationship influences on siblings as it is possible that parents could modulate exposure of children to some characteristics, counterbalance them with positive experiences or supports, or be motivated to alter some characteristics and behaviors. Some research points to interparental conflict as a detrimental influence on sibling relationships. For example, in one study, interparental conflict during middle childhood predicted young adolescent sibling relationships, even accounting for children’s temperament, parental warmth, and differential parental negativity (see below for further discussion on differential parenting). In a second study with data from 3,681 sibling pairs, interparental affection and hostility predicted change in sibling relationship quality over 4 years (Dunn, Deater-Deckard, Pickering, Golding, and ALSPAC Study Team, 1999). Interparental relationships demonstrated both direct and indirect pathways to sibling relationship quality in that study, with the latter operating via parent–child relationships. Notably, the authors did not find that interparental conflict was related to either parent–child negativity or sibling relationship quality among step-families. Interparental conflict may affect sibling relationships through several mechanisms. First, within a social learning framework such conflict likely provides a behavioral model for siblings, who may then internalize expectations for future relationships to have high levels of conflict as well. Furthermore, interparental conflict can be highly negatively arousing for children (Cummings and Smith, 1993; De Arth-Pendley and Cummings, 2002) and generate feelings of anxiety (that interparental conflict will “spill over” and lead to harsh parenting; (Erel and Burman, 1995) or emotional insecurity (due to perceived threats to family stability and safety; (Davies et al., 2002). These feelings of threat, anxiety, and insecurity may lead to increased levels of rivalry, competition, and conflict among siblings. A family systems orientation also sensitizes researchers to the variations in relationship quality across family relationships. One source of this variability is simply that children are born sequentially (apart from twins), and this allows parents opportunities to learn from their experiences with one child and apply this learning with others. Consistent with axioms like “practice makes perfect,” experience with parenting should promote greater familiarity with parental roles and potentially improve parental efficacy. The role of experience in parenting has long been recognized. Schachter (1959), for example, characterized parents of firstborns as insecure and ill informed; in contrast, he identified parents of laterborns as more relaxed, knowledgeable, and confident. Perhaps reflecting parents’ greater knowledge and confidence, Tessler (1980) found that, controlling for family size and other potential confounding factors, children from later ordinal birth positions were less likely to visit medical offices and see physicians than children from earlier ordinal birth positions. Despite this early work and the commonsense notion that parenting experience matters, little scientific work has explicitly explored how parenting behaviors actually vary across children as a result of birth order. Perhaps the role of experience is assumed or the traditional design of obtaining from one-parent (usually a mother) and one child prevented its study, but some work highlights how parental experience shapes subsequent expectations and rearing strategies. We first note that an investigation of maternal parenting and infant behaviors when the child was 5 months old did not find mother or infant behavior to differ on average across firstborn and 236

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secondborn siblings; further, maternal behaviors were uncorrelated across siblings (Bornstein, Putnick, and Suwalsky, 2016). However, studies with older children have found differences across earlier and laterborn siblings. Mothers’ knowledge of child development when children were 2 years old increased from first- to secondborn (Bornstein, Cote, Haynes, Hahn, and Park, 2010). In comparing parents’ expectations about their youth’s impending adolescent years, Whiteman and Buchanan (2002) found that experienced mothers (i.e., those who had parented an adolescent previously) were less likely to expect stereotypically negative behaviors from their laterborn offspring compared to parents who had not yet had experience with adolescent offspring. More importantly, they found that the nature of mothers’ experiences with earlier-born children predicted similar expectations for laterborns: Those with more positive experiences with earlier-borns expected fewer problems and more prosocial behaviors from laterborns. In contrast, those with poorer earlier experiences had more negative expectations for laterborns. This latter pattern highlights that not all of what parents learn from prior experience is positive. (East, 1998), for example, found that parents questioned their efficacy and lowered their expectations for laterborn children’s behaviors following a teenage daughter’s pregnancy and subsequent childbearing. In addition to influencing expectations, experience with earlier-born children can also shape parents’ behaviors and rearing strategies with laterborns. For example, using longitudinal and withinfamily data, Whiteman, McHale, and Crouter (2003) discovered that parents had greater knowledge about their younger children’s everyday activities and less frequent conflict with younger children as compared to their older siblings when examined at the same age (i.e., when both children were 13 or 15 years). Using longitudinal data from the same project, Wray-Lake, Crouter, and McHale (2010) found that younger siblings were granted more autonomy in their relationships with parents as compared to older siblings when measured at the same age in adolescence. Perhaps rearing an earlier-born child provides parents with a greater range of strategies that lead to more effective parenting. In infancy and early childhood, skills could include how to handle dinner and bedtime routines. In middle childhood and adolescence, parents may expand their ability to elicit key information about their children’s days, improve their conflict resolution strategies, and learn which battles to fight and which to flee. Ultimately, findings like these highlight how families work as systems, with experiences of one child reverberating throughout the entire system and shaping the experiences of others. It is critical that future work on parenting (and not just parenting siblings) investigate how rearing strategies vary not just across families but also within them. Family processes such as differential parental treatment, learning from experience and emotion spillover will only be apparent when incorporating data from across the family system.

Family Systems: Sibling Effects Given parents’ own views of sibling conflict as one of the most stressful aspects of family life, it is surprising that more research has not more fully explored “sibling effects,” the ways that sibling dynamics can compromise parenting quality. For example, in the face of high levels of sibling conflict, one might expect parents to withdraw and disengage, just as some parents do when faced with a single difficult child (Howe, Aquan Assee, and Bukowski, 2001). This work would extend research on child effects—the way a single child’s characteristics and behaviors influence parenting (Bell, 1968). For example, one study traced child effects from the older sibling to the parent and then to the younger sibling: Older siblings’ academic and social competence led to increased maternal self-esteem and decreased depression, which in turn was linked to more positive parenting toward the younger sibling—with beneficial results for the younger sibling’s emotional and behavior adjustment (Brody et al., 2003). However, the dynamics of the sibling relationship per se can also impact parenting. A unique aspect of sibling dynamics that may influence parenting is collusion against parental authority (Patterson, 1984). A relatively sizable literature demonstrates that siblings can influence 237

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each other’s engagement in problem behaviors such as delinquency, crime, and substance use (Bank et al., 2004; Criss and Shaw, 2005; Low, Shortt, and Snyder, 2012; Stormshak, Comeau, and Shepard, 2004). Indeed, an important route through which youth find opportunities to try cigarettes, alcohol, or illicit drugs is through the provisions, friends, and activities of siblings (Rowe and Gulley, 1992; Samek, McGue, Keyes, and Iacono, 2015; Whiteman, Jensen, Mustillo, and Maggs, 2016; Windle, 2000). Additionally, dynamics within the sibling relationship can reinforce such antisocial or risky behaviors. In a process termed “deviance training,” childhood or adolescent friends reinforce each other’s tendencies toward antisocial behavior by positively reinforcing (often through shared laughter) each other’s comments and jokes that have an antisocial, anti-authority theme (Bullock and Dishion, 2002).The result can be an increase in delinquent and antisocial behavior over time. Siblings can also engage in deviance training by reinforcing each other’s anti-authority commentary and behaviors, and this too influences youth development (Bullock and Dishion, 2002). Sibling deviance training can also take the form of colluding together against parental authority—both covertly (e.g., cooperating and planning ways to break rules) and overtly (e.g., one sibling lies about or covers up the other’s misbehavior). To date, little research has examined how parents can effectively respond to sibling deviance training, disrupt the negative collusion, and foster more positive sibling dynamics. Overall, results from the few studies on the topic suggest that across the course of childhood and adolescence parents may need to utilize different strategies for supporting their offspring’s sibling relationships. Although adolescents’ time spent with parents and siblings declines throughout adolescence (Larson and Richards, 1991), maintaining family time in both childhood and adolescence appears critical for relational harmony. Given adolescents’ drive for autonomy, parents may also benefit from allowing adolescent-aged siblings to work out their differences independently as opposed to directly intervening in their conflicts.Yet, it is critical that future research explore these possibilities in greater detail, as many questions remain unanswered. An attractive idea proposed by some sibling researchers is that siblings may compensate with support and warmth with each other when faced with difficulties in other areas, such as interparental conflict or negative parenting (Dunn, Slomkowski, and Beardsall, 1994). There is some, but limited, evidence of this sibling compensation hypothesis, however (Brody, Stoneman, and MacKinnon, 1986; Brody et al., 1992; Kim et al., 2006; Stocker, Dunn, and Plomin, 1989). Compensation may be a phenomenon that takes place only in some contexts, such as among families in relatively high risk contexts, or where siblings demonstrate individual or joint signs of resilience (e.g., temperament, conflict resolution skills). This is an area worth further examination as understanding when and how sibling compensation occurs naturally may help program developers create ways to encourage such compensation processes.

Sibling Relationships Across Adulthood Sibling relationships are distinct from other close relationships in their potential lifelong scope, and this unique characteristic has implications for the nature of sibling relationships in adulthood and the role of parents in those sibling dynamics. Unlike parent–child relationships that often end by midlife at the death of parents, romantic relationships that usually commence in young adulthood and may end through separation or divorce, and friendships that are entered and exited by choice, sibling relationships are non-voluntary. Even siblings who choose to have little contact after leaving the home of their family of origin remain siblings, retaining a shared family history and experiences. And indeed, the limited data on sibling relationships across adulthood suggest that most siblings remain close throughout their lives, with frequent contact and positive regard, and that they exchange support and help including childcare, chores, and advice (Cicirelli, 1995; Spitze and Trent, 2006). Sibling relationships may even improve in terms of reduced conflict and greater cohesion across early adulthood: After siblings move out of their parents’ homes and establish their own alternative bases of security 238

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(family, work), the conditions leading to sibling rivalry and conflict may weaken (Jensen, Whiteman, Fingerman, and Birditt, 2013). One longitudinal study revealed greater declines in sibling conflict and increases in intimacy when older siblings moved out of the home after high school graduation as compared to families with older siblings who continued to live at home (Whiteman, McHale, and Crouter, 2011). Siblings’ personal characteristics and life experiences, however, shape their later relationship experiences, and this suggests that parents’ early socialization efforts may have long-term influence. Maintaining communication is important, however, work by Lindell, Campione-Barr, and Killoren (2015) identified social media communication as a factor promoting sibling closeness among college students. Highlighting the role of cultural socialization, Killoren, Alfaro, Lindell, and Streit (2014) found that Mexican-origin college students’ familism values—values that emphasize the significance of family relationships and responsibilities—served as a protective factor, promoting high levels of contact among sibling dyads with low levels of intimacy. Below, we elaborate on the role of culture in parental socialization when we consider the larger contexts of sibling relationships. Longitudinal data on sibling relationships in adulthood are generally lacking, but cross-sectional data from a large national data set provides insights into age differences in sibling contact across adulthood, suggesting that contact is lower in young and middle adulthood than later in life (White, 2001). Siblings’ marital status and gender influence levels of contact, but geographical distance between siblings appears to be the strongest correlate of sibling contact (Spitze and Trent, 2016).White (2001) also reported that declines in contact leveled off in middle adulthood when, presumably, responsibilities to the family of procreation decrease. Although Spitze and Trent (2016) found that the frequency of visits and the provision of social support declined, sibling closeness in terms of reports of how well siblings get along, and even some forms of contact (i.e., telephone calls), remained common and did not decline in old age. The research on parents’ role in adult sibling relationships is quite limited. What can be gleaned from this literature is that parent–child dyadic relationships in childhood set the stage for adult sibling relationships. For example, young adults’ states of mind regarding their early attachment relationships with parents, specifically dismissive and preoccupied orientations, were linked to observed and self-reported lower levels of warmth and higher levels of conflict and negativity (Fortuna, Roisman, Haydon, Groh, and Holland, 2011). Furthermore, young adults’ empathy and perspective taking competencies—shown to be linked to parenting as early as the transition to siblinghood period (Dunn and Kendrick, 1981)—were associated with positive sibling engagement. Additionally, overall family communication style has been linked to sibling relationships quality in young adulthood (Schrodt and Phillips, 2016). Most research on parents’ role in adult sibling relationships, especially in midlife, focuses on parents (most often mothers’) differential treatment of siblings. As in childhood and adolescence, perceived favoritism and differential treatment—both current and retrospective reports of childhood experiences—are linked to poorer sibling relationships from young adulthood (Jensen et al., 2013; Siennick, 2013) to middle age (Suitor et al., 2009). Research in this area, however, has identified important moderators and mediators of differential treatment-adjustment linkages: Consistent with findings at earlier developmental periods, factors including sibling acknowledgment and confirmation of differential treatment and shared family identity (Phillips and Schrodt, 2015a, 2015b), as well as perceptions that differential treatment is justified or fair (Boll, Ferring, and Filipp, 2005) appear to mitigate the negative effects of differential treatment on adult sibling relationships. In a departure from research on childhood sibling-related family dynamics, an important element of siblings’ differential experiences with parents in adulthood is differences in the caregiving and other assistance that adult siblings provide for parents. Responsibility for elderly parents is most often unequally shared by siblings (Cicirelli, 1992), with daughters and offspring who live in closer proximity more likely to take on caregiving roles (Stuifbergen, van Delden, and Dykstra, 2008). However, 239

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siblings may also negotiate care-based on perceived competencies and resources, availability, and quality of their relationships with the parent (Roff, Martin, Jennings, Parker, and Harmon, 2007). Feelings of caregiving burden (Ngangana, Davis, Burns, McGee, and Montgomery, 2016) and perceptions that the distribution of care among siblings is unequal and unfair (Ingersoll-Dayton, Neal, Ha, and Hammer, 2003) have been linked to poorer sibling relationships. Parents’ influences on sibling relationships do not necessarily end with their death. Although a parent’s death may bring some siblings closer together, earlier family experiences, including parents’ differential treatment can push others apart (Greif and Woolley, 2015). Based on their qualitative interviews, these clinical researchers suggested that clear end-of-life plans that are discussed and explained to offspring in advance of death may be the most positive legacy parents can provide to support their children’s sibling relationships into the future.

The Cultural Contexts of Sibling Relationships Parents’ opportunities and decisions about where to live and bring up their children may be the most profound and enduring of parental influences on children generally, including parents’ influences on sibling relationships (Weisner, 1993). The settings of children’s lives are defined by resources and demands of the larger context and its interconnected cultural values and practices, which together imbue meaning into parents’ and children’s daily activities, routines, and social exchanges. From cross-cultural research on families we gain insights into the wide variations in siblings’ roles and relationships and associated family dynamics, including Western biases that privilege mother-child and marital bonds, biases that may help to explain the limited attention to sibling relationships in our research literature (Updegraff et al., 2011). Attention to the cultural contexts of sibling relationships, however, highlights the ubiquity of siblings in the lives of children throughout history and around the world (Weisner, 1993). Indeed, as we have noted, more U.S. children grow up living in a home with a sibling than with a father. Furthermore, most parenting is undertaken in the context of sibships (McHale et al., 2012). One way that parents orchestrate their children’s sibling relationships is by determining when and how many offspring they will rear—patterns that vary across time and place. Sibship size in Western cultures, for example, declined dramatically during the nineteenth and twentieth centuries. One historian of Anglo culture connects the secular change from communal orientations, such as familism values to the individualistic values of White majority Western society, to the decline in sibship size (Davidoff, 2012). In the United States today, sibship size varies across cultural groups, such that those of Latinos are larger on average than the sibships of African, Asian, or European American families (McHale et al., 2012); the degree to which sibship size varies between cultures in step with familism values is an open question as social, religious, and economic factors also play a role. Sibship size may have implications for siblings’ involvement with one another—for instance, adolescent-age siblings in Mexican-origin families in the United States spend more time together each day than do those in European American families (Updegraff et al., 2005), and adult siblings from immigrant minority families living in the Netherlands—who have larger sibships sizes, on average, than native Dutch families—have more contact with their siblings than native Dutch siblings (Voorpostel and Schans, 2011). Parents’ cultural values transmitted to children also make a difference: Research with Mexican-origin families shows that adolescent siblings spend more time together when familism values—which stress the significance of family bonds and responsibilities—are stronger (Updegraff et al., 2005). In addition to their centrality in everyday life, research on the cultural contexts of family life highlights the significance of siblings’ roles in their families and thereby, their significant influences on one another’s development and well-being and larger family dynamics.This work shows that siblings’ family roles differ considerably across place. Although majority Western cultural values promote 240

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egalitarian norms (Parsons, 1972), within other cultural groups around the world, siblings’ family roles are distinguished in terms of responsibilities and privileges, most often as a function of gender and birth order. Frequently, sibling caregiving comes within the purview of older sisters, and inheritance and authority lies in the hands of eldest brothers (Hafford, 2010). Hafford reported that sibling caregiving was historically the norm in the United States as well, and still is common in urban settings and among U.S. minority and immigrant groups in which parental resources, including language and other host culture knowledge, are limited (Reynolds and Faulstich, 2008; Valenzuela, 1999). In turning to offspring for caregiving and other distinctive family roles, parents implicitly socialize their children’s identity with values regarding family solidarity in general as well as their sibling relationships. For instance, in cultures in which parents grant high-status and privilege to firstborn sons as the family head, the eldest brother is treated with deference and respect by his siblings, but has corresponding responsibilities for them throughout life (Sung and Lee, 2013). In such family contexts, Western patterns of everyday sibling conflict and rivalry are not typically present. Likewise, assigning caregiving roles to older sisters is thought to promote close, lifelong sibling bonds (Hafford, 2010). In a larger context of family solidarity, the emotional ambivalence deemed characteristic of sibling relationships in majority Western families (Bryant and Crockenberg, 1980) may not be evident. Consistent with this idea, Updegraff et al. (2011) reviewed studies of adolescent sibling relationships in African, European, and Mexican American families that classified sibling relationships by their levels of positivity and negativity. Although a high-conflict/high closeness, or ambivalent, type of relationship was evident among European American families, this type did not emerge in analyses of African and Mexican American families. In these ways, the larger cultural context provides norms about family roles and relationships that have implications for sibling relationships, and parents influence the course of sibling relationships by promoting these cultural norms. Research on culture and ethnic variability in parenting and sibling relationships must recognize that there may be demographic and socioeconomic factors which could be confounded with cultural differences. For example, one study found higher levels of PDT among lower-income families, families with higher levels of marital dissatisfaction, and single-parent families (Jenkins et al., 2003). These results suggest that PDT may be exacerbated in part by stress. For example, it may be that socioeconomic stress undermines a parent’s ability to self-regulate in the service of a goal toward equal treatment of siblings—a hypothesis supported by another finding from the same study: the influence of children’s temperament on differential negativity was greatest among low SES families. Thus, culture and ethnicity must be understood within a context of resources and stressors on families that may be due to economic or institutional factors. Much can be learned about sibling relationships through cross-cultural comparisons, but the substantial variation within cultural groups also can be tapped to provide additional insights into how the cultural practices and values that parents transmit to their children have implications for sibling dynamics (Updegraff et al., 2011). For example, using an ethnic homogeneous design aimed at identifying factors that explained differences among the sibling relationships of Mexican American adolescent dyads, Killoren, Thayer, and Updegraff (2008) showed that, in families with stronger familism values, siblings exhibited more effective conflict resolution. Studying the same sample, McHale, Updegraff, Shanahan, Crouter, and Killoren (2005) found that parents’ differential treatment of siblings was more sex-typed (e.g., brothers granted more privileges and sisters assigned more chores) when parents where more attuned to Mexican and less attuned to Anglo culture. Cultural orientations not only can explain differences in sibling dynamics, but also have implications for how those dynamics are linked to youth individual adjustment. For example, although parents’ differential treatment was linked to negative adjustment among Mexican American youth who endorsed weak familism values (as in Western majority samples), this link was nonsignificant for youth who held stronger familism values, possibly because youth were less focused on individualistic, and more 241

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focused on communal needs and interests (McHale et al., 2005). In other words, the same parenting behaviors may have different effects on youth and their sibling relationships depending on the cultural beliefs and values that characterize a family. As another example, Solmeyer and McHale (2017) found that African American parents’ cultural socialization efforts aimed at promoting adolescents’ identification and appreciation for African American culture mitigated the negative implications of differential treatment. Although some parenting behaviors invariably lead to more positive or negative sibling relationship outcomes, parent educators and parents themselves should be attuned to how larger sociocultural contexts of family life imbue meaning into parental practices and socialization efforts and thereby their implications for how siblings get along.

Siblings With Disabilities In 2010, almost 20% of the U.S. population (about 56.7 million individuals) had a disability, including physical, cognitive, sensory, and/or emotional challenges—and rates of disability are increasing (Brault, 2012). These data suggest that having a sibling with a disability is a not uncommon experience. With respect to autism spectrum disorder (ASD) alone, the period from 1997 to 2008 saw an increase of almost 300% in the number of children growing up with a sibling with ASD (Boyle et al., 2011).The lifelong nature of sibling relationships means that the health and well-being of their siblings remains a concern throughout the lives of sisters and brothers. Parents’ role in promoting positive sibling relationships and family dynamics may therefore be of special importance in these families. The relatively limited literature on the relationships of sibling dyads in which one has a disability suggests that these relationships are generally positive—indeed, these relationships may involve less conflict than those of typically developing siblings—but, there also tends to be less warmth and involvement (Heller and Arnold, 2010; Kaminsky and Dewey, 2001; Pollard, Barry, Freedman, and Kotchick, 2013). As in the case of typically developing siblings, some, mostly cross-sectional research, suggests that sibling contact and positive exchanges decline from adolescence through middle adulthood (Hodapp and Urbano, 2007; Orsmond and Seltzer, 2007), but in middle adulthood, warmth may increase (Orsmond and Seltzer, 2007). Findings vary across studies, however, and within studies there is also substantial variation in sibling dynamics. This variability has led investigators to identify individual and family factors that are linked to more positive sibling relationship outcomes. Findings from this small body of work are consistent with the research on typically developing siblings in suggesting that parents indirectly influence sibling relationships through their own interactional behaviors: warmth and support in parent–child and marital relationships, for example, are linked to positivity and involvement among siblings and better adjustment among non-disabled siblings (Orsmond, Kuo, and Seltzer, 2009; Rivers and Stoneman, 2003). The larger context of family life and parents’ own well-being—including parents’ stressors, supports, and mental health—also influence sibling relationships (Orsmond and Seltzer, 2009). Family experiences that may distinguish individuals with typically developing versus disabled siblings include the possibility of greater family responsibilities, such as when parents allocate sibling caregiving tasks (Burke, Fish, and Lawton, 2015; Coyle, Kramer, and Mutchler, 2014; Floyd, Costigan, and Richardson, 2016). Additionally, siblings often have concerns and questions about their role in their sister’s or brother’s care later in life when parents no longer can do so (Burke et al., 2015; Coyle et al., 2014; Floyd et al., 2016). Related to their increased family responsibilities, parents’ differential treatment also is more pronounced in these families as parents work to manage their child’s special needs (McHale and Pawletko, 1992), and siblings who are dissatisfied with their parents’ differential treatment exhibit poorer adjustment (Rivers and Stoneman, 2008). Finally, in adolescence, in particular, perceived stigma associated with having a disabled family member may be a concern for some youth, along with issues of identity that may arise as youth try to discern ways in which they are alike and different from 242

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their sibling; these concerns may extend to concerns about whether their own offspring are likely to manifest the disabling condition (Milačić-Vidojević, Gligorović, and Dragojević, 2014; Milevsky, Schlechter, and Machlev, 2011; Petalas et al., 2012). Some research suggests that greater knowledge of their siblings’ condition is linked to more positive sibling relationships and well-being (MilačićVidojević et al., 2014); if information and knowledge influences sibling relationships (rather than the reverse), this finding implies that parental communications may be particularly important in helping typically developing youth understand and, in turn, cope with their siblings’ challenges and needs. Some parents may have access to interventions specially designed for typically developing child and young adolescent age siblings whose siblings have disabilities such as the Sibshops (Meyer,Vadasy, and Lassen, 1994) and SibworkS (Roberts, Ejova, Giallo, Strohm, and Lillie, 2016) programs. These interventions vary in their foci but are often designed to be a source of social support, build children’s knowledge of their siblings’ disability condition, and provide advice about handling sibling-related challenges, including from peers in similar circumstances. Although there is some evidence that such programs have positive effects, including on children’s well-being and sibling relationship quality, systematic evaluations are rare and findings are inconsistent (Tudor and Lerner, 2015). In the face of parental concerns about the well-being and adjustment of typically developing youth who are growing up with a sibling with a disability, adult siblings report that they have benefited from the relationship such as in their awareness of others’ needs and its impetus into satisfying human service careers (Hodapp, Urbano, and Burke, 2010; Pompeo, 2009). Furthermore, many adult siblings expect to, and eventually assume some responsibilities for their siblings when parents are no longer able to do so (Heller and Arnold, 2010). Siblings who are anticipating caregiving roles express concern about the future and those who undertake these responsibilities may face economic challenges and difficulties navigating support systems (Bigby, Webber, and Bowers, 2015; Burke et al., 2015; Sonik, Parish, and Rosenthal, 2016). Thus, parents may help promote their children’s sibling relationship over the long term by planning for the disabled child’s future and providing typically developing siblings with the knowledge they have gleaned from their own experiences in caring for and obtaining supports for their child with special needs.

Practical Information in Parenting Siblings As we were writing this chapter, a journalist called one of us to ask about recommendations we could make for parents on how to intervene and stop sibling bullying. Not only were there few evidencebased recommendations we could make about parenting strategies specific to siblings, but it also became evident that we have little to no data on the prevalence of sibling bullying: Although we have some data on levels of conflict and aggression in sibling relationships across samples, we have little understanding of the proportion of families in which asymmetric and marked sibling bullying occurs versus reciprocal aggression. Furthermore, we have not defined the threshold at which we would we place a sibling dyad in the category of a bullying relationship rather than lower-level sibling bickering or conflict. The lack of data, understanding, and recommendations that we can offer the general public is embarrassing—particularly given the high degree to which sibling conflict and especially victimization can affect siblings’ lifelong development and adjustment. More generally, very few systematic efforts have been made to develop and assess strategies for assisting parents to manage and enhance sibling relationships. We review the prominent exceptions below, but first we caution that simply focusing on eliminating sibling conflict altogether should not become a central goal of preventive or clinical interventions. Children can learn valuable negotiation and perspective-taking skills in conflictual interactions with siblings (Dunn and Munn, 1986; Foote and Holmes-Lonergan, 2003), and thus a broader goal would be to help parents reduce unregulated, hostile, and harmful sibling conflict, and foster social competencies, such as the ability to problem solve rather than simply avoid disagreements. 243

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Several small-scale intervention studies aimed at testing the view that parents should allow siblings to resolve their disagreements, rather than intervening prematurely, were carried out in the 1970s. The results suggested that training parents to stay out of middle childhood-aged sibling conflicts can lead to a decrease in such conflict (Kelly and Main, 1979; Leitenberg, Burchard, Burchard, Fuller, and Lysaght, 1977; Levi, Buskila, and Gerzi, 1977). However, these studies were generally very small, and it is hard to draw firm conclusions from them; moreover, later research, indicates that parent intervention strategies may be more or less effective depending on developmental stage and pre-existing sibling characteristics including level of conflict. Family scholars have developed a range of systematic programs and strategies designed to support parenting of individual children, and many have been evaluated with experimental (i.e., randomized trial) or quasi-experimental designs. In contrast, only a few such programs have been developed and tested to assist parents with managing sibling relationships. For example, a brief program developed by Ross et al. for parents of siblings in middle childhood was aimed at teaching parents to help their children engage in constructive approaches to sibling conflicts rather than resorting to expressions of anger and aggression (Siddiqui and Ross, 2004). In this brief intervention, mothers received 90 minutes of conflict mediation training, focused on how to help guide siblings through the process of developing their own resolutions to conflicts, with the ultimate goal of allowing siblings to resolve problems on their own. A short-term evaluation revealed that siblings of parents in the mediation condition showed less conflict and were better able to compromise, and that younger siblings took a more active role in the conflict resolution process compared to a control group (Siddiqui and Ross, 2004; Smith and Ross, 2007). A few other sibling-focused programs have been developed and evaluated. These have combined a focus on supporting parents’ management of sibling relationships as well as helping siblings improve their relationship directly. For example, Bank and Snyder (2004) developed a sibling dyad-focused program for middle childhood-aged siblings at elevated risk for conduct problems that was intended to be an adjunct to parent management training (PMT). Grounded in a social and operant learning approach, the sibling component consisted of eight sessions focused on fostering each sibling’s dyadic relationship skills to reduce conflict and aggression. In addition to the standard PMT program, parents were provided with information about what was taught in each sibling session and coached in how to support and reinforce the targeted child behaviors. In a three-arm trial, Bank compared the PMT + sibling program to PMT alone and to a control condition. The children in both of the intervention conditions demonstrated less growth in parent-reported antisocial behavior compared to the control group. However, teacher reports demonstrated advantages of the PMT + sibling condition over the other two, with the PMT + sibling participants demonstrating lower levels of antisocial behavior and deviant peer association as well as more academic progress and more positive peer associations than children in the other two conditions. Playground observations indicated the PMT + sibling group had lower rates of negative peer interaction and social isolation than the other two groups (Lew Bank, personal communication). Kramer’s More Fun with Sisters and Brothers program (MFWSB; Kennedy and Kramer, 2008) was developed as a universal social skills training program for sibling pairs between 4 and 8 years of age. The goal of MFWSB is to promote prosocial behaviors toward siblings and reduce conflict by teaching children emotion regulation and social relationship skills. MFWSB was grounded in research on peer relationships, which suggests that children who are better able to regulate their negative emotions and take another’s perspective are able to respond effectively to a variety of social situations and have more positive outcomes. In MFWSB, sibling pairs attend small group sessions where they learn skills such as social problem solving, identifying emotions, and how to respond in a prosocial manner to a sibling’s invitation to play. Parents were able to observe these training sessions through a video monitoring system and were instructed in how to promote and reinforce positive sibling interactions at home. The program demonstrated modest effects for increasing sibling warmth and reducing parents’ need to intervene around children’s emotionality, high activity levels, and misbehavior. 244

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Finally, we (MF and SM) developed a sibling-focused intervention with a parent component (Feinberg, Solmeyer, Hostetler, et al.). The program was based on our conceptual model of how sibling relationships lead through multiple family, school, and peer pathways to problems in emotional and behavioral adjustment including risky and antisocial behaviors (Feinberg, Solmeyer, and McHale, 2012). Siblings Are Special (SIBS) is a universal prevention program for fifth graders, their younger siblings, and parents, aimed at reducing siblings’ risk for negative adjustment and substance use. Small groups of up to four sibling pairs attended 12 weekly after-school group sessions. Some skills introduced to children are similar to those used in other child focused, non-sibling programs—the development of SIBS was guided by social-emotional programs such as PATHS (Greenberg, Kusche, Cook, and Quamma, 1995) and the Fast Track social skills training curriculum (Bierman and Greenberg, 1996). Parents joined the sibling groups for an additional three “family nights.” The family nights consisted of a first period in which children met separately from parents; during this time, facilitators provided parents with guidance and discussion around parenting of siblings—specifically, enhancing positive guidance and involvement and discouraging authoritarian control. During the second part of the family nights, siblings joined their parents, presented material on what they had been learning, and engaged in family activities designed to foster both parenting and sibling skill practice. In a randomized trial of the program, we recruited 174 sibling dyads and their parents from public schools in central Pennsylvania. The primarily European American sample was not screened or selected on the basis of child, sibling dyad, or family risk status.The results indicated that the program had some impact (effect sizes were about d = .3) on targeted parenting strategies for managing sibling relationships as well as on the positive dimension of sibling relationships. Findings also demonstrated that children exhibited increased self-control, social competence, and academic performance (by teacher report). Finally, program exposure was also associated with reduced maternal depression and child internalizing problems. However, no effects of SIBS were found for the negative dimensions of sibling conflict, sibling collusion, or children’s externalizing problems. It is possible that sustained positivity in the sibling relationship would, over time, lead to reduced negativity and conflict. It is also possible that altering negative aspects of sibling relationships through a group-format program and limited sessions with parents may not have provided sufficiently intensive intervention. Updegraff and colleagues (2012) conducted a pilot trial of SIBS with 54 Mexican American families. Given that family cohesiveness (referred to as familismo or familism in this cultural group) is a strong value in Mexican culture, the investigators expected that family members would be motivated to adopt the program’s strategies and skills, with positive effects on siblings and their families. Results indicated that the program had moderate-sized effects (ds = .40 to .64) on the authoritarian parenting of siblings as well as the positive and negative dimensions of both sibling relationships and parent–child relationship quality. Notably, in both trials of SIBS, recruitment rates, session attendance, and parent satisfaction were high (Feinberg, Solmeyer, Hostetler, et al., 2012; Updegraff et al., 2014). These implementation process results suggest that, in contrast to the low levels of engagement in parenting programs generally, siblingfocused programs may meet parents’ perceived need for support and guidance, and through their focus on improving sibling relationships, a non-stigmatized source of family stress, improve engagement. More generally, given the results from all four of the programs described here, interventions that incorporate a focus on enhancing the parenting of siblings may be a promising approach to promoting positive individual and relationship functioning across development, from preschool through adolescence.

Future Directions in Research on Parenting Siblings There are ample opportunities for important and even foundational research on parenting in the context of sibling relationships. Areas we identified include a better descriptive understanding of 245

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parent’ attitudes, cognitions, goals, strategies, and behaviors toward their children’s sibling relationships, from their earliest days and across development into adulthood. It is also important for the next wave of research to move away from a focus on a uni-directional socialization pathway from parenting to sibling relationships, but, adopting a systems perspective, work to understand the multiple intersecting relationships in the family. It is likely that parenting of siblings and siblings’ relationships develop in a dynamic, mutually interacting process—suggesting that, as a beginning step, researchers attend to reciprocal effects linking sibling dynamics to parenting. It is also possible for researchers to draw on modern evolutionary theories of family behavior across humans and other species. For example, parent–offspring conflict theory centers on understanding both parent and child strategies for gaining and sharing resources through a understanding of reproductive fitness, genetic relatedness, and resource dynamics between parents and children (Schlomer, Del Giudice, and Ellis, 2011). The irony is that, although this theory addresses central issues in the study of parenting siblings (i.e., parent and sibling competition and sharing) and has been applied in anthropologically oriented work, it has not been systematically applied to the empirical study of siblings and families within the field of family psychology. Moreover, parenting of siblings is not a solo activity; the vast majority of parents, especially during the formative early childhood period, have one or more coparents involved such as another parent, grandparent, or other extended family or adult. Thus, just as the field of coparenting research has helped us understand how parenting occurs and influences children in the context of more than one parent, a similar coparental approach to parenting of siblings will likely prove productive. Families with different structures—whether intergenerational, joint custody in two households, step-families extended families—provide contexts from which to draw insights into how the tasks of rearing siblings are managed. Research focusing on parenting siblings in high-risk, transient situations—such as foster care or homelessness may help us provide maximal support to children’s sibling bonds in these challenging circumstances. The risk in expanding our scope is that the basic study of one parent’s parenting of only two siblings begins with a complex phenomenon. Introducing each additional individual family member to the scope of research not only increases the number of respondents or targets to observe, but also increases the number of relationships exponentially, necessitating, for some kinds of analyses, greater power—that is, a larger sample size—to accommodate the increase in parameters. (Although sibling researchers can also take advantage of the increase in power that comes about in some analytic models when dependent variables are measured for each child in the family, even accounting for dependency.) Thus, the complexity of our conceptual thinking, analytic methods, and/or resources may constrain the kinds of questions we may ask. Additionally, we seek an inclusive, rich understanding of the way parenting of siblings occurs in families across different household structures, neighborhoods, ethnic groups, cultures, financial resources, and a variety of challenges—such as meeting the needs of a child with a disability. There is much we can learn from families in different places and situations that can be helpful in other contexts. For example, by studying sibling caregiving in non-Western cultures, we may come to an understanding that allows us to foster mutual sibling caring in our own individualistic culture. In such investigations, there is a role for both descriptive and hypothesis-driven inquiry. In descriptive work with non-European-American cultures, maintaining an open attitude of exploration through, for example, ethnographic and qualitative work is very helpful. And quantitative methods that can account for more than two siblings at a time—such as multilevel approaches employed by Jenkins (Jenkins, Rasbash, Leckie, Gass, and Dunn, 2012; Jenkins, Dunn, O’Connor, Rasbash, and Behnke, 2005)—will be more critical to incorporate. In the area of hypothesis-driven research, the field continues to evolve slowly in terms of conceptual and theoretical models that are proposed and then examined in a coherent line of research, moving from correlational to longitudinal to experimental designs. An exemplar of a theoretical approach engaged with empirical data is Reiss’ 246

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The Relationship Code (Reiss and Hetherington, 2009). Although neglected in the sibling literature, this work is a rare example of hypothesis-driven family process inquiry; moreover, the large-scale study that informs the work is focused on parenting of siblings. Reiss’ work traces how the distinction between genetic and environmental influences illuminates our understanding of the pathways we have considered in this chapter: parenting, sibling relations, and children’s adjustment.

Conclusions We end with not the usual complaint of neglect by sibling-focused research, but with a vision of a growing interest in understanding how parents shape and are shaped by sibling relationships— one of the few large but still largely unknown influences on the health, happiness, and well-being of children and their parents. The existing body of research on parenting siblings points to the substantial influence that parents can have on sibling relationships—both directly through parenting siblings (fostering warmth and understanding, resolving conflict, orchestrating time use, etc.) as well as indirectly, through parenting directed at each child separately. As sibling relationships have greater influence on children’s development and lifelong adjustment than generally acknowledged, fostering positive sibling relations represents an important new area by which parents can promote children’s long-term well-being. Scholars should also continue to examine the reciprocal “siblingeffects” pathway: Sibling conflict is recognized by almost all Western parents of more than one child as a significant parenting challenge. The impact of sibling conflict and other sibling dynamics—such as collusion against parental authority—on parents and parenting are areas where we have little research-based knowledge to date. Indeed, the field of parenting siblings is still in an early stage. We lack basic information on the epidemiology of sibling violence, for example, despite the fact that the sibling relationship is the locus of most family aggression for the majority of families with more than one child. Consequently, our ability to recommend strategies for parents’ preventing and managing such violence (and nonphysical bullying) is quite limited. And while we have accumulated information about links between parenting siblings, sibling relationships, and the development of specific adjustment problems such as substance use, teen pregnancy, depression, and physical aggression, we know little about the specific and differential mechanisms by which parent–sibling interactions and relationships lead to (or prevent) these problems. By pursuing and supporting further research into such interpersonal and intrapersonal mechanisms, we will better understand better the parent–sibling emotional, cognitive, and behavioral processes that parenting interventions should target. It is also critical for family scientists to expand upon theories and research paradigms that study parenting as isolated dyadic interactions. As Irish (1964) pointed out over a half-century ago, the ubiquity of siblings in families across the world necessitates the contextualizing of parenting in triadic and larger family systems processes. Further, by including siblings in research on parenting and family studies, scholars also open up avenues through which often discussed but difficult to empirically demonstrate systemic effects, like relational spillover, learning from experience (i.e., parental practice effects), family coalitions, and compensation versus congruence across family dyads, can be observed. In these and other ways, by incorporating sibling dynamics into our theories and research, we will gain both a more nuanced and a more holistic view of family systems processes, including parenting.

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8 PARENTING GIRLS AND BOYS Christia Spears Brown and Michelle Tam

Introduction One of the first studies to examine how parents treat girls and boys differently was described in Patterns of Child Rearing (Sears, Maccoby, and Levin, 1957). The authors discussed how parents made distinctions in rearing their girls and boys in the domains of aggression and dependency. For example, they noted that parents withdrew love from girls in response to their aggressive behaviors, whereas they did not for boys. They argued that relatively higher rates of aggression in boys and dependency in girls were a result of parents rewarding behaviors associated with the child’s gender and punishing the behaviors deemed inappropriate for their gender. This early work was the precursor to a robust body of research within developmental science that has focused on how parents socialize girls and boys differently and in accordance with their respective gender stereotypes. A 2011 analysis of published articles in the journal Sex Roles empirically documented how studies on gender socialization dominated the field of gender development research in the 1960s and 1970s (Zosuls, Miller, Ruble, Martin, and Fabes, 2011). Most research on gender development during that period concentrated on parents’ socialization of girls and boys through different expectations and attitudes; this focus on differential treatment, however, was ultimately limited (Zosuls et al., 2011). Although empirical studies documented examples of differential treatment by parents, study findings were inconsistent within the literature. The inconsistencies and discrepancies across studies led researchers to increase their attention to critical moderators and individual differences across children, parents, and families in explaining the role of parents in gender development, including an increased focus on the importance of cultural diversity (Zosuls et al., 2011). This chapter reviews research on how parents rear their daughters and sons, at times similarly and at times differently.This chapter is meant to complement, rather than replace, previous reviews.Thus, we first address the importance of diversity across individual children and their parents and across cultures. Second, we briefly outline some theoretical frameworks that guide research on how parents influence their children’s gender development.Third, we describe recent research on the critical ways that parents influence the differential development of their daughters and sons (1) by enhancing the importance of gender as a social category and (2) by socializing girls and boys differently. Fourth, we discuss research on parenting gender diverse and gender nonconforming children. Fifth, we describe research on how parents help their children cope with gender bias and discrimination. We conclude the chapter with suggestions and recommendations for future directions of research.

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Individual Diversity and Cultural Contexts of Gender Although gender is associated with biological sex (the categories of male and female determined by chromosomes, hormones, and genitalia), gender actually refers to the “meanings that societies and individuals ascribe to male and female categories” (Wood and Eagly, 2002, p. 699). As such, gender is inherently socially constructed, and thus there is diversity in the ways that parents interact with girls and boys across cultures. These differences in cultural contexts can be the function of historical trends, religious beliefs, and societal traditions. These differences can also be the function of institutionalized biases that indirectly influence how parents shape gender development; one example highlighted here is the difference in parental leave policies for mothers and fathers in different countries. Importantly, there is also diversity within cultures because of the individual diversity of girls and boys and the diversity of parents and families. This type of individual diversity, because it is so critical to later discussions, is described first.

Diversity of Girls and Boys In discussions of parenting girls and boys, it is important to first recognize that gender is a multidimensional construct that includes psychological, social, and behavioral components (WHO, 2014). As such, there is enormous individual diversity within gender categories. Two core ways in which individuals differ within their gender category is by sexual orientation and gender identity (collectively, SOGI; Temkin, Belford, McDaniel, Stratford, and Parris, 2017). Specifically, gender identity refers to how an individual perceives their own gender, which may or may not fall within a male or female binary category. Those individuals who do not fall within the traditional gender binary can be referred to as gender nonconforming, gender expansive, genderqueer, or gender diverse (to name a few). Even among girls and boys who identify within the gender binary and with their sex assigned at birth, many may express themselves in gender-nonconforming ways in their appearance, behavioral styles, and activities; previous research has shown that 23% of boys and 39% of girls exhibited 10 or more behaviors that are considered nonconforming for their gender (Sandberg, Meyer-Bahlburg, Ehrhardt, and Yager, 1993). Individuals who do not identify with the sex category they were assigned at birth often identify themselves with the label transgender (in comparison to the label cisgender, referring to individuals who identify with the same-sex assigned at birth). Although it is difficult to determine the exact percentage, by middle school approximately 1.3% of youth identify as transgender (Shields et al., 2013), and by adulthood approximately 2.4% of individuals identify as transgender (Tate, Ledbetter, and Youssef, 2013). Finally, individuals differ in their sexual orientation, with 2.1% of youth by middle school identifying as bisexual, 1.7% identifying as lesbian or gay, and 12.1% being unsure (Shields et al., 2013). By the time they are adults, 3.5% of the population identify as lesbian, gay, or bisexual (Gates, 2011a). These SOGI-based differences impact how parents interact with their daughters and sons (D’Augelli, Grossman, and Starks, 2008; Savin-Williams, 2001). For example, parents of sons who are gender nonconforming may try to more heavily reinforce masculine gender stereotypes than parents of more gender-conforming sons. Furthermore, parents are often more accepting of gender nonconformity in daughters than in sons (see Egan and Perry, 2001). As described later in the chapter, parents’ reactions to the sexual orientation, gender identity, and gender conformity of their children can have serious implications for child development. It is also important to recognize that the vast majority of research on girls’ and boys’ development presumes that the children in the study are cisgender and relatively gender-conforming, yet does not actually assess SOGI status. Thus, our extant knowledge of gender development is ultimately limited until we better examine the diversity of the children included in the research.

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Diversity of Parents In addition to individual diversity of gender categories for children and adolescents, there is diversity of parents within families. Parents may consist of mothers and fathers in the same household or in separate households (separated either because of divorce, dissolution of the relationship, or because they never lived in the same household). After divorce, 81% of custodial parents are mothers and 18% are fathers (Cancian, Meyer, Brown, and Cook, 2014).The gender of the parent or parents within the home is an important consideration in the examination of how parents shape the development of girls and boys. Relatedly, families may consist of two mothers or two fathers. The number of households in which there is at least one sexual minority parent has been growing, with between 2.0 and 3.7 million children under age 18 in the United States have lesbian, gay, bisexual, and transgender parents (LGBT; Gates, 2011b). Parents are also not the only ones “doing the parenting”: Approximately 3% of families are multigenerational households (Jung and Yang, 2016), in which grandparents also play a parenting role (Profe and Wild, 2017). Parents and grandparents, because of generational differences, may hold different gender stereotypes and ideals that impact their interactions with girls and boys.Taken together, this means that researchers must attend to the gender composition and diversity of the children within a family, and to gender composition and diversity of the parents.

Cultural Diversity Most work focusing on parenting girls and boys has been conducted with White parents from Western cultures.Yet, it is important to attend to the role of culture in shaping parenting and child development, as there are significant differences across cultures in how parents engage with their daughters and sons. For example, in many parts of the world, parents exhibit strong preferences for sons over daughters (The Economist, 2010). Often this reflects the sons’ roles as future financial providers for the family. Because of this, in some low-income countries in which compulsory education is not required of all children, parents often have sent only their sons to school (UNESCO, 2010).This decision obviously leads to different developmental outcomes for girls and boys. In Bangladesh, for example, literacy is twice as high in boys than girls (48% versus 24%, respectively; see Stewart, Bond, Abdullah, and Ma, 2000). Across cultures, there are also differences in the impact of parenting behaviors across daughters and sons. For example, in Islamic cultures, there is closer monitoring of girls than boys, and boys are given more unrestricted access to peers than girls (Stewart et al., 2000). In a study with Bangladeshi youth, girls who reported their parents’ close supervision of them perceived their parents to be warmer, whereas boys who reported parents’ close supervision perceived their parents as more dominating (Stewart et al., 2000). These different perceptions had different implications for psychological outcomes. Additionally, in Pakistan, parental autonomy granting was important and positive for boys’ outcomes, but unrelated to girls’ outcomes (Stewart et al., 2000). In other words, there is cultural diversity in how parents treat girls and boys and cultural diversity in the impact of that differential parenting on children. Even within Western samples of families, it is critical to examine parenting and child development through the lens of intersectionality, such that attention is paid to the overlapping—or intersecting— social identities to which all individuals simultaneously belong (such as ethnicity, social class, sexual orientation, and gender). Children and their parents’ culture, ethnicity, and gender intersect in complex ways. First, parents’ specific cultural background (often articulated by ethnicity or nationality) influences how parents rear their daughters and sons. For example, previous research has shown that Latino families are typically more traditional in socializing gender roles than European American families (Azmitia and Brown, 2000; Baca Zinn and Wells, 2000; Hondagneu-Sotelo, 1994; Valenzuela, 1999). Women are typically viewed as the people who maintain relational ties with families and preserve the

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ethnic traditions and integrity of the culture (Gil and Vazquez, 1996; Phinney, 1990). Thus, girls are often expected to remain close to the home and family, whereas boys are expected to gain independence and autonomy (Raffaelli and Ontai, 2004; Suárez-Orozco and Qin, 2006). Perhaps based in concerns about protecting their daughter’s virginity, girls often have more restrictions and are more closely monitored than are their brothers (Raffaelli and Ontai, 2004; Suárez-Orozco and Qin, 2006). Boys, in contrast, are given more freedom, mobility, and privileges than are girls (Domenech, Rodriguez, Donovich, and Crowley, 2009; Love and Buriel, 2007; Suárez-Orozco and Qin, 2006). In addition, girls are often given more chores and responsibilities than their brothers (Raffaelli and Ontai, 2004). One example is that Mexican American parents are more likely to choose their daughters than their sons to translate for them (i.e., language brokering); the greater language brokering, however, typically involves tasks that can be completed within the home, such as filling out paperwork (Love and Buriel, 2007;Valenzuela, 1999). Not surprisingly, although both girls and boys respect and value their families (Valenzuela and Dornbusch, 1994), girls are socialized to be even more connected to their families than boys (Raffaelli and Ontai, 2004). Second, gender and ethnicity intersect when the child’s gender impacts how parents in ethnically marginalized groups discuss racism, culture, and discrimination with their children. For example, African American parents deliver more messages to boys than to girls about preparation for bias and about the realities of ethnic barriers in society (Bowman and Howard, 1985; McHale et al., 2006; Rowley et al., 2014). In contrast, parents of girls deliver more messages designed to promote cultural socialization or to promote cultural pride than parents of boys. These gender differences, with an increased focus on possible discrimination for sons, are likely reflective of a very real fear for their sons’ physical safety. Ultimately, because of the social construction of gender, gender development cannot be studied in isolation from culture.

Gendered Parenting Across Cultures: Impacts of Parental Leave Policies Because the gender of the parent is important in understanding how parents rear girls and boys, it is important to consider how mothers and fathers divide the labor of parenting. There has traditionally been, and largely continues to be, a gendered asymmetry in parental labor and childcare. For example, in U.S. American heterosexual two-parent households, 70% of families have both an employed mother and father. Despite equal hours in outside employment, mothers spend approximately twice the amount of time on childcare and housework as do fathers (Parker and Livingston, 2016). Additionally, mothers spend more time performing low-control childcare tasks, such as diaper changing and bathing, relative to fathers, who spend more of their time on high-control tasks such as playing (Drago, 2011). Indeed, this asymmetry is why most developmental research has focused on the role of mothers as the primary caregivers of children. Yet, this gendered division of parental labor is heavily influenced by cultural norms, and can be exacerbated and institutionalized by a country’s specific parental leave policies. Currently, among the 35 Organization for Economic Co-operation and Development (OECD) countries, parental leave policies vary widely: They range from allowing parents 12 weeks to 3 years off work following the birth of a child, and replace 0% to 100% of their wages while off (Kamerman, 2000; OECD, 2016a). Scandinavia leads the rest of the world in both the length and generosity of its parental leaves, with leaves lasting approximately 1 year or more and most countries replacing at least 75% of wages (OECD, 2016b; Ray, Gornick, and Schmitt, 2010). Parents in Spain and Germany can take up to 3 years off to stay home with their children (Kamerman, 2000). Unfortunately, the United States has the worst parental leave policy in the world: it is the shortest, at only 12 weeks (matched only by Mexico); it replaces no wages (whereas Mexico replaces the full wages during leave); and it is the only OECD country that does not guarantee paid leave to all new parents (Deahl, 2016; Kamerman, 2000).

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These policies are relevant to understanding the parenting of girls and boys, because they often foster a gendered division of parental labor. Currently, 25 of the OECD countries offer either paid paternity leave or reserve portions of their paid parental leave for the father (OECD, 2016c), but the amount of leave fathers are given is vastly disproportionate to the leave time given to mothers. On average in the OECD, mothers receive five times longer leaves than do fathers. Furthermore, fathers are more likely than mothers to return to work early, without utilizing either the full length or any of their leave time (Evans, 2007). For example, in 2003, Swedish fathers utilized only 17% of their time off (Plantin, 2007), and only 2% of Japanese fathers (Nakazato and Nishimura, 2016) and 10% of Luxembourg fathers (Zhelyazkova, Loutsch, and Valentova, 2016) took advantage of their parental leave. If fathers are not taking time off to care for their infants at the same rate mothers are, there will continue to be a gendered asymmetry in parental labor. Some European countries have tried to remedy this asymmetry by incentivizing fathers to stay home (Evans, 2007). Croatia offers an additional 2 months of paid leave if both parents stay home, and France increases the percentage of wages replaced if both parents take leave (Kowalski, Blum, and Moss, 2016). In 2007, Germany passed a reform that allowed 2 “daddy months” at 67% wage replacement in the hopes of increasing paternal involvement in the months immediately following birth, and paternal uptake of benefits increased from 3.5% to 32% from 2006 to 2013 (Blum, Erler, and Reimer, 2016). Austria offers couples an additional 1,000 Euros if they split their leave time equally, and estimates of paternal leave uptake have risen from approximately 1% in 1990 to 29% in 2015 (Rille-Pfeiffer and Dearing, 2016). Thus, the mere presence of paternal leave does not necessarily translate to higher rates of father involvement, but it is possible to encourage fathers to stay at home through the use of either time or monetary incentives. Equalizing parental leave policies, and thus reducing gender asymmetry in parental labor, is important for child development. Heymann and colleagues (2013) found that longer parental leave was associated with higher rates of childcare by fathers that continued even after leave ended. Similarly, Nepomnyaschy and Waldfogel (2007) found that fathers who spent more than 2 weeks at home immediately following the birth of their child engaged in more childcare activities including diaper changing, feeding, dressing, and bathing 9 months later relative to fathers who took fewer than 2 weeks off. Studies have also found an association between paternal involvement and how securely attached infants are to their fathers—especially if paternal sensitivity is low—with more involved fathers having more securely attached infants (Brown, Mangelsdorf, and Neff, 2012; Caldera, 2004).These studies support the theoretical and empirical work of Bronfenbrenner, who argued for the importance of the ecology of the child in shaping development, and who specifically noted that national work policies that affect families intimately affect children as well (e.g., Bronfenbrenner, 1974).

Theoretical Frameworks for Parental Influences on Gender There are multiple theoretical justifications for why and how parents influence their girls and boys differently. From the beginning, parents influence the development of girls and boys by facilitating children’s active creation of gender stereotypes and schemas. Children’s own gender schemas then drive their beliefs about themselves, attitudes about others, and behavior (see Martin, Ruble, and Szkrybalo, 2002). Developmental intergroup theory (Bigler and Liben, 2007) argues that contexts that increase the physical and psychological salience of gender increase children’s attention to gender as an important human category. When children are more attuned to a particular social category—and this attention is directed toward any social group that adults use to sort, label, or categorize—they are more likely to develop stereotypes about that category. Thus, when parents increase the salience of gender in their everyday behaviors, they are inadvertently increasing children’s attention to gender, and thus increasing the strength of their developing gender stereotypes.

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Furthermore, once children recognize their own gender category (a milestone reached within the first 2 years of life; Martin and Ruble, 2010), gender schema theory argues that they become motivated to be prototypical members of that group, as being prototypical helps with both self-definition and cognitive consistency. To become prototypical, children seek out same gender-consistent information and ignore other gender-consistent information (Martin et al., 2002). One way children seek out same gender-consistent information, according to social cognitive theory, is by modeling relevant others (Bussey and Bandura, 1999). When children attend to same-gender models (i.e., girls to mothers and boys to fathers), and those models engage in gender stereotype-consistent behaviors, children’s own behaviors and attitudes become stereotype-consistent. Social cognitive theory (Bussey and Bandura, 1999) also asserts that parents provide direct instruction to sons and daughters and help construct specific environments that further promote genderconsistent development, including purchasing gender-specific toys and allowing greater access to same-gender peers (e.g., via birthday parties and sleepovers). The role of parents as direct instructors of gender norms and providers of gender-specific opportunities is well articulated in the work of McHale, Crouter, and Whiteman (2003), who draw from Parke and colleagues (Parke and Buriel, 1998). These environments, opportunities, and direct instruction, combined with children’s motivation to be typical members of their gender category, contribute to children’s growing knowledge and valuing of gender-consistent information.

Parenting Girls and Boys Using Gender as a Category As highlighted in developmental intergroup theory (Bigler and Liben, 2007), stereotyping and prejudice are more likely to occur when social categories are made salient. Parents commonly increase the salience of their children’s gender from birth.They increase gender salience by assigning of gendered first names, hairstyles, clothing fashions, bedroom decorations, colors, and toy purchases (Leaper, 2015). For example, by 5 months, girls are more likely to be dressed in pink and boys in blue clothing, and boys are more likely to have blue walls, bedding, and curtains (Pomerleau, Bolduc, Malcuit and Cossette, 1990).These distinctions, while subtle, direct children’s attention to gender as a category. As described above, this focused attention to gender, and children’s belief that gender must determine other traits as well, results in an increase in children’s gender stereotypes (Bigler, 1995; Bigler and Liben, 2007).

Different Socialization of Girls and Boys Beyond establishing gender as a uniquely important category, thus ensuring children will actively create their own strong gender stereotypes, parents also socialize girls and boys differently. At times implicitly and at times explicitly, parents treat sons and daughters differently in such domains as emotion and aggression, self and body esteem, language, academic concepts, play, and household expectations. By treating children differently according to gender, parents increase the likelihood that girls and boys will have different developmental trajectories.

Emotion and Aggression It is widely believed that women are more emotional than men (Plant, Hyde, Keltner, and Devine, 2000). Even preschool children believe the stereotype that girls are relatively more likely to be fearful, sad, and happy, whereas boys are more likely to be angry (Birnbaum and Croll, 1984). Meta-analytic

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research, however, shows very few actual differences in emotionality between infant girls and boys (Else-Quest, Hyde, Goldsmith, and Van Hulle, 2006). Specifically, there are no gender differences in emotionality, sadness, or anger, and only a small difference favoring girls in fearfulness (Else-Quest et al., 2006). Meta-analytically, boys are shown to be more aggressive than girls, with a moderate effect size, and particularly for physical aggression (Hyde, 2005). Even in adulthood, men’s and women’s actual emotional reactions to individual situations do not differ (Barrett, Robin, Pietromonaco, and Eyssell, 1998). Despite this similarity, women do describe themselves as more emotional than men, identifying as more empathetic, and report being more intensely and openly affective (Barrett et al., 1998; Brackett, Mayer, and Warner, 2004; Goldshmidt and Weller, 2000; Mestre, Samper, Frias, and Tur, 2009). Because there is no actual gender gap in emotionality in infancy, but a self-perceived gender gap develops over time, researchers have examined whether girls’ increasing perceived emotionality relative to boys is due to stereotype-consistent socialization. Specifically, researchers have examined whether parents contribute to increasing emotional expressiveness among girls, as parents provide both explicit socialization about emotions and serve as emotive models for their children. Parent–child discussions about emotions help young children articulate their emotions later (Dunn, Bretherton, and Munn, 1987). Thus, discussions about emotions may help children develop greater emotional awareness and acceptance, and if directed more toward girls than boys, would partially explain girls’ greater willingness to express emotions. Considering the gender difference in emotionality between adult women and men, it is not surprising that mothers use more emotion language and show greater sensitivity to their children’s emotions than fathers (Aznar and Tenenbaum, 2015; Fivush, Brotman, Buckner, and Goodman, 2000; Garside and Klimes-Dougan, 2002; Hallers-Haalboom et al., 2014; van der Pol et al., 2015; cf. Adams, Kuebli, Boyle, and Fivush, 1995). Even among studies that found no overall difference between mothers and fathers in the amount of emotion words they used, sons used emotion words more with their mothers than with their fathers (Roger, Rinaldi, and Howe, 2012). Beyond differences in mothers’ and fathers’ emotional expression, parents discuss emotion more, and use a greater variety of emotion words, with their daughters than with their sons (Adams et al., 1995; Aznar and Tenenbaum, 2015; Kuebli, Butler, and Fivush, 1995; Kuebli and Fivush, 1992; Maccoby, 1998; Mascaro, Rentscher, Hackett, Mehl, and Rilling, 2017; cf. Ersay, 2014). In addition, Mandara and colleagues (2012) found that mothers were more encouraging, warm, and empathetic with daughters than with sons, and Lambie and Lindberg (2016) found that mothers validated their daughters’ emotions more than they did their sons’. Not only do parents discuss and validate emotions more overall with daughters than sons, the discussions are gender-differentiated according to the type of emotion. For example, parents discuss negative emotions, especially sadness, more with daughters than sons (Adams et al., 1995; Fivush, 1991; Kuebli and Fivush, 1992; Kuebli et al., 1995; Mascaro et al., 2017). They are also more likely to pay attention to their daughters’ submissive, and thus stereotypically feminine, emotions (e.g., sadness, anxiety) relative to their sons (Chaplin, Cole, and Zahn-Waxler, 2005; Fivush, 1991). Furthermore, fathers reward girls’ expression of sadness, but punish boys’ expression of sadness; mothers, instead of punishing, try to distract sons more than daughters when they express sadness (Fabes and Martin, 1991). There is, however, an exception to this tendency to discuss emotion more with daughters than sons. Parents are overwhelmingly more likely to discuss anger and accept aggression with their sons than with their daughters (Archer, 2004; Block, 1983; Eisenberg, Cumberland, and Spinard, 1998; Fivush, 1991; Hastings and Rubin, 1999; Letendre, 2007; Maccoby, 1998; Morris, Silk, Steinberg, Myers, and Robinson, 2007). This may be because anger is a stereotypically masculine emotion (Archer, 2004; Hastings and Rubin, 1999; Letendre, 2007). Indeed, when parents read stories to their children that had androgynous characters displaying happiness, anger, sadness, and fear, parents tend to label characters as male when they display anger and as female when they display happiness or 264

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fear (van der Pol et al., 2015). Furthermore, in general, parents view aggression as more normative in their sons than in their daughters (Letendre, 2007; Maccoby, 1998). In a longitudinal study, Hastings and Rubin (1999) found that, although mothers were unhappy with aggression in their sons, they were surprised and puzzled if their daughters developed aggressive tendencies. Parents were also more accepting of anger and retaliation in their sons, and in turn, boys expected fewer negative consequences in response to their anger than girls (Eisenberg et al., 1998; Fivush, 1991; Maccoby, 1998). Parents also seem to model anger more to sons than daughters. For example, mothers of sons report expressing fewer positive emotions and more anger toward their sons than their daughters (Garner, Robertson, and Smith, 1997). Parents also tend to use more physical control (e.g., spanking, holding, grabbing) with boys than with girls (Endendijk et al., 2017; Kochanska, Barry, Stellern, and O’Bleness, 2009). In sum, whether directly or indirectly, parents overwhelmingly are more accepting of anger and aggression in their sons than in their daughters. Not only are there gender differences in parents’ discussions and reactions to different emotions in sons and daughters, but parents also differ in how they teach their sons and daughters to respond to emotion. First, parents may react differently to their children’s emotional responses based on their social acceptability. Cassano and Zeman (2010) found that parents respond more supportively when their children’s emotional reactions are normative for their gender compared to when the reactions violate gender norms, and this is especially true for father-son dyads. Furthermore, parents encourage their sons to use active/instrumental coping strategies (i.e., problem focused; Eisenberg et al., 1998; Morris et al., 2007), whereas they encourage their daughters to be more relationship focused and discuss emotions in a social interaction context (Fivush, 1991; Morris et al., 2007). These differences in how parents react to emotion in their children are not without predictable consequences. Girls initiate more emotion conversation and use a greater volume and variety of emotion words (Adams et al., 1995; Aznar and Tenenbaum, 2015; Kuebli et al., 1995; Maccoby, 1998). Girls are also typically better at emotion regulation (Morris et al., 2007) and have higher levels of emotional awareness (Lambie and Lindberg, 2016). It is possible that such differences are biological, but parents’ behavior is predictive of their children’s. Chaplin and colleagues (2005) found that parental attention to submissive emotions in preschool predicted expression of submissive emotions at school age, and as would be expected, girls in turn expressed more submissive emotions than boys. In contrast, across development, boys decrease in their likelihood of expressing sadness (Fuchs and Thelen, 1988). The majority of research on emotional socialization of girls and boys has been conducted with European American,Western, middle-class samples, and it is possible that these patterns differ among other ethnicities and cultures. For example, African American mothers are more likely to perceive negative social consequences for displays of negative emotion and be less supportive of their sons’ negative emotions, than are European American mothers (Brown, Craig, and Halberstadt, 2015; Nelson, Leerkes, O’Brien, Calkins, and Marcovitch, 2012). This evaluation of negative emotions is likely a reflection of African American mothers’ awareness of cultural stereotypes and discrimination, and the subsequent concerns about the safety of their African American sons if they express negative emotions. Similarly, European American parents show more physical affection and verbalize emotion more than Asian American parents, regardless of the gender of the child (Le, Berenbaum, and Raghavan, 2002). Thus, it is important to consider how differences due to cultural norms and differing social presses impact the gendered socialization of emotions. In summary, although few differences in emotionality exist in infancy, gender differences emerge across development. Aligned with those differences, parents seem to play an important role in the socialization of emotion in their children. They tend to talk more about emotions with their daughters, especially negative and submissive emotions. In contrast, parents talk more about anger with their sons, and are more accepting of aggressive behaviors from and toward their sons compared to daughters. These differences in socialization, whether explicit or indirect, predict children’s later emotional expression. 265

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Self and Body Esteem Self-esteem as a global construct refers to the overall evaluative “regard that one has for the self as a person” (Harter, 1993, p. 88). In addition to examining global self-esteem, researchers also study selfesteem within specific domains, such as academics, social relationships, athletic abilities, and physical appearance. In general, having a positive self-esteem is associated with positive adjustment and psychological well-being (Kling, Hyde, Showers, and Buswell, 1999). Meta-analyses point to complex gender differences in self-esteem (Kling et al., 1999). Specifically, there is a quadratic age effect: prior to age 10, there are no gender differences; as children enter adolescence, boys have more positive self-esteem than girls, and the gap grows throughout the teens; by adulthood, the gender gap declines (Kling et al., 1999). At its greatest, however, the gender gap would be classified as a small effect size, and only within European, Latino, and Asian ethnic groups. Furthermore, in the past decade, already small gender differences have further diminished (Zuckerman, Li, and Hall, 2016). There are also some specific gender differences across domain-specific self-esteem. In a metaanalysis of the different domains of self-esteem (Gentile, Grabe, Dolan-Pascoe, Twenge, and Wells, 2009), boys were found to have a more positive athletic self-esteem (i.e., they were more positive about their athletic abilities), and girls were found to have more positive behavioral conduct and moral-ethical self-esteem (i.e., they were more positive about their behavior and ethics). There were no differences in academic self-esteem, family relationship self-esteem, or social acceptance selfesteem (Gentile et al., 2009). There are also significant gender differences in appearance or physical body esteem (Gentile et al., 2009). Satisfaction with the body, or body esteem, decreases for girls during adolescence, whereas it is more stable for boys (Hargreaves and Tiggemann, 2002; Harter, 1990, 1993). Although the gender difference on body esteem is largest during early adolescence (Gentile, et al., 2009), this body dissatisfaction among girls persists through adulthood (Forbes, Adams-Curtis, Rade, and Jaberg, 2001;Tiggemann and Rothblum, 1997). The greater body dissatisfaction among girls and women is primarily a reflection of Western feminine gender norms that prioritize girls’ appearance over other traits, such as intelligence (Fredrickson and Roberts, 1997; Mahalik et al., 2005). Because of this primary focus on the appearance of girls, although both girls and boys can show concerns about their appearance, girls are typically more appearance-focused than boys (Dunn, Lewis, and Patrick, 2010; Jones and Crawford, 2006). Not surprisingly, because ideal bodies are impossible to attain, girls’ greater focus on appearance can lead to greater dissatisfaction with their body (i.e., lower body esteem). Considerable research has examined whether parents play a role in fostering positive global self-esteem among their children. Because of the gender difference in global self-esteem and body esteem, much of that work has examined whether parents differentially influence the self-esteem of their daughters and sons. This work has focused less on explicit socialization (compared to, for example, research on emotion that largely examines how parents talk to girls and boys about their emotions). Instead, this area of research has primarily focused on how general parenting styles, such as monitoring, warmth, and psychological control, differentially shape the self-esteem of girls and boys. What predicts positive self-esteem among children? Most studies find that parental support and warmth, particularly when combined with authoritative monitoring, promote positive self-esteem, regardless of the gender of child. Indeed, many studies showing links between self-esteem and parental support, warmth, or monitoring find similar patterns for both girls and boys (Bean, Bush, McKenry, and Wilson, 2003; Bush, Supple, and Lash, 2004; Bush, Peterson, Cobas, and Supple, 2002; Cotterell, 1992; Gecas and Schwalbe, 1986; Hoffman, Ushpiz, and Levy-Shiff, 1988; Li, Albert, and Dwelle, 2014; Plunkett, Henry, Robinson, Behnke, and Falcon, 2007; Tafarodi, Wild, and Ho, 2010). Some research (Burnett and Demnar, 1996) suggests that closeness with mothers is more closely related to positive self-esteem for children than closeness to fathers (although paternal attachment may be particularly meaningful for boys; Pan, Zhang, Liu, Ran, and Teng, 2016). Conversely, psychological

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control and punitiveness have been associated with decreases in self-esteem, regardless of the gender of the child (Abd-El-Fattah and Fakhroo, 2012; Bean et al. 2003; Bush et al., 2002; Cai, Hardy, Olsen, Nelson, and Yamawaki, 2013). When looking beyond self-esteem, other work finds similar patterns for related constructs. For example, work with Bangladeshi adolescents found that perceptions of parents as dominating were associated with self-derogatory ideation for both girls and boys (Stewart et al., 2000), and rigid parenting predicted an increase in depressive symptoms comparably among European and African American early adolescent girls and boys (Weed, Morales, and Harjes, 2013). Other research, however, finds that the links between the parenting relationship and self-esteem are more pronounced among girls relative to boys (Plunkett, et al., 2007; Stewart et al., 2000). For example, in a sample of fifth through eighth graders, higher levels of perceived parental criticism predicted lower self-esteem, but only among the girls (Felson and Zielinski, 1989). Similarly, maternal rejection is more negatively associated with self-esteem for Korean adolescent girls compared to boys (Park, Kim, and Park, 2016). More pointedly, perceiving parents to prefer one gender over the other also leads to declines in self-esteem, but only among girls (Siah, 2015). Beyond self-esteem per se, a lack of emotional closeness to parents predicts more depressive symptoms among early adolescents, but only for girls and not the boys (Lewis et al., 2015). In contrast to girls, whose self-esteem may be more influenced by parental closeness and warmth, some evidence suggests that boys’ self-esteem may be more influenced by perceptions of how controlling versus autonomy granting their parents are (Bush et al., 2004; Gecas and Schwalbe, 1986). Specifically, boys, but not girls, who were given more autonomy had more positive self-esteem than boys who felt more controlled by their parents, perhaps a reflection of greater societal value placed on boys’ independent agency relative to girls (Bush et al., 2004; Gecas and Schwalbe, 1986). The research on how parents differentially influence the body esteem of girls and boys has been more limited than that on global self-esteem. The quality of the relationship with their parents plays an important role in predicting girls,’ but not boys,’ satisfaction with their body. For example, young adolescent girls’ dieting behaviors and body esteem are predicted by their perceptions of their relationships with their parents (e.g., conflict and warmth), both longitudinally and concurrently (Archibald, Graber, and Brooks-Gunn, 1999). Other work finds that maternal control negatively predicts body esteem for girls, but is unrelated to the body esteem of boys (Sira and White, 2010). This disparity may be due to the different types of feedback girls receive about their bodies and the importance of their appearance. Specifically, girls report receiving more appearance-related feedback from their parents than do boys; this feedback, in turn, negatively predicts the body esteem of girls, whereas it is unrelated to the body esteem of boys (Schwartz, Phares, Tantleff-Dunn, and Thompson, 1999). Indeed, pressure from family and friends may drive the gender difference in body esteem. When appearance-based pressure from family and friends was accounted for, there was no difference in girls’ and boys’ body esteem (Ata, Ludden, and Lally, 2007). Other research that has focused more closely on boys’ body esteem indicates that boys are not immune from parental influences on their body esteem.When researchers include relationships with both mothers and fathers, parents who match the gender of the child may be more influential. Namely, among sixth and seventh grade students, mothers’ acceptance positively affects girls’ body and self-esteem, but not boys’; in contrast, fathers’ acceptance positively affects boys’ body and selfesteem, but not girls’ (Ohannessian, Lerner, Lerner, and von Eye, 1998). Thus, it may be the parent who is more physically similar to the child who is most influential in promoting the child’s positive attitudes about their physical appearance. Taken together, the research on self and body esteem suggests that positive parenting characteristics (e.g., warmth and monitoring) are equally positive for girls and boys. When differences do emerge, girls may be more sensitive to parental closeness and warmth, whereas boys may be more sensitive to how much autonomy they are granted by parents. Girls’ body esteem seems to be

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distinctly influenced by the parental relationship, although this relationship may be primarily due to girls’ greater feedback and pressure to focus on their appearance.

Language Children primarily learn language through exposure and observation of others (Chomsky, 1986; Kuhl, 2004). As parents are often the primary source of contact for infants and toddlers, they play an important role in children’s language acquisition and development. Indeed, children whose parents talk to them more often have more advanced language development (e.g., Huttenlocher, Haight, Bryk, Seltzer, and Lyons, 1991; Tomasello, Mannle, and Kruger, 1986). Because there are gender differences in language development from an early age, considerable research has focused on how parents might contribute to this difference. Research consistently finds that, on average, girls acquire language more quickly than boys (Bornstein, Hahn, and Haynes, 2004; Fenson et al., 1994; Hyde, 2005; Merz et al., 2015; Skeat et al., 2010; Zambrana,Ystrom, and Pons, 2012).They have larger vocabularies, learn to combine words faster, and score higher on measures of language comprehension. Boys are more likely to have speech impediments (Hammer, Farkas, and Maczuga, 2010; Whitehouse, 2010), and parents of boys are more likely to seek help/advice for their child’s language development or place them in speech therapy (Department of Health, 2004; Skeat, Eadie, Ukoumunne, and Reilly, 2010). There are also differences in the types of language used by girls and boys. On average, girls have been found to use more affiliative speech than boys, who in turn, tend to use more assertive speech (Cook, Fritz, McCornack, and Visperas, 1985; Leaper and Smith, 2004). Some suggest that girls’ earlier language acquisition indicates differential capacities for language between girls and boys (Huttenlocher et al., 1991). However, many of these studies note small effect sizes (Hyde, 2005), and Fenson and colleagues (1994) stated that the within-group differences of the two genders are often much larger than between-group differences. In examining the role of parents in fostering this gender difference in language development, researchers have investigated possible differences in the language use of mothers and fathers. Among European American, Western, middle-class samples, meta-analytic research has shown that mothers are more talkative than fathers with their children (Leaper, Anderson, and Sanders, 1998).Yet, similar differences were not found among a sample of low-income parents (Rowe, Coker, and Pan, 2004). Across both types of samples, however, fathers are more cognitively demanding in their conversations with children than mothers. Fathers asked more “wh-” questions and posed more requests for additional information and clarification than did mothers (Leaper et al., 1998; Rowe et al., 2004). These cognitively demanding conversational patterns can lead to greater conversational challenges for children when talking to their fathers compared to their mothers (Rowe et al., 2004). Other studies have looked not just at how much mothers and fathers talk to their children overall, but at how much they talk to sons versus daughters. The majority of studies, supported by a metaanalysis, suggest that parents are more talkative with daughters than sons (Brachfeld-Child, Simpson, and Izenson, 1988; Leaper et al., 1998; Vandermaas-Peeler, Sassine, Price, and Brilhart, 2012). For example, when reading with their children, fathers offer more explanations to daughters than to sons and give twice as much guidance (e.g., asking questions) to daughters than sons (Vandermaas-Peeler et al., 2012). Mothers use more verbal encouragement toward daughters than sons (Karrass, Braungart-Rieker, Mullins, and Lefever, 2002). In studies of parent-child interactions while reading books, mothers talk more with newborn daughters than sons, although this effect seems to diminish with age (Johnson, Caskey, Rand,Tucker, and Vohr, 2014; see also Gilkerson, Richards, and Topping; 2017) Parents have also been shown to use verbal direction more with girls than boys. In one study, while instructing their 8-month-old infants to put a cube into a cup, parents used more imperatives (e.g., instruction), negatives (e.g., preventing an action), and exhortations (e.g., “come on”) with daughters than sons (Brachfeld-Child et al., 1988). Furthermore, during discussions about past events, parents 268

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prompted girls (e.g., “What did you guys talk about?”) almost twice as often as boys (Ely, Gleason, and McCabe, 1996). Of course, not all studies find a verbal preference for girls over boys (see Huttenlocher et al., 1991), and it is likely that there are important moderating factors. The disparities suggest that the overall speech directed toward daughters and sons may not uniformly differ for all groups of children, but that differences may exist in specific contexts. It is clear, based on the extant literature, that parents speak more frequently to their children about stereotype-consistent topics than non-stereotype-consistent ones. Specifically, parents use more language with daughters in the context of discussing emotion and social situations, and use more language with sons in discussions of math and science. For example, when discussing emotion (perceived as more feminine than masculine, as described above), parents are much more voluble with their daughters than with their sons (Aznar and Tenenbaum, 2015; Fivush et al., 2000; Kuebli and Fivush, 1992; Kuebli et al., 1995). In addition, in a study in which mothers talked with their young children about their day at preschool, mother-daughter dyads spent more time talking about other people than did mother-son dyads (Flannagan, Baker-Ward, and Graham, 1995). In contrast, parents used more words related to numbers (Chang, Sandhofer, and Brown, 2011) and science concepts (Crowley, Callanan, Tenenbaum, and Allen, 2001; Tenenbaum, Snow, Roach, and Kurland, 2005) in conversations with sons compared to daughters, described in more detail below. Taken together, mothers tend to talk more than fathers to their children, and parents tend to talk to daughters more than sons. These differences, however, seem to vary by contexts and topics of conversation. Not surprisingly, parents talk more to their children about gender-stereotypical topics (e.g., girls and emotions, and boys and science), which partially explains why children develop greater vocabulary and understanding for those topics (e.g., Aznar and Tenenbaum, 2015).

Academic Concepts Considerable research has examined gender differences in math and science performance, ability, and choices. Although girls now earn higher grades in math and science courses through the end of high school than boys (Hill, Corbett, and St. Rose, 2010; NCES, 2013) and show similar scores on math standardized tests (Else-Quest et al., 2006; Hyde, Lindberg, Linn, Ellis, and Williams, 2008), girls are still underrepresented relative to boys in the higher levels of certain domains of STEM education. For example, in college, although 57% of all bachelor’s degrees recently went to women in the United States, only 43% of mathematics degrees, 20% of physics degrees, 16% of computer and information sciences degrees, and 18% of engineering degrees went to women (NCES, 2013). Although there do not appear to be gender differences in STEM capabilities, differences in STEM degrees and occupations are, in part, a reflection of children’s and adolescents’ beliefs about their STEM abilities. Research relying on both explicit and implicit measures have found that both girls and boys as young as 6 believe that boys like math more than girls (Cvencek, Meltzoff, and Greenwald, 2011). They also stereotype males as better than females in math (Muzzatti and Agnoli, 2007; Steffens, Jelenec, and Noack, 2010), physics (Kessels, 2005), and computer science (Mercier, Barron, and O’Connor, 2006).These gender stereotypes are reflected in children’s own self-concepts as well. Specifically, boys implicitly associate me and math more than girls do (Cvencek et al., 2011; Steffens et al., 2010). Importantly, the more girls endorse the implicit stereotype that boys are better at math (which they endorse by about age 9), the more their own academic self-concept shifts away from math and toward languages (Steffens et al., 2010; Steffens and Jelenec, 2011). Parents play a role in shaping children’s beliefs that STEM concepts are more appropriate for boys than girls and in fostering boys’ greater interest in STEM fields. Parents themselves hold stereotypes about girls’ and boys’ STEM abilities and interests. For example, parents perceive boys to be more logical, to like math and computers more, to be more independent in math, to need math more, and to have higher math achievement than girls (Andre, Whigham, Hendrickson, and Chambers, 1999). 269

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Parents also believe that science is less interesting and more difficult for daughters than sons, despite children’s own reports of their self-efficacy and interest in science showing no gender differences (Tenenbaum and Leaper, 2003). Beyond assumptions about interest and abilities, when children are successful in math, parents are more likely to attribute their sons’ success to ability, whereas they attribute their daughters’ success to extra effort (Yee and Eccles, 1988). These beliefs are important, because parents’ beliefs that girls are not as good as boys at math predict their actual behaviors toward their children. Parents’ stereotypical expectations and beliefs about math result in different levels of encouragement and support behaviors for boys versus girls (e.g., offering help with homework, buying additional supplies), and a greater likelihood of intrusively monitoring their daughters’ homework, providing daughters’ unsolicited help, and reminding their daughters more often than sons to do their math homework (Bhanot and Jovanovic, 2005). In turn, girls perceive these behaviors as reflective of their poor abilities in math, which serves to reinforce the stereotype (Bhanot and Jovanovic, 2005). Parental stereotypes and expectations can be even more important than actual academic experiences. Parents’ beliefs about their children’s abilities and interests affect their children’s self-perceptions; these self-perceptions, in turn, affect children’s actual performance (Gunderson, Ramirez, Levine, and Beilock, 2012; Jacobs, Vernon, and Eccles, 2005). Adults’ beliefs about children’s abilities and interests in science predict children’s science self-efficacy, persistence, and competency (Tenenbaum and Leaper, 2003). Parents’ expectations and encouragement about computer science are stronger predictors than children’s own computer-based activities in predicting children’s computer self-efficacy (Vekiri and Chronaki, 2008). Parents also impact their children’s academic lives through more explicitly differential treatment as well (Gunderson et al., 2012). Parents steer children’s occupational choices in stereotypical directions (Chhin, Bleeker, and Jacobs, 2008; Whiston and Keller, 2004). More proximally, parents of sons discuss math and science concepts more frequently and in more detail with their children than do parents of daughters. At a science museum, for example, parents were three times more likely to explain science exhibits to sons than daughters (Crowley et al., 2001); during a physics task, fathers of sons used more cognitively demanding and interesting talk (e.g., by asking for causal explanations and using conceptual descriptions) than did fathers of daughters (Tenenbaum and Leaper, 2003); and mothers talked more about scientific processes with sons than with daughters (Tenenbaum et al., 2005). In an analysis of parents’ naturalistic language use with their 2-year old children, mothers spoke about numbers twice as often to boys as to girls and were three times more likely to use cardinal numbers when talking to boys than girls (Chang et al., 2011). Even more overtly, some adolescent girls report hearing discouraging comments about their STEM abilities from their parents. Specifically, 15% of girls reported hearing negative comments from their fathers, and 12% reported hearing similar comments from their mothers (Leaper and Brown, 2008). These comments, in turn, predict girls’ more negative attitudes about their math and science abilities, over and above their actual grades (Brown and Leaper, 2010). Taken together, this differential treatment by parents provides sons with considerably more background knowledge, comfort, and support in math and science than daughters, impacting their selfefficacy and interest in these academic domains independent of their own academic experiences. In turn, the differences in self-efficacy and interest seem to be a key factor in predicting academic choices, and thus occupational trajectories, among girls and boys.

Play One of the most gender-differentiated behaviors in childhood is play style and toy choice (O’Brien and Huston, 1985), and parents are important contributors to this difference. Indeed, a meta-analysis assessing parents’ differential socialization of girls and boys found that the primary way that parents 270

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differ in how they treat their daughters and sons is through the encouragement of sex-typed play and activities (Lytton and Romney, 1991). Parents promote children’s gender-typed toy play by providing greater access to gender-typed toys than cross-typed toys and by positively reinforcing play with gender-typed toys and punishing play with cross-typed toys. Parents endorse gender stereotypes about the appropriateness of gender-specific toys for girls and boys. For instance, parents believe that toys such as dolls, make-up, and tea sets are feminine toys and thus are more appropriate for girls than boys, and toys such as trucks and tools are masculine and thus more appropriate for boys than girls (Campenni, 1999; Fisher-Thompson, 1990; Wood, Desmarais and Gugula, 2002). Even before the child is born, parents believe that their child will like genderspecific toys. This means that parents hold stereotypical beliefs about toy play before their children actually express any gender-typed interests (Peretti and Sydney, 1984). Furthermore, children are aware of their parents’ gender stereotypes about the appropriateness of gender-specific toys for girls and boys, reporting that gender-typed play would be seen as “good” or “doesn’t matter” by both their parents, but that cross-typed play would be seen as “bad” by their fathers (Raag and Rackliff, 1998). Because parents hold stereotypical beliefs about gender-specific toys, and parents control children’s early environments and access to toys, it is not surprising that children have greater access to gender-specific toys. For example, children’s rooms are predominantly furnished with gender-typed toys and objects (O’Brien and Huston, 1985; Pomerleau et al., 1990; Rheingold and Cook, 1975). Children are also more likely to receive gender-typed toys as gifts from their parents than cross-typed toys, regardless of what types of toys they requested (Etaugh and Liss, 1992). Because parents control access to toys, they can socialize children to prefer gender-typed toys by simply granting greater access to those types of toys than more cross-typed toys. There is asymmetry, however, in parents’ stereotypic beliefs about toy play and their providing their children greater access to gender-typed toys. Specifically, parents typically believe that it is appropriate for girls and boys to play with masculine toys (such as trucks), but only girls can play with feminine toys (such as dolls; Campenni, 1999; Wood et al., 2002). In addition, when buying toys for children, adults are more likely to buy a gender-typed toy than a cross-typed toy, and they are even more likely to do so for a boy than for a girl (Fisher-Thompson, 1993). Relatedly, boys are less likely than girls to receive cross-typed toys as gifts, even when boys request them (Robinson and Morris, 1986). This asymmetry parallels the belief that masculine traits are desirable for both girls and boys, but feminine traits are only desirable for girls. Thus, both girls and boys have limited access to crosstyped toys, but boys are especially unlikely to have access to these toys. Not only are boys more restricted in their access to gender-typed toys than girls, but fathers are more likely than mothers to be the primary enforcer of gender-typed play. In general, fathers hold more rigid gender role beliefs and enforce more sex-typed behaviors than mothers (Bradley and Gobbart, 1989; Langlois and Downs, 1980; Leaper and Friedman, 2007). Although both mothers and fathers encourage sex-typed play among their children, meta-analyses indicate that the effects are stronger for fathers (Leaper and Friedman, 2007; Lytton and Romney, 1991). For example, fathers are more likely than mothers to present their children with gender-typed toys than neutral or cross-typed toys during an observed play session (Bradley and Gobbart, 1989). Fathers are especially important in socializing their children’s gendered play behaviors, because the time they spend with their children is predominately spent in play, compared to mothers’ primary focus on caregiving activities (Lamb, 1997). Perhaps not surprisingly given this previous research, children from households without a father present are less gender-typed in their toy choices than children from households with both a father and mother (Brenes, Eisenberg, and Helmstadter, 1985; Hupp, Smith, Coleman, and Brunell, 2010). Additionally, fathers spend more time playing with their children than do mothers, and they also spend more time in physical play than do mothers (Crawley and Sherrod, 1984). Specifically, fathers, more so than mothers, frequently engage in rough-and-tumble play with their children (Crawley 271

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and Sherrod, 1984). Furthermore, both girls and boys enjoy rough-and-tumble play, but fathers are more likely to engage in rough-and-tumble play with their sons rather than their daughters (Jacklin, DiPietro, and Maccoby, 1984). Boys are then more likely to engage in rough-and-tumble play with their peers (DiPietro, 1981).Thus, fathers play an important role in the socialization of children’s play. In addition to providing differential access to gender-typed toys, parents also positively reinforce children when they play with gender-typed toys and punish children when they play with cross-typed toys. Langlois and Downs (1980) reported that mothers and fathers reward children for playing with gender-typed toys and punish children for playing with cross-typed toys. However, the reinforcement of gender-typed toy play is more likely to be subtle than overt. Researchers who brought parent– toddler pairs into the laboratory asked the parents to open a series of boxes and play with whatever toys were in them (Caldera, Huston, and O’Brien, 1989). Some boxes contained masculine toys (e.g., trucks and wooden blocks), and some boxes contained feminine toys (e.g., dolls and a kitchen set). Parents, especially fathers, were noticeably more excited when they opened a box containing a toy that was consistent with their child’s gender than when it was cross-gendered. One father of a daughter, upon opening a box with a truck in it, said, “Oh, they must have boys in this study.” He promptly closed the truck box and went back to playing with the dolls from the previous box. He never gave his daughter a chance to play with the truck. Eight parents were excluded from the analyses because they did not play with the cross-typed toys long enough to be analyzed. Again, fathers seem to encourage gender-typed toy play more than mothers (Langlois and Downs, 1980; Leaper, 2000). Parents socialize children to play with gender-typed toys by providing greater access to those toys, by reinforcing gender-typed toy choices and play (and punishing cross-typed play), and by modeling gender-typed play behaviors. Although prior research has primarily focused on heterosexual, European American, Western parents, new research examines how more diverse families socialize children’s gender-typed toy play. For example, research with children from different ethnic groups (e.g., Mexican, African American, and Dominican) has shown that ethnically diverse children and parents show more similarities than differences in their levels of gender-typed play (Halim, Ruble, Tamis-LeMonda, and Shrout, 2013; Leavell, Tamis-LeMonda, Ruble, Zosuls, and Cabrera, 2012). There appear to be differences, however, among families of differing sexual orientation. Specifically, Goldberg, Kashy, and Smith (2012) found that children of gay or lesbian parents were less likely to engage in gender-typed toy play than children of heterosexual parents. Future research is needed to examine whether this lower level of gender-typed toy play is due to differences in the gender stereotypes of parents, differences in the degree to which parents differentially reinforce gender-typed play, or differences in the available models of gender-stereotypical behavior.

Household Expectations Finally, parents are directly socializing their daughters and sons differently by having different household expectations for them based on gender. Despite the entrance of women into the workforce in higher numbers than ever before, one of the biggest gender differences in adulthood is the division of household labor. Despite equal hours in outside employment, mothers spend approximately twice the amount of time on childcare and housework as do fathers (Parker and Livingston, 2016). This gender difference in adulthood parallels developmental research that examines the division of household chores assigned to girls and boys. Across a range of socio-politically and culturally diverse high-income countries (e.g., Israel, Spain, Germany, United Kingdom) and low- and middleincome countries (e.g., Bangladesh, Vietnam, Serbia), girls are consistently more likely than boys to work inside the home doing household chores, childcare, and elder care (Bruckauf and Rees, 2017; Bonke, 2010; Evans, 2010; Putnick and Bornstein, 2016; Webbink, Smits, and De Jong, 2012). Girls are also substantially more likely to do excessive household chores (defined as more than 28 hours in a week) than boys (Allais, 2009; Putnick and Bornstein, 2016). 272

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The gender of the child often supersedes any differences in parental household expectations that might be due to birth order or age. Namely, older siblings tend to do more housework than younger siblings (Tucker, McHale, and Crouter, 2003); the sole exception is in older brother-younger sister dyads, in which the sister still does more housework than her brother (McHale and Crouter, 2003). Other research, using a sample of African American adolescent sibling dyads with single mothers, found that girls were given more chores than boys, regardless of their age (Mandara,Varner, and Richman, 2010). When researchers examine the specific types of household expectations, however, findings suggest that parents are actually differentiating in the types of chores assigned to daughters and sons.That differentiation aligns with their perceptions of the gendered norms of children’s chores. Overall, studies show that adults perceive domestic chores as the most feminine, followed by self-care (e.g., cleaning their room); helping with siblings is perceived as gender neutral; technical (e.g., home repair) and outside chores are perceived as masculine (Kulik, 2006). This division is consistent with the chores that kindergarten, third grade, sixth grade, and eighth-grade children indicate being assigned at home (Etaugh and Liss, 1992). Girls report being given more chores overall than boys and are more likely to be given kitchen-related chores or babysit; boys are more likely to either take out the trash or have no chores at all (Etaugh and Liss, 1992). Similar patterns occur in international samples. For example, in the international sample of low- and middle-income countries, although there is considerable variability across countries, on average, girls are more likely than boys to do household chores, whereas boys are more likely to engage in family farm or business work (Putnick and Bornstein, 2016). The division of household labor seems to be stronger in families that may have culturally more traditional gender roles. For example, in more Mexican-oriented families, girls in girl-boy sibling dyads are assigned more household tasks and given fewer privileges (e.g., going to friend’s house, staying out late) than boys; this pattern is not apparent in more Anglo-oriented families (McHale, Updegraff, Shanahan, Crouter, and Killoren, 2005). This pattern is supported by Latina early adolescent girls’ qualitative reports of gender bias, where they frequently note that their parents assign them more household chores and place greater restrictions on them than their brothers (Brown, Alabi, Hyunh, and Masten, 2011). For example, one eighth-grade Latina girl noted, “Like when me and my brother want to go next door. My mom said yes to my brother and to me she said come back at 8:00.” European American and African American girls do not report similar types of gender bias from parents (Brown et al., 2011). Ultimately, it may be parents’ own gendered division of household work that is most influential for children’s later gender attitudes and behaviors. In a 31-year longitudinal study, results indicated that individuals whose mothers held more egalitarian gender attitudes when they were young children held more egalitarian attitudes, particularly about the ideal division of household labor, at age 18 (Cunningham, 2001a). When those children were in their 30s, boys whose fathers participated in more “feminine” household tasks did the same as adults, and girls whose mothers worked more outside the home participated in fewer “feminine” household tasks as adults (Cunningham, 2001b). In other words, it was parents who engaged in more counter-stereotypical behaviors within the family that reared adult children who engaged in more counter-stereotypical behaviors as adults. However, considering the widespread gendered division of labor, which is further reinforced by workplace leave policies that make it easier for mothers to engage in more early childcare than fathers (Heymann et al., 2013), it is logistically difficult to not replicate stereotypical patterns of behavior.

Parenting LGBTQ and Gender Diverse Children Parents implicitly and explicitly treat their sons and daughters differently on average.There is considerable diversity, however, within gender groups that also influences how parents interact with their children. Even cisgender, heterosexual children and adolescents differ in the degree to which they conform to gender norms. 273

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By age 11, children across ethnic groups report feeling pressure from their parents to conform to gender stereotypes (Corby, Hodges, and Perry, 2007; Egan and Perry, 2001). In addition, the degree of children’s gender nonconformity is related to their risk of parental verbal, psychological, and physical abuse (Grossman, D’Augelli, Howell, and Hubbard, 2005). However, an increasing number of parents in many Western, industrialized societies are accepting of transgender and other gender-nonconforming children (Becker and Todd, 2015).When parents are more accepting of their gender-nonconforming or transgender children, their children report more positive psychological outcomes and less distress about their gender identity (Simons, Schrager, Clark, Belzer, and Olson, 2013; Toomey, Ryan, Diaz, Card, and Russell, 2010). Although parents’ differential treatment of their sons versus daughters can shape their children’s interests and abilities (as described above), this treatment is not, by in large, negative in valence. For example, the most negative behavior within the gender development literature is fathers punishing their sons for playing with cross-typed, or feminine, toys. Many argue that this punishing behavior is motivated by parents wanting to ensure their children, especially their sons, are not gay (D’Augelli et al., 2005). This negative attitude, and the anticipated negative reactions, may be the reason that most LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer) individuals first disclose their sexual orientation to their friends and peers before their parents (D’Augelli and Hershberger, 1993; Savin-Williams and Ream, 2003). This concern about negative parental reactions is not unwarranted. More than half of adolescents perceive their parents to initially react with some degree of negativity when they disclose their sexual orientation to them (D’Augelli and Hershberger, 1993). One-quarter of adolescents report that their parents were extremely rejecting of them (D’Augelli et al., 2008; Savin-Williams, 2001). In addition to verbal threats, some parents perpetrate physical violence against their children, most frequently their sons. Fortunately, many adolescents perceived their parents to be less rejecting over time. There are, however, differences in gradual acceptance between mothers and fathers. In a sample of Israeli adolescents, approximately 10% perceived their parents to be moderately rejecting when they disclosed their sexual orientation, whereas 15% perceived their parents to be fully or almost fully rejecting at the time of disclosure (Samarova, Shilo, and Diamond, 2014). Of the parents who were perceived as moderately rejecting at the time of disclosure, 64% of mothers were perceived by their adolescents to be more accepting over time. In contrast, only 16% of fathers were perceived to be more accepting over time. Of the parents who were perceived to be more harshly rejecting, a slight majority of parents (55% of mothers and 61% of fathers) were perceived by the adolescents to remain rejecting. For LGBTQ youth, the negative treatment from parents can be extreme and lead to serious, life-threatening consequences (D’Augelli et al., 2005). Specifically, LGB youth whose parents discouraged gender-atypical behaviors and labeled them as lesbian or gay while growing up were more likely to attempt suicide than LGB youth with more accepting parents. This negative treatment can include being called “sissy” or “tomboy” by their families. As D’Augelli and colleagues (2005) poignantly stated, “Because parents are of the utmost importance to youth during adolescence, years of disappointing parents as a result of gender atypicality or identification as LGB can cause strong emotional responses . . . With parental approval uncertain, LGB youth may feel increasingly isolated . . . with no place to turn” (p. 658). Taken together, the research on children across a range of SOGI status highlights the important role of parents in development. Although parents often react negatively toward their gender nonconforming or LGBTQ children, their acceptance of their children’s gender expression, gender identity, and sexual orientation is critical for their psychological, emotional, and physical well-being.

Helping Children Cope With Gender Bias The majority of this chapter describes ways in which parents contribute to gender differences. Parents can also provide support in the face of gender bias by others. Specifically, parents can help 274

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children cope with gender discrimination. Some evidence suggests that having a feminist identity, defined as the belief in equality for men and women, helps girls (and women) cope more actively with gender discrimination at school and from peers (Ayres, Friedman, and Leaper, 2009; Leaper and Arias, 2011) and cope more actively with sexual harassment (Leaper, Brown, and Ayres, 2013). These active coping styles, also called approach strategies, can include confronting perpetrators of sexism or seeking out others for advice and emotional support after experiencing discrimination, and are often associated with being the most effective at stress reduction (Cortina and Wasti, 2005). Parents are important in fostering such a feminist identity. Adolescent girls are more likely to have a feminist identity if their parents (typically their mothers) self-identify as feminists and teach them about feminism. In this way, mothers can help their daughters actively cope with gender discrimination by helping foster an identity that incorporates a belief in the equality of men and women. Parents can also help protect their children from the negative effects of discrimination by being emotionally supportive of their children who are in the midst of experiencing discrimination (Smith-Bynum, Anderson, Davis, Franco, and English, 2016). In general, it appears that children who have emotionally supportive and positive relationships with their parents are better equipped to cope with discrimination. For example, feeling supported by parents (particularly mothers) seems to strengthen girls’ confidence to use active or approach coping strategies when sexism occurs (Leaper et al., 2013). Relatedly, more accepting parental attitudes toward LGBTQ status seems to moderate the negative effects of sexual minority stress (Feinstein, Wadsworth, Davila, and Goldfried, 2014). In contrast, having conflict with parents (i.e., feeling a lack of emotional support) exacerbates the link between discrimination and poor mental health among LGBTQ adolescents (Freitas, D’Augelli, Coimbra, and Fontaine, 2016).

Directions for Future Research in Parenting Girls and Boys Research on parenting influences on the differential outcomes of girls and boys has been fruitful and robust. Despite all of the previous work on parenting girls and boys, there are still important areas that need to be further explored and refined. First, there needs to be an improvement in how we identify the gender of research participants. All developmental researchers should include a better assessment of the SOGI status of the children and adolescents.Temkin and colleagues (2017) provide recommendations. We urge all researchers to follow those recommendations, even those researchers not studying gender identity or sexual orientation: to include the basic questions of “What gender were you at birth, even if you are not that gender today? That is, what is the gender on your birth certificate?” and “What is your current gender identity, even if it is different than the gender you were born as?” This question allows researchers to better understand the gender composition of their samples. For example, most of the research described in this chapter simply asked girls and boys in the study to report their gender: girl or boy. The results were then interpreted based on the presumption that those participants were cisgender, and thus their genetic and hormonal make-up is consistent with their identification. This is not necessarily the case, however, and leads to flawed data and analysis. Particularly because gender developmental researchers try to disentangle the influence of biological predispositions from socialization in predicting girls’ and boys’ outcomes, it is critical to better measure who those girls and boys actually are. Methodologically, more longitudinal studies should be conducted on parental influences on girls’ and boys’ differential outcomes. Although this is a common critique of developmental research, it is particularly important in this context. Currently, there is surprisingly little longitudinal research, with Cunningham (2001a, 2001b) a notable exception. Most of the extant literature documents that (1) there is an existing gender difference on a particular psychological or academic construct, (2) parents differ in their treatment of daughters and sons on a related construct (which is typically inferred from a mean difference in parenting behavior or attitudes based on the gender of the child), or (3) a 275

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particular parent attitude about gender or behavior is associated concurrently with a child outcome. The inference is then made that the observed gender difference is due to the differential treatment by parents. For example, (1) there is a reliable gender difference in math self-efficacy, (2) parents of sons rate their child’s competence in math higher than parents of daughters, and (3) parents’ expectations of their children’s math abilities predict their children’s efficacy in math, controlling for grades in math. The inference is that gender differences in math efficacy are, at least in part, explained by parents’ differing beliefs about their child’s math abilities. This inference actually involves several logical leaps. Because children are active in the construction of their gender schemas and development, and seek out and attend to information consistent with their gender group (Martin and Ruble, 2010), it is particularly difficult to pinpoint parent-driven effects versus child-driven effects. Obviously, as with most constructs, parents and children bidirectionally influence one another, and the starting point of this trajectory can be difficult to ascertain without longitudinal research. This is particularly important in the context of gender because of the biological underpinnings of gender, the changes that occur because of puberty, and the complexity and diversity within gender groups—all of which can change the influence of parents on girls and boys. To use the previous example, it may be that boys are more responsive than girls to parental expectations in math because of a biological sensitivity to math cues that comes online with the sexual differentiation of puberty; perhaps parental expectations are only predictive of math efficacy for a small development window, and that influence is not predictive of later math behaviors or efficacy beliefs; or perhaps parental expectations are shaped by family dynamics not captured in tightly constrained studies.Without longitudinal research beginning early in development, these questions are difficult to examine. Future research should also explore the role of implicit gender attitudes in shaping children’s development. According to a meta-analysis, parents’ explicit gender role attitudes are only related to children’s outcomes with a small effect size (Tenenbaum and Leaper, 2002). However, this small association is likely a result of parents’ behaviors being shaped by implicit attitudes more so than explicitly stated beliefs (most parents want to appear egalitarian). Research on gender development should learn from research on ethnicity (another important social category). For example, that research shows that parents’ implicit ethnic attitudes shape their nonverbal and subtle behaviors, and children detect those subtle parental behaviors and change their own attitudes accordingly (Castelli, Zogmaister, and Tomelleri, 2009). It may be that gender attitudes operate similarly, and are an area ripe for future research. Future research should also take a family dynamics approach more often, including a clearer focus on interactions with both parents, and between siblings and other family members. McHale and Crouter (McHale et al., 2003) have long argued for this approach, but the field has yet to fully follow. Likely, this is because of the complexity and diversity of fully articulated family models. Specifically, future research should make more within-family comparisons, as gender-differential treatment likely becomes amplified for a particular child when there is a different-gender child in the same household (McHale et al., 2003). This gender-differential treatment can have important implications for development. To use the same example, a girl who sees her own parents show more confidence in her brothers’ math abilities may be more impacted by the STEM gender stereotype relative to a girl who only sees her parents’ attitudes toward daughters. Furthermore, this impact may differ across developmental periods (hence the need for longitudinal research).

Conclusions Although there is considerable variation across cultures, ethnic groups, socioeconomic groups, and family structures, parents seem to provide different opportunities for girls and boys in accordance with culturally held stereotypes. This includes providing stereotypically different language opportunities and environments.Thus, in addition to simply getting more verbal input, girls learn more about emotions, particularly sadness, and social interactions from their parents; boys, in contrast, learn more 276

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about anger and aggression, as well as math and science. Parents also provide gender-differentiated training for adulthood. By rewarding doll play and nurturing role play in early childhood, and by being assigned more household chores, girls are provided training in domestic tasks and childcare. Boys are punished for feminine toy play and given fewer opportunities to learn domestic tasks. This training telegraphs the gendered division of household and parenting labor in adulthood, in which women are engaged in substantially more childcare and domestic tasks than men. Parents also implicitly shape the values and attitudes of their children in stereotypical ways. They provide more feedback to their daughters about their appearance than their sons, and girls come to focus more on their appearance as their body esteem declines. At the same time, parents are more confident of sons’ math and science abilities than daughters,’ and thus, regardless of grades, boys show greater interest and confidence and less anxiety in math and science than girls do. Ultimately, we must be mindful of how gender impacts children and parents in universal ways, in culturally specific ways, and in idiosyncratic ways. Hopefully, research examining how parents contribute to gender disparities will continue to evolve and inform—as our methodologies become more sophisticated, as our understanding of gender diversity is enriched, and as the social construction of gender changes with greater political, occupational, and financial equity for women.

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9 PARENTING AND TEMPERAMENT John E. Bates, Maureen E. McQuillan, and Caroline P. Hoyniak

Introduction Social competencies, such as smiling at the right time, understanding what “no” means, or clearly expressing one’s needs, develop over time. How this happens is of great importance from multiple perspectives. Qualities of development are crucial in human society, both for individuals and for individuals’ social groups. Social development research asks how social competencies grow by considering processes and outcomes of biological, psychological, and social systems. It considers these processes and outcomes in terms of both normative development and individual differences. The present chapter considers two key types of processes in social development, parenting and temperament processes, and how they contribute to individuals’ behavioral, emotional, and cognitiveacademic adjustment outcomes. Parenting and temperament are often seen as independent contributors to social development, but the literature also suggests ways in which these constructs are linked across time. The linkage may involve whether and how parenting predicts changes in child temperament, as well as whether and how child temperament influences changes in parenting. Despite wellrecognized stability in temperament and parenting traits, evidence suggests that there is some change in both. For example, as evidence that parenting can change in response to the social environment, changes in maternal responsiveness have been linked to children’s maturation and to challenges and opportunities in other facets of the mothers’ lives (Bornstein, Tamis-LeMonda, Hahn, and Haynes, 2008; Hart and Risley, 1992; Isabella, 1993; Landry, Smith, Swank, Assel, and Vellet, 2001; Smith, Landry, and Swank, 2000). Parenting is often considered to be the most important subsystem of the broader social developmental system (Bronfenbrenner, 1979; Bugental and Grusec, 2006). Qualities of parenting are regarded as central elements of children’s processes and outcomes in developing skills and attitudes for participating in social relationships, networks, and cultures. This chapter views parenting in relation to a complementary subsystem, child temperament—a set of biologically based individual differences that are also important for socialization outcomes.We discuss research on how parenting and temperament, separately and interactively, predict development. We examine how a parent’s customary responses to a child can forecast child social development, including possible changes in temperament. We also consider how children’s characteristics might influence and interact with parenting to forecast child social development. Our interest in the topic stems from our clinical experiences with families working on child behavior problems and, in a transactional process, from the field’s and our own empirical studies of development.

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Historical, Theoretical, and Method Considerations in the Study of Temperament and Parenting Toward a Developmental Systems Theory The conceptual context for this chapter is developmental systems theory (Lerner, 2006; Bates, Schermerhorn, and Petersen, 2014). Child adjustment outcomes, and the many biological and social factors involved in those outcomes, are all elements of a developing system. As with any attempt to describe life, a developmental systems view of social development considers the orderly and chaotic transactions between elements of the system. The challenge is to discover manageable, empirically supported models that increasingly encompass the organic and probabilistic transactions among elements of the child’s social development system.The area of social development has far to go, but seen in its own developmental context has shown remarkable growth in the quality of measurement and study design, the adequacy of definitions of elements, and the complexity of models of transactions among elements of social developmental systems. In historical terms, the science of social development has evolved at a brisk pace. Although seminal research on the effects of parenting began in the 1920s, research on parenting hit its empirical stride only in the 1950s (Maccoby, 2000). In a further step toward encompassing a broader developmental system, transactional processes between children and parents had been recognized conceptually from early in the history of research on parenting (Cairns and Cairns, 2006). However, it was only circa the 1970s, prodded by Bell (1968), that the area started empirically concentrating on the possibility that children could affect the behavior of those who were supposedly socializing them. By the most recent decades, systems models consider not only parenting dimensions and child temperament dimensions, but also interactions between parenting and temperament dimensions. These models have been informed by increasingly rich measures of biological, psychological, and social factors in development. In later sections, this chapter considers research on parenting and child temperament factors in social development, but first it describes some key foundational concepts in parenting and temperament.

Parenting Much research in social development has focused on the question of how parenting qualities influence social development outcomes. An important product of the first several decades of social development research is that measurable dimensions of parenting emerged, with conceptual similarities across research projects and sets of measures. Parenting is operationalized with a variety of kinds of measures, including self-report and observational methods, and scales for many particular qualities of parenting. It was discovered that multiple indexes of parenting could be summarized with just a few dimensions. As summarized by Maccoby and Martin (1983) and many other reviewers, most studies find a warmth dimension that includes levels of affection, sensitivity, and responsivity, and some find that affection and responsivity are distinguishable. Studies also find a second, fairly independent dimension pertaining to parents’ effective control of the child.The dimension of effective versus ineffective parental control may represent two at least partially independent dimensions, with level of harsh control as one dimension and positive management as the other. A parent could avoid harsh control methods (i.e., seldom yelling or spanking), but lack the resources for strategically managing a child’s misbehavior with non-harsh control tactics or for establishing a warm, mutually enjoyable relationship to encourage socialization (Hoffman, 1977; Kochanska, 1997b). Such parenting profiles are common in families with young children with oppositional behavior problems—a parent avoids harsh discipline, but fails to use enough positive guidance and mild, effective discipline. The specifics of the warmth and control factors vary somewhat from study to study, depending on measurement techniques, including the particular questionnaires and observational systems used, child age, and study design. Sometimes control or warmth

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are represented with the two aforementioned sub-constructs, but overall the literature suggests that, despite these differences, the various dimensions of warmth and control converge with other measures of the family system in expectable ways (Grusec, 2011). Effective limit setting and authoritative control (Baumrind, 1966), positive and involved parenting (Goodnight, Bates, Pettit, and Dodge, 2008; Pettit, Bates, and Dodge, 1997), and scaffolding are all associated with positive development and fewer behavior problems. Authoritarian, harsh, hostile, intrusive, and inconsistent parenting are associated with less positive development and more behavior problems (Dodge, Coie, and Lynam, 2006). Articles on parenting have historically emphasized the malleability of children, while often minimizing or ignoring child effects on parenting. As consensus about parenting dimensions emerged, however, the social development field began to theoretically transcend simple parent effects models. All the classically dominant theoretical frameworks (psychodynamic, cognitive, and behavioral) had recognized that child characteristics could influence parents (Cairns and Cairns, 2006), even if most research articles’ interpretations of findings were in terms of parent effects. However, with growth in knowledge about genetic and other biological bases for individuality, and following Bell’s (1968) systems theory reinterpretation of evidence that had been generally interpreted only in terms of parenting effects, it became insufficient to assume that observed correlations between parenting and child outcomes were simply due to parenting effects on child development. In parallel with the emerging clarity of measurement of parenting, larger, more definitive studies were being conducted. As the findings from these more sophisticated parenting studies were published, the social development field started to recognize that, even if the likelihood of bidirectional effects in the parent–child relationship were set aside, the correlations between parenting measures and child social development outcomes were far from explaining truly practical amounts of variance. In this context, coinciding with increased awareness of natural systems in science in general (Gleick, 1989; Plomin, 1982; Thelen, 1989), researchers showed a readiness to add constructs from a different realm—child innate, biological differences. Temperament concepts and measures became widely used to represent the biological and child effects parts of the developmental system.

Temperament A set of constructs known collectively as temperament became a major complement to the parenting environment in social development research. Temperament constructs were regarded as representing biologically based, early-appearing, and relatively stable individual differences (Bates, 1989).The concept of temperament has been invoked since ancient times, but during much of the twentieth century, temperament constructs were seldom used.The field’s scientific attention was largely directed to understanding the social-environmental causes of individual differences in children, which may have been partly due to societal reaction against the wave of biological determinism of the early twentieth century, with its excesses of eugenics and racism. Starting in the late 1960s and 1970s, however, a breakout in research on temperament began (Rothbart and Bates, 1998). The U.S. psychiatrists Thomas and Chess deserve credit for inspiring these new efforts by publishing their longitudinal descriptions of early child characteristics that could influence transactions in the family system (Thomas, 1968; Thomas, Chess, Birch, Hertzig, and Korn, 1963). Perhaps indicating how far out of use the concept of temperament had become, at the beginning of their work,Thomas and Chess did not use the term temperament. Their early descriptions spoke of “primary reaction patterns,” which they identified inductively in their longitudinal study (Thomas et al., 1960). Relatively soon, measures of temperament came to be routinely included in studies of social development (Rothbart and Bates, 1998, 2006). Research exploring temperament concepts as factors in social development was a trickle in the 1960s and became a torrent by the mid-1980s (Bates, 1989). A great many possible traits could be measured under the rubric of temperament, and quite a few constructs have been measured with some validity. The constructs have been measured via caregiver 290

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reports (Bates, Freeland, and Lounsbury, 1979; Buss and Plomin, 1975; Carey and McDevitt, 1978), structured tasks in the home and the laboratory (Bornstein, Gaughran, and Segui, 1991; Goldsmith, Reilly, Lemery, Longley, and Prescott, 1995; Goldsmith and Rothbart, 1999; Kagan and Snidman, 1991), and, less systematically, psychophysiological indexes (Fox, Henderson, Perez-Edgar, and White, 2008; White, Lamm, Helfinstein, and Fox, 2012; Whittle, Allen, Lubman, and Yucel, 2006). Nevertheless, like the discovery of dimensions in parenting, a rough consensus has emerged on dimensional frameworks for temperament (Bornstein et al., 2015; Rothbart and Bates, 2006), especially for temperament measured by caregiver reports. Based on factor analytic work, conceptual mapping, and observed correlations between measures, sets of three to five dimensions of temperament have achieved empirical support, like the three to five dimensions often found in more general personality (Halverson, Kohnstamm, and Martin, 2014; Rothbart and Bates, 2006). Among the top three temperament dimensions, there are individual differences in two major aspects of reactivity to situations, positive emotionality and negative emotionality, and there are individual differences in self-regulatory capacities. Positive emotionality encompasses scales including interest, appetite, joy, and assertion. Negative emotionality encompasses scales including discomfort, distress, fear, and, at least early in development, anger (which is certainly negative, but later becomes more associated with frustrated approach, as children become more mobile). Positive and negative emotionality can be seen as somewhat unrelated, such that one child could be both high on positive emotionality and high on negative emotionality, whereas another could be high on one but not the other. Negative emotionality can be further divided into important subdimensions. Angry temperament, shown most clearly in relation to frustration, is often associated with high levels of positive reactivity, whereas fearful temperament is more independent of positive reactivity (Rothbart and Bates, 2006). Self-regulation, especially the construct of effortful control, is the crucial third dimension in temperament. It encompasses individual differences in the set of predispositions or abilities that allow a child to self-regulate by inhibiting dominant responses and performing subdominant responses (Rothbart and Bates, 2006). Of course, it is recognized that self-regulatory dispositions, as they are measured, not only contain innate characteristics, but are also actively shaped by the environment (e.g., socialization) and unfolding physical maturation (e.g., frontal lobe growth and connectivity; Diamond, 2002).This complexity in temperamental self-regulation adds special difficulty to interpretations of findings, even beyond the usual ambiguities of conceptual and operational definitions. Despite conceptual and operational measurement challenges, temperament constructs, including temperamental self-regulation, have plausible groundings in observable behavior and biological processes, including genes, neurotransmitter differences, and neural activity in relevant brain structures (Fox, Henderson, Rubin, Calkins, and Schmidt, 2001; Kagan, Reznick, and Snidman, 1987; Lesch, Bengel, and Heils, 1996; Pezawas et al., 2005).

Parenting and Temperament in Combination and Interaction The parenting and temperament measures developed in the 1970s and 1980s have become relatively standard tools. The field has been using these measures to address questions more complex than the original ones of whether parenting or temperament affects children’s social development, instead considering questions of how parenting and temperament might influence each other over time and how they may moderate one another’s effects on development. Research of the past 15–20 years has expanded the empirical description of systems in social development in striking ways. As a foundation for the current review, we highlight, briefly, a few relevant patterns of findings (see Bates and Pettit, 2015) to serve as a foundation for the main sections of the chapter. 1. Parenting and temperament as independent predictors. It might be expected that, in studies that measure both parenting and temperament as predictors of child social development, both kinds 291

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of measures would uniquely predict outcomes. However, a clear pattern of additivity did not always emerge in multiple regression analyses (Bates and Bayles, 1988; Bates, Maslin, and Frankel, 1985). In a previous review, Bates and Pettit (2015) concluded, based on studies published from 2005 to 2013 examining how temperament and parenting supplement one another in predicting child outcomes, that only about half of the studies showed supplemental prediction. In many studies, one of the constructs predicted adjustment outcomes, but not both. Several measurement explanations could shed light on these findings. Parenting and temperament measures show correlations with one another, in both cross-sectional studies (reviewed in Bates and Pettit, 2015; Bates, Schermerhorn, and Petersen, 2012) and longitudinal studies (Kochanska and Kim, 2013; Pitzer et al., 2011). These correlations are modest, but even small-to-moderate levels of collinearity can affect the accuracy of models, sometimes leading to exclusion of significant predictors (Graham, 2003), so the correlations between parenting and temperament might explain some instances in which additive effects are not found. In addition, both parenting and child temperament traits could have genetically based personality roots (Collins, Maccoby, Steinberg, Hetherington, and Bornstein, 2000; Moffitt et al., 2007), and it is quite possible that they are shared by inheritance. However, genetically informed designs have shown that the effects of the parenting environment on child development cannot be fully explained by shared genes (Ganiban, Ulbricht, Saudino, Reiss, and Neiderhiser, 2011; Leve, Winebarger, Fagot, Reid, and Goldsmith, 1998), and as discussed next, cross-time, lagged associations are interesting even if genetic effects ultimately cannot be ruled out. 2. Parenting change as an outcome of temperament. Bates and Pettit (2015) described several studies suggesting that child temperament predicts change in parenting. The temperamental dimension of child negative emotionality predicts, in cross-lag models, changes in parenting, with at least one study showing each of the following patterns: child fearfulness predicting increases in mother warmth and decreases in inconsistent control, encouragement of child autonomy, and directiveness; and child anger/frustration predicting increases in authoritarian parenting over time. However, these patterns of prediction were not strong enough for broad conclusions. Bates and Pettit (2015) found too few studies showing children’s positive emotionality predicting parenting changes to draw even a tentative conclusion. For child temperamental self-regulation, several studies showed that self-regulation predicted increased parental supportiveness and decreased restrictiveness, but the pattern was not replicated in all studies. 3. Child temperament change associated with parenting. Warm, sensitive parenting predicts decreases in child negative emotionality, while harsh parental control predicts increases in negative emotionality (Bates and Pettit, 2015). Similar parenting dimensions also predict changes in child fearfulness in two, quite different ways: challenging (e.g., directive and not-too-nice) parenting in early childhood predicts decreases in fearfulness, and insensitive parenting predicts increases in fearfulness, but there have also been a few non-confirmations of these patterns. Harsh parenting has also been shown to predict increases in angry temperament and reductions in effortful control (Lee, Zhou, Eisenberg, and Wang, 2013). Parental positive involvement has been shown to predict increased infant positive emotionality (Belsky, Fish, and Isabella, 1991). Finally, across several studies (with only one non-finding), parental warmth and positive involvement predict increases in child effortful control, whereas parental intrusive control predicts reduced effortful control (Bates and Pettit, 2015). 4. Parenting and child temperament interacting in prediction of outcomes. Two, relatively well-supported patterns have emerged in the literature on temperament by parenting interactions: First, children high on general negative emotionality have worse social development, especially if they have parents who are high on negative parenting or low on positive parenting; and second, children who are fearless could develop high externalizing problems if they experience low positive parenting or high negative parenting (Bates and Pettit, 2015). 292

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Based on previous reviews, at the outset of the current review we expected to find that parenting and child temperament are both involved in child social development, even if indexes of the constructs do not always supplement one another in predicting development; that parenting and temperament influence one another; and that parenting and child temperament combine and interact in forecasting social development. Two more preliminary notes provide a foundation for the chapter’s updated picture of findings about parenting, temperament, and development: It may be helpful to consider first some theoretical mechanisms relevant to the emerging data on social development involving parenting and temperament and, second, a few methodological considerations that affect reading the literature.

Theoretical Mechanisms in Social Development Empirical specifics about temperament, parenting, and development have been emerging at a relatively fast rate. Evidence suggests that both temperament and parenting predict child social development, and that temperament and parenting sometimes change, despite their notable levels of stability.Temperament and parenting also influence changes in one another. How do these predictive associations happen? We briefly consider general models for the developmental processes that could account for these predictions. As anticipated by the developmental systems models emerging in the 1960s and 1970s (Bell, 1968; Sameroff, 1975), findings show dynamic, transactional relations between biological constitution and environment in social development (Collins et al., 2000). First, concerning the association between parenting and developmental outcomes, there are several leading possibilities for how parenting could be involved. Parenting helps to create conditions for learning what the world is like, what one’s position is in the world, and how one can and should get physical, cognitive, and social needs met (Ainsworth, 1979; Cummings, Davies, and Campbell, 2000; Patterson, Reid, and Dishion, 1992). Parenting provides both antecedents and consequences for the child behaviors that comprise the child’s skills, habits, attitudes, and self-concept. Second, concerning temperament and developmental outcomes, there are also several leading possibilities for how temperament could be involved in development (Rothbart and Bates, 1998). The most straightforward ones involve direct linear processes, such as when a high level on a temperament trait, such as fearfulness in response to novelty, marks variations in psychophysiological systems that also serve as part of the foundation for development of an anxiety disorder. Also straightforward, but richer in detail about developmental process, are indirect linear processes—such as a mediation process in which high child negative emotionality sometimes elicits reinforcing consequences, even if it is in the form of hostility from caregivers and peers (Patterson et al., 1992), which in turn give opportunities to develop coercive habits through modeling and negative reinforcement. Third, concerning parenting and temperament changes over development, the most appealing model is one of transactional process (Sameroff, 2009), in which the child behaviors that operationally define temperament elicit and shape parenting responses, and parenting responses reciprocally elicit and shape child behaviors that represent temperament. For example, if a child is high in negative reactivity and a parent manages the child in ways that maximize the child’s sense of security and success, the child would not only experience less distress over time, but also develop cognitive control over emotional reactivity. So, the child’s rank-order level of negative reactivity might decrease over time. By contrast, if the parents, because of their own emotional reactivity (perhaps triggered by negative thoughts, such as resentment or hopelessness), lack of cognitive self-regulation skills, or environmental stressors, are not able to manage such a child in effective ways, a cycle of negative transactions could lead to increased negative emotionality in both child and parent. As complex as these processes are, still more complex transactional processes are likely—ones involving nonlinear interactions between child temperament and parenting. For example, a child’s temperamental impulsivity matters more for the development of externalizing behavior problems, as seen by either teachers or mothers, when 293

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the child has a parent who is observed to be low in control than when the child has a parent high in control (Bates, Pettit, Dodge, and Ridge, 1998). Theoretically, the process should involve differential motivational and learning impact of a particular parenting behavior on children according to their biologically based differences in reactivity and self-regulation (Belsky et al., 2007; Wachs, 2000). Although we have mentioned some possible mechanisms to explain the empirical data, it is understood that the actualities of development are subtler and more chaotic than revealed by standard measures of parenting and temperament. For example, some development may be shaped by small, daily events, such as when parents differentially reinforce irritable child behavior, whereas other development may be shaped by extreme, divergent events, like physical abuse (Dodge, Pettit, Bates, and Valente, 1995). Development would also involve other factors that supplement the effects of parenting or temperament, such as intellectual functioning, nutrition, sleep, family stress, social support, teachers, and peers. Nevertheless, although it is important to recognize the many social development subsystems, parenting and temperament are core elements of social development, are extensively studied, and therefore merit a special focus.

A Few Methodological Considerations in Research on Temperament and Parenting For the present chapter, the methodological consideration most emphasized is the design of the study. Longitudinal designs are the most relevant to the questions considered. We especially emphasize longitudinal designs that allow meaningful controls for initial levels of the constructs.This design allows researchers to model changes in temperament and parenting as functions of one another. Measurement is a background consideration, but not emphasized.The validity of measures (i.e., their relations and non-relations with a network of other measures) is encouraging but still in progress. When we talk about changes in temperament, we recognize that this is change in a measure, an operational construct, not necessarily in the abstract, theoretical construct. Perhaps there are changes at a relatively core, biologically influenced level, too, but the behavioral phenotype is what is most likely to change (Bates, 1989). A second methodological emphasis is on interaction effects between temperament and parenting in the prediction of social development outcomes, such as behavior problems. There are so many temperament X parenting findings that researchers have been increasingly interested in the particular shape of the interactions they discover, most often comparing models of diathesis-stress processes, where vulnerable children perform at the level of their peers when exposed to more positive or less negative environments, versus models of sensitivity to both stress and support, commonly referred to as differential susceptibility, where sensitive children outperform their peers when exposed to more favorable environments.

Studies of Parenting and Temperament as Independent Predictors of Social Development Social development models often have separate terms for parenting practices and child temperament as independent predictors. Do the two kinds of variables additively supplement one another in predicting child outcomes, thereby accounting for more variance in concert than singly? Bates and Pettit (2015) found that some studies did and others did not find additivity. They identified 20 studies that examined whether temperament and parenting supplement each other when predicting adjustment. Of the 20 studies, 11 showed additive, supplemental effects for parenting and temperament, and 9 studies showed that either parenting or temperament predicted adjustment, but not both. Additions to the literature since that review suggest similarly uncertain conclusions. For the present review, we identified 23 additional studies that examined the prediction of a variety of child outcomes, including internalizing and externalizing problems, performance in the strange situation, 294

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social skills, scholastic competence, and relationship with the teacher.We separated the 23 studies into 59 separate cases depending on the outcome studied and the measure used (observed versus questionnaire; mother, father, or teacher report). Of these 59 cases, 20 indicated an additive effect of parenting and child temperament, and 39 did not. Of the 39 that did not demonstrate an additive effect, 12 showed an effect for parenting practices only, 19 showed an effect for child temperament only, and 8 showed only an interaction effect between parenting and child temperament, with neither parenting nor temperament showing a main effect. Therefore, although parenting and child temperament sometimes supplement each other in predicting adjustment outcomes, they just as often do not. The lack of converging evidence for supplemental effects could reflect measurement deficiencies, but could also reflect processes concerning how child temperament and parenting might influence one another. If parenting and temperament are correlated contemporaneously or even influence one another across development, this would introduce collinearities that could affect their regression weights, even if each has a simple, bivariate relation with the outcome. The next sections consider recent research on how parenting and child temperament relate to one another across development.

Child Temperament Effects on Parenting Parenting traits change even if there is also, in general, strong stability in parenting traits. Can some change in parenting be explained by children’s temperament or the problem behaviors that temperament measures have been shown to predict? The present section focuses specifically on the influence of temperament on parenting, and generally on the effects of child behavior problems (which are conceptually and empirically linked with particular temperament dimensions; Bates, 1989) on parenting. Problematic child behavior often creates challenges for parents, including disruption in the family system, increased time demands, and parent feelings of frustration, worry, guilt, and/or embarrassment regarding their child’s behavior (Bussing et al., 2003). Child behavior problems also tend to elicit harsher and less supportive parenting. Murray and colleagues (2013) showed that adolescents’ selfreported aggression predicted increases in their perceived levels of parental psychological control 3 months later, controlling for initial levels of psychological control. Changes in positive parenting have also been shown in association with changes in child aggression. For example, in an intervention study with cross-lagged tests at pre-intervention, post-intervention, 6-month follow-up, and 12-month follow-up, decreases in child aggression predicted increases in child reports of positive parenting (Te Brinke, Dekovic, Stoltz, and Cillessen, 2017). Similar links have been found in cross-lagged designs for diagnostic symptoms of oppositional defiant disorder and conduct disorder, which predict more timid use of discipline, poorer communication, and less parental involvement and supervision (Burke, Pardini, and Loeber, 2008). Children’s callous-unemotional traits, particularly low levels of guilt and empathy, also predict change in parenting over 12 months, toward less parental involvement and more inconsistent discipline and punishment, controlling for prior levels of these parenting practices, as well as child hyperactivity and antisocial behavior traits, among other covariates (Hawes, Dadds, Frost, and Hasking, 2011). Externalizing behavior problems in general predict decreases in parental support (Huh, Tristan, Wade, and Stice, 2006) and increases in maternal negativity (Zadeh, Jenkins, and Pepler, 2010). It can be argued that behavior problems provide a window on the active role the child may play in the socialization process, shown by their accounting for change in parent behavior. Behavior problems have roots in early temperament (Rothbart and Bates, 2006). Are there similar processes, then, involving child temperament influences on parenting? Evidence suggests there are.

Child Negative Emotionality Predicts Parent Behavior Most findings of child temperament effects involve the influence of child negative emotionality on parenting. Children who are high in negative emotionality tend to show immediate and intense 295

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negative emotional reactions (e.g., anger or fear) in response to changes in the environment, and this has been shown to be associated with parental stress (Gelfand et al., 1992) and with angry and controlling parental reactions (Scaramella and Leve, 2004). Children’s negative emotionality is associated with high levels of parental psychological and behavioral control (Laukkanen et al., 2014) and with parents’ psychological aggression and corporal punishment (Xing, Zhang, Shao, and Wang, 2017), but in much of this research it is hard to infer direction of effects. Many studies rely on parent reports to measure both parenting and temperament. This kind of data could be of interest, especially in a longitudinal design, as a description of parents’ views of their own experience across time, but studies with multiple sources of information are typically regarded as more definitive. Cross-sectional studies, especially when they have multiple, cross-validating measures, are useful as initial checks on theoretical models and measures, and for generating hypotheses for later longitudinal studies. Longitudinal studies have shown that higher levels of child negative emotionality predict increased use of negative parenting practices (e.g., harsh control, rejection, inconsistent discipline, and authoritarian parenting) with autoregressive controls for prior levels of parenting across infancy (Bridgett et al., 2009), preschool years (van der Bruggen, Stams, Bogels, and Paulussen-Hoogeboom, 2010), and elementary school years (Bates, Pettit, and Dodge, 1995; Eisenberg et al., 1999; Lee et al., 2013; Lengua and Kovacs, 2005). These findings are suggestive of developmental influences, but they do not rule out genetic mechanisms. Genetically informative designs allow further rigor in testing child effects. Studies of monozygotic and dizygotic twins enable estimates of variance in parenting attributable to genetic factors (e.g., child temperament), shared environment (e.g., family structure, demographics, and values), and experiences unique to each twin (e.g., interpersonal relationships that are different with one twin from the other). Twin studies have shown, via significant heritability estimates, that children’s genetic predisposition for temperamental difficultness predicts hostile parenting in infancy (Boivin et al., 2005) and toddlerhood (Forget-Dubois et al., 2007). Jaffee and colleagues (2004) also found that twins’ genetic predisposition for negative emotionality at age 5 predicts parental use of corporal punishment, but not maltreatment, suggesting that use of corporal punishment may be driven by child characteristics, whereas harsh discipline that crosses a boundary to maltreatment may be more driven by parent characteristics. Although twin studies can elucidate the extent to which parent behaviors are shared or uniquely experienced by siblings depending on their genetic and temperamental predispositions, adoption designs can lead to even stronger conclusions about child effects because the evocative effects of a child who is genetically distinct from an adoptive parent can be tested (Lipscomb et al., 2011). Biologically related parents and children share genetic predispositions, so the genotype and environment (e.g., parent behavior) are inherently linked and difficult to disentangle.This passive gene-environment correlation may partially explain why parents appear to be influenced by child temperament. For example, parents who tend to be highly negatively reactive may be especially challenged by and reactive to their biologically related and similarly reactive child, and such parents may be more likely to engage in ineffectual, harsh responses to child behavior. Adoption studies with children and parents not genetically related can set this passive gene-environment correlation aside. Lipscomb and colleagues (2011) examined age-related changes in children’s negative emotionality at 9, 18, and 27 months using growth curve modeling of latent variables in a large sample of adoptive families and found that the slope across time for child negative emotionality was positively associated with the slope of adoptive parents’ overreactivity and inversely associated with the slope for parental efficacy. This finding suggests that increasing child negative emotionality is associated with increasing parental overreactivity and decreasing parental efficacy, even in parents who are not biologically related to the child. However, this study does not advance understanding of the directionality of links between child temperament and parent behavior, because change in parent behavior could just as plausibly predict change in child temperament as the reverse. In other adoption studies, the temperamental or behavior problem 296

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characteristics of the biological parents have been considered as a proxy for the child’s genetic, temperamental predisposition. For example, Klahr and colleagues (2017) found that birth parent antisocial behavior predicted increases in adoptive fathers' (but not mothers') use of negative parenting practices from 18 to 27 months, providing additional preliminary evidence to suggest that children who are at risk for developing externalizing behavior problems tend to evoke harsh parenting practices. Child social wariness or fearfulness at 18 months has also been shown to predict lower levels of adoptive parent directiveness observed during a clean-up task at 27 months, controlling for prior levels of parenting and for changes in child social wariness (Natsuaki et al., 2013).This is a pattern also previously seen in non-adoptive families (Mills and Rubin, 1990).

Child Positive Emotionality Predicts Parent Behavior Child positive emotionality, often referred to as surgency, involves high levels of activity, approach of people and objects, and smiling or laughter. Children who are high in positive emotionality also tend to seek out high-intensity pleasure. They tend to be extraverted and sociable (Putnam and Rothbart, 2006). Child positive emotionality is typically associated with more positive parenting and less negative parenting (Putnam, Sanson, and Rothbart, 2002;Wilson and Durbin, 2012). In an adoption study, Hajal et al. (2015) found that sociability of the birth mother was inversely associated with adoptive fathers’ harsh parenting. That is, children with a genetic disposition to high positive reactivity appear to have elicited less harsh parenting than did less positive children. Harold et al. (2013) measured a different birth mother trait, ADHD symptoms, which we tentatively assume are related to temperament variables, including positive emotionality-related traits of strong approach, reward sensitivity, and sensation seeking. Birth mothers’ symptoms of ADHD were associated with more hostile parenting in the adoptive parents at child age 6, mediated via adoptive child impulsivity, activation, reward sensitivity, and sensation seeking at age 4.5. It is probably too soon for a full theoretical model in this area, but we would interpret these studies as supporting a developmental process in which some aspects of child positive emotionality, like interest and joy, lead to positive reciprocation by the parents. Not only are interested, joyful, active children likely to elicit reciprocal positivity, they may also be more responsive to positive parenting efforts. Parents do not automatically know how to rear a specific child, they learn how to do it (Hart and Risley, 1992), and positive, assertive children can help them learn to be positive parents. Other aspects of the broad positive emotionality construct, such as reward sensitivity and sensation seeking, might be experienced by parents as more negative (frustrating, frightening, etc.) and therefore elicit negative parenting, especially when the child’s positive emotionality is accompanied by high levels of impulsivity or low effortful control.

Child Effortful Control Predicts Parent Behavior The third core dimension of temperament, effortful control, serves to regulate the negative and positive reactivity, as foreshadowed in our interpretation of the Harold et al. (2013) ADHD findings. In general, high levels of child effortful control are associated with lower parental control efforts, potentially because these children need less parental guidance to regulate their own behavior. Lee and colleagues (2013) showed that poorer effortful control at time one (first and second grade) was associated with more authoritarian parenting practices at time two (fifth and sixth grade), using autoregressive controls for prior levels of parenting and multiple informants—parent, teacher, and child. Longitudinal studies, such as Lee et al. (2013), which measure parenting and temperament at multiple time points, are important. We expect to see more of such studies, including ones spanning across major developmental eras. Longitudinal designs spanning developmental eras are important because the magnitude and directionality of the link between temperament and parenting might change depending on developmental stage. Tiberio et al. (2016) examined bidirectional links 297

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between temperament and parenting from ages 3 to 13 or 14. By using an autoregressive, cross-lag model across multiple stages of development, they found evidence that children’s effortful control influenced parenting and stage of development moderated the influence of child temperament on parenting. The general pattern was for child effortful control to influence later parenting when children were younger, and for parenting to have more influence on child effortful control when the children were older. High levels of parent-reported child effortful control at age 3 predicted increases in a multimethod composite measure of mothers’ positive parenting at age 5, as well as decreases in fathers’ negative parenting (poor discipline). Child effortful control at age 5 did not predict increases in mothers’ positive parenting at age 7, but did predict decreases in mothers’ negative parenting, and did not predict changes in fathers’ parenting. Child effortful control at age 7 predicted increases in mothers’ positive parenting at the age 11–12 follow-up, but did not predict fathers’ parenting. Effortful control at age 11–12 did not predict changes in parenting at age 13–14. However, fathers’ positive parenting at age 7 predicted increased child effortful control at age 11–12, and mothers’ lower levels of poor discipline at age 11–12 predicted higher levels of child effortful control at age 13–14. Worth highlighting in the development of research on temperament and parenting is the notable increase in observational measurement of parenting. Observations of parenting, especially across a long period of development, are likely to show smaller levels of cross-age continuity than parents’ self-reports, even equating for measurement reliability. Parents’ self-reports may show high cross-age correlations because of constancy in how parents view themselves, perhaps due in part to response sets, such as social desirability (Edwards, 1990; Wiggins, 1973), which would leave little cross-time variance to account for by child characteristics. Observational or multimethod measures of parenting, as in Tiberio et al. (2016), may have more change to explain, and useful findings about sources of the cross-age variance may emerge. To the extent that cross-age variance in observations of parenting are not simply due to unreliability or lack of validity in observational measures, observed parenting might index parents’ sensitivity to changes in their child, which, as an instance of lawful discontinuity (Sroufe and Rutter, 1984), would be theoretically interesting. For example, increases in child effortful control may forecast a change in promoting versus inhibiting child autonomy. Several studies have used ecologically valid, semi-structured parent–child interaction tasks to measure various parent behaviors across tasks, contexts, and time. Klein and colleagues (2016) used observed measures of both child effortful control and parenting and found that better child effortful control at 36 months was associated with less observed maternal negativity at 54 months during parent–child tasks in a cross-lagged panel model design.This result parallels prior work showing inverse associations between child effortful control and negative parenting practices (Bridgett et al., 2009; Eisenberg et al., 1999; Lengua, 2006). Lower child self-regulation from 4–12 months of age predicts more negative parenting at 18 months (Bridgett et al., 2009), and similarly, lower child regulatory ability at 6–8 years predicts more frequent parental punitive reactions to negative child emotions at 8–10 years (Eisenberg et al., 1999). Likewise, lower initial levels of effortful control predict increases in parental rejection across ages 8–15 (Lengua, 2006). In addition to well-established links between child effortful control and changes in parental management, there is also an inverse association between child effortful control and maternal supportive parenting, again suggesting that well-regulated children may elicit more autonomy or less parental guidance. In a longitudinal adoption design with autoregressive controls, infants with low levels of effortful control tended to experience more maternal support, structuring, and clear instruction during parent–child interaction tasks as adolescents, which in turn was concurrently associated with less adolescent delinquency (van der Voort et al., 2013). This finding suggests that mothers may strategically use gentle forms of guidance to meet children’s needs and effectively buffer the child’s lack of effortful control. However, this finding somewhat contradicts earlier, related work which showed direct associations between child effortful control and other forms of positive parenting behavior. Poorly regulated toddlers concurrently experience less parental monitoring, sensitivity, and use of warm control (Feldman and Klein, 2003), and children rated by their mothers at age 5 as 298

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high in resistance to control (and thus poorly regulated) similarly experience less parental monitoring through grades 5–11 (Pettit, Keiley, Laird, Bates, and Dodge, 2007). It is worth noting that the study of adoptive families showed a different pattern than studies of non-adoptive families. Perhaps adoptive parents of a child with low effortful control have a better chance of responding adaptively because they are less likely than biological parents to share the same predispositions to dysregulation. The differential effect for adoptive parents could also be because they tend to be older. In contrast, birth parents may share the genetic predisposition for low levels of effortful control and be younger themselves and thus may be more likely to respond to challenging child behavior with poorly regulated responses, rather than with sensitivity and warmth. To summarize, effortful control appears to affect parent behavior but potentially in varying ways depending on the relation between parent and child, the age examined, and the measures used.

Parenting Effects on Child Temperament Although temperament is considered to be relatively stable, evidence suggests that there is some variability in the rank-order stability of temperament across childhood (Rothbart and Bates, 2006). How do such shifts in temperament occur? Studies have considered changes in the phenotypic expression of temperament as a function of qualities of parenting. Perhaps because temperament traits are theoretically more stable than parenting traits, we have seen less research focusing on the effect of parenting on child temperament than focusing on the possible effect of child temperament on parenting. Cross-sectional associations between parenting and child temperament are often interpreted as child effects, but could as easily be seen as indicating effects of parenting on child temperament. Fortunately, some longitudinal studies allow interpretations of parent effects. Unless otherwise specified, the studies highlighted in this section have longitudinal designs and include controls for previous levels of child temperament.

Parenting Predicts Child Negative Emotionality Positive parenting practices in infancy and toddlerhood, including maternal sensitivity and responsiveness, have been associated with subsequent decreases in negative emotionality (Belsky et al., 1991; Pauli-Pott, Mertesacker, and Beckmann, 2004; Rispoli, McGoey, Koziol, and Schreiber, 2013) and fear reactivity (Braungart-Rieker, Hill-Soderlund, and Karrass, 2010), although not in every study (Rubin, Nelson, Hastings, and Asendorpf, 1999). Negative parenting has been shown to be associated with increased child negative emotionality in pre-adolescence (Eisenberg et al., 1999). Inconsistent parenting in middle childhood has been associated with greater levels of child fearfulness and irritability 1 year later (Lengua and Kovacs, 2005). A complication to consider is that temperamental negative emotionality and its changes over time can be the result of different contributing factors for different children. This condition is illustrated by the Kopala-Sibley et al. (2015) finding that poor-quality parent– child relationships were associated with increases in negative emotionality in early childhood, but only for children with high levels of cortisol reactivity, which suggests that the effect of parenting on temperament may depend on the child’s own biological susceptibility to stressors, or alternatively, that temperament will ultimately be better conceived as a more detailed, multifaceted profile of dispositions than just those shown in a single scale of a caregiver report temperament questionnaire.

Parenting Predicts Child Positive Emotionality There is little support for the proposition that positive parenting practices are associated with increases in child positive emotionality, with the notable exception of Belsky et al. (1991) showing that high parental positive involvement at age 3 months predicts increased infant positive emotionality at 299

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9 months. A small amount of additional support comes from Kopala-Sibley et al. (2015), who found an association between high-quality parent–child relationships and subsequent increases in positive emotionality, but only for children with low levels of cortisol reactivity. However, overall, evidence at this point is too scant for strong conclusions on the effects of parenting practices on child positive emotionality.

Parenting Predicts Child Effortful Control The most robust area of research on the influence of parenting practices on child temperament has focused on effortful control. Longitudinal findings suggest that positive parenting practices in early childhood, including high levels of maternal support, nurturance, and responsiveness, are associated with later increases in parent- and observer-reported effortful control (Klein et al., 2016; Kochanska, Murray, and Harlan, 2000; Pitzer et al., 2017). Additionally, parent limit setting and scaffolding observed in parent–child interaction tasks are associated with improved, observed effortful control in toddlers and preschoolers (Klein et al., 2016; Lengua, Honorado, and Bush, 2007; Lengua et al., 2014). Children from low-income families have lower effortful control than do children from higher-income families, and it appears that this association is mediated by lower levels of parental limit setting and scaffolding (Lengua et al., 2007; Lengua et al., 2014). Findings of Kopystynska et al. (2016) support the notion that positive parenting practices are associated with improved effortful control outcomes. Maternal sensitivity observed at 18 months was associated with improved child effortful control at 30 months. However, this association was not present across the 30- to 42-month span. Concerning the interactive effects of multiple parenting measures, Kopystynska et al. (2016) also found the best effortful control outcomes at 30 months in children whose parents used gentle control strategies and showed high levels of sensitivity. The cross-lagged findings of Tiberio et al. (2016), mentioned in the previous discussion of child effortful control on parenting, also showed that, at least in older children, positive parenting can predict changes in child effortful control. Negative parenting appears to adversely affect child effortful control. Higher levels of observed maternal intrusiveness during a parent–child interaction task in early childhood are associated with subsequent decreases in parent-reported effortful control (Taylor, Eisenberg, Spinrad, and Widaman, 2013). Additionally, higher levels of authoritarian parenting in middle childhood, a parenting style characterized by low levels of warmth and responsiveness and high levels of punitive disciplinary strategies, are associated with decreases in child effortful control nearly 4 years later (Lee et al., 2013). Similarly, punitive reactions to child emotionality are associated with decreased regulatory abilities in pre-adolescence (Eisenberg et al., 1999). Moreover, the Tiberio et al. (2016) study also found that negative parenting is associated with decreases in child effortful control at older but not younger ages. In summary, the literature on parenting effects on child temperament generally supports previously noted patterns in which positive parenting measured at one age has some chance of producing positive changes in child temperament traits measured at a later age. Studies have also extended the field by pointing to the possible value of considering multiple dimensions of parenting at the same time to identify potentially complex influences on child temperament. In addition, the findings open the question of whether the effects of temperament on parenting or parenting on temperament differ according to developmental stage.

Parenting X Temperament Moderator Effects The literature on interactions between parenting and temperament in predicting child social development is extensive enough that we have organized our review of it, first, by the type of parenting practice examined—negative or harsh versus positive or warm. Positive parenting is not simply the inverse of negative parenting (Pettit and Bates, 1989), so it would make sense to consider both 300

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negative and positive practices. Second, under the two kinds of parenting, we have organized our review according to the major dimensions of temperament—negative emotionality, positive emotionality, and effortful control.

Interactions With Negative Parenting Practices Negative parenting practices, including overcontrol, rejection, and hostility, are associated with both internalizing (Rapee, 1997) and externalizing (Dodge et al., 2006) adjustment problems. Beyond these main effects, it appears that some temperament characteristics may make children relatively susceptible to the impact of negative parenting, and other characteristics may make children relatively resilient. In the present section, we consider how negative parenting interacts with the major dimensions of child temperament in forecasting social development outcomes.

Negative Parenting X Negative Emotionality By far, the most robust literature examining negative parenting by temperament interactions has focused on child negative emotionality. The literature largely supports the notion that children high in negative emotionality are the most vulnerable to the effects of negative parenting practices (Bates et al., 2012; Bates and Pettit, 2015). Findings highlight a child vulnerability or diathesis-stress model: Among children exposed to negative parenting practices, those who are high on negative emotionality are more likely to develop externalizing and internalizing problems, low social competence, and diminished cognitive performance. Many longitudinal studies support the vulnerability hypothesis. Infants reported by parents to be high in anger and frustration and exposed to hostile parenting are more likely to develop co-occurring internalizing and externalizing problems at age 5, whereas infants reported to be low in anger and frustration and exposed to hostile parenting are more likely to develop internalizing problems at age 5 (Edwards and Hans, 2015). Similarly, consistent exposure to negative parenting practices from ages 6 to 36 months interacts with infant negative emotionality to predict observed negative emotions and discomfort expressed when left alone or with a stranger at 36 months (Dix and Yan, 2014). Consistent with the vulnerability hypothesis, when exposed to consistently negative parenting practices, children high in negative emotionality show more separation distress than children low in negative emotionality. However, it should be noted that Dix and Yan (2014) also measured behavior problems, social competence, and attachment security, but separation distress was the only child outcome for which the pattern of findings supported the child vulnerability hypothesis. Such null findings highlight the need for continued research on which adjustment outcomes are most likely to be susceptible to parenting by temperament interactions. Additionally, from a developmental perspective, it is of interest to examine how such processes differ across spans of development (i.e., are the processes similar across ages or are there developmental shifts in how parenting and temperament interact?). In a longitudinal study with a high-risk sample of toddlers, high levels of parent intrusiveness and parental negative regard predicted increased child behavior problems a year later, controlling for initial levels of behavior problems, but only for children with high levels of observed fear reactivity (Barnett and Scaramella, 2015). Harsh parenting in toddlerhood also predicted increased levels of a neural biomarker thought to index risk for anxiety (the error-related negativity event-related potential) at age 4, but only for children displaying high levels of fearfulness (Brooker and Buss, 2014). Children with lower levels of fearfulness did not show a neural activation pattern indicative of increased susceptibility for anxiety, even when they did experience harsh parenting. In a converging, cross-sectional finding, preschoolers with high temperamental negative and positive emotional reactivity tended to be more disruptive during peer interactions, but only if their parents reported high levels of authoritarian parenting (Gagnon et al., 2014). Also in a sample of preschoolers, those 301

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with high levels of parent-reported child negative emotionality and whose parents reported negative parenting practices (a composite of nonreasoning, over-directiveness, and negligence), tended to have higher internalizing problems, whereas for those with low negative emotionality, the level of aversive parenting did not matter for internalizing problems (Ren, Zhang, Zhou, and Ng, 2017). Another example of the interaction between negative parenting and child temperament in predicting adjustment outcomes is the Prinzie et al. (2014) finding that a child’s trajectory of internalizing problems across middle childhood is partly explained by the interaction of overreactive parenting and child shy personality. For children high in parent-reported shyness, exposure to lower levels of overreactive parenting predicts membership in a trajectory class starting high on internalizing, but decreasing over the years. Children exposed to average and high levels of overreactive parenting do not show this association. This finding complements the Lewis-Morrarty et al. (2012) finding that children who are highly inhibited in childhood also show high social anxiety in adolescence, but only if they are observed during a parent–child interaction to be exposed to parental overcontrol. Although the Prinzie et al. findings provide support that higher levels of overreactive parenting may be associated with more detrimental outcomes in children high on parent-reported shyness, the latent class methodology makes it difficult to make assertions about how exposure to overreactive parenting is associated with anxiety at any given time point.

Negative Parenting X Positive Emotionality The literature on the interaction between negative parenting practices and positive emotionality has remained relatively sparse. Our previous review identified a general pattern that children high in positive emotionality are relatively protected from the effects of negative parenting when compared to children low in positive emotionality (Bates and Pettit, 2015). We did not find further studies focused on the interaction between negative parenting practices and child positive emotionality.

Negative Parenting Practices X Effortful Control In the literature on the interaction between negative parenting and effortful control, we saw a somewhat contradictory pattern of findings (Bates and Pettit, 2015). Studies suggested that children with low levels of effortful control have worse adjustment outcomes than do peers with higher levels of effortful control when they are exposed to negative parenting practices (Leve et al., 2005; Poehlmann et al., 2011). Conversely, Hilt, Armstrong, and Essex (2012) found that children high in effortful control showed an increased tendency toward rumination if they were exposed to overcontrolling parenting. We concluded that there was more evidence supporting an increased susceptibility to negative parenting practices in children with low levels of effortful control (Bates and Pettit, 2015). Two additional studies have examined the interaction between negative parenting practices and child effortful control. For children with low levels of executive functioning (thought to be highly related to effortful control), Gueron-Sela, Bedford, Wagner, and Propper (2017) found that exposure to high levels of harsh/intrusive parenting at age 5 was associated with higher levels of internalizing problems at school entry, but for children with higher levels of executive functioning, exposure to harsh parenting was not associated with subsequent internalizing problems. Similarly, in another study, children with low levels of parent- and teacher-reported effortful control were more likely to develop internalizing problems in pre-adolescence if their parents reported using authoritarian parenting practices, but not children with high levels of effortful control (Muhtadie, Zhou, Eisenberg, and Wang, 2013). These findings support the conclusion that children with low levels of effortful control are particularly susceptible to the effects of negative parenting practices. Overall, exposure to negative parenting practices is associated with worsened adjustment outcomes in children high on negative emotionality and low on effortful control. Additionally, high 302

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levels of positive emotionality may serve as a buffer to the effects of negative parenting on adjustment outcomes.

Interactions With Positive Parenting Practices Positive parenting practices, including warmth, sensitivity, emotional availability, contingent and appropriate responsiveness, scaffolding, consistent responses to children’s needs, and authoritative parenting (Baumrind, 1967; Biringen, Derscheid, Vliegen, Closson, and Easterbrooks, 2014; Bornstein and Tamis-LeMonda, 1989; Lamb and Easterbrooks, 1981), are associated with positive adjustment outcomes, including not only good behavioral adjustment, but also language development and academic success (Darling and Steinberg, 1993; Denham et al., 2000; Kochanska and Aksan, 1995; Landry et al., 2001; Stams, Juffer, and van IJzendoorn, 2002). Although distinctions can be made among the positive parenting constructs, they tend to be correlated with one another and have similar associations with socially valued child outcomes. Positive associations between positive parenting and child adjustment may be amplified for certain children depending on their temperamental disposition. The differential susceptibility model (Belsky, Bakermans-Kranenburg, and van IJzendoorn, 2007) proposes that susceptible children would have the poorest outcomes within negative environments and the most favorable outcomes within positive environments. These theorized interaction effects with positive parenting have been examined in two ways: (1) correlational analyses to determine whether higher levels of positive parenting are associated with better adjustment outcomes for children of a particular temperament or (2) intervention or experimental studies to manipulate parenting and examine within-subjects effects of improved parenting.

Positive Parenting Practices X Negative Emotionality Because there have been so many relevant studies of positive parenting in interaction with child negative emotionality, we discuss the findings separately. 1. Correlational studies of general negative emotional reactivity. In many studies, negative emotionality has been measured broadly, with measures that sum across numerous situations and ways of showing negative emotion. In longitudinal-correlational studies, children displaying high levels of difficultness (i.e., high levels of negative emotionality) at ages 2–3 showed fewer externalizing behavior problems at ages 6–8 when they experienced higher levels of maternal empathy (Pitzer et al., 2011) or higher levels of parent-reported contingent praise, sensitivity, and enjoyment of parent–child interactions (Gallitto, 2015). Similarly, in Roisman et al. (2012), children’s difficult temperament interacted with observed maternal sensitivity (at 6, 15, 24, and 36 months) to predict higher levels of teacher-reported academic skills and social competence and fewer total behavior problems. The shape of the interaction supports a differential susceptibility interpretation, in which highly difficult children who also experienced maternal sensitivity showed the fewest behavior problems and had the best academic performance and social competence. When the same interaction was tested using mother reports of social skills and objective tests of academic skills, however, the results were more consistent with the diathesis-stress model, in which highly difficult children with low levels of maternal sensitivity had the worst adjustment outcomes but had average outcomes when exposed to high levels of maternal sensitivity. This vulnerability effect finding of Roisman et al. resembles the significant interaction found by Gallitto (2015), in which high levels of positive parenting resulted in difficult, average, and easy children having the same levels of behavioral adjustment, and low levels of positive parenting were associated with difficult children’s adjustment becoming notably worse than others’ adjustment. Several other studies examining the interaction between positive parenting and child 303

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negative emotionality have shown more support for the diathesis-stress, or vulnerability, model than the differential susceptibility model. Stoltz, Beijers, Smeekens, and Dekovic (2017) found that children high in negative emotionality who experienced more observed positive parenting at age 5 showed less teacher-reported externalizing behavior at age 12.Visual inspection of the plots generated from this interaction effect suggested evidence for differential susceptibility, but more stringent statistical tests failed to find convincing evidence for the differential susceptibility hypothesis, finding instead an effect that was more suggestive of diathesis-stress. Also fitting a diathesis-stress model better than a differential susceptibility model is the study of Kochanska and Kim (2013), which showed that highly difficult children displayed more observed compliance and less mother-reported externalizing when they had experienced high levels of observed parental responsiveness, but difficult children’s adjustment was not any more positive than that of children who were low to average in difficult temperament traits. 2. Correlational studies of subdimensions of negative reactivity. The last section concerned studies of general negative emotionality. This section concerns the more specific negative emotionality domains of anger/frustration versus fearfulness. Diathesis-stress interactions between positive parenting and these specific temperament variables have been found. Children who are high in anger/frustration show high levels of internalizing problems when they experience low levels of authoritative parenting, but when they experience high levels of authoritative parenting, their levels of internalizing problems are like those of their peers who are low to average in anger and frustration (Muhtadie et al., 2013). Augustine and Stifter (2015) reported that highly fearful children show the highest levels of moral behavior when exposed to high levels of parental reasoning and explanation. When parents are low in reasoning and explanation, highly fearful children’s moral behaviors (including avoidance of cheating and high levels of generosity) are like those of their non-fearful peers. This pattern differs somewhat from the diathesis-stress or vulnerability pattern. It is referred to as vantage sensitivity—performing better than peers in positive environments and performing at average levels when exposed to less positive environments. Barnett and Scaramella (2015) also found this pattern with children displaying varying levels of fearfulness/fearlessness as measured during interactions with a roaring remote-controlled robot.When parents were low in supportive parenting, fearful children (i.e., those who were less likely to approach the robot) showed levels of behavior problems that were like their fearless, high-approach peers. However, the fearful/low approach children showed the fewest behavior problems when they experienced more supportive parenting, again behaving better than peers in positive environments and behaving at average levels when exposed to less positive environments. A related finding is that of Zarra-Nezhad et al. (2014), which showed that, for children who were socially withdrawn in kindergarten, their mothers’ lack of affection predicted development of more externalizing behavior problems in grades 1–3, whereas for non-withdrawn children, mothers’ lack of affection was not so predictive. Similarly, among preadolescents whose fathers had psychiatric problems, those with temperamental low flexibility (indicating poor adaptability to change and high levels of distress in response to novelty) showed higher levels of both internalizing and externalizing symptoms when they experienced less positive parenting, particularly from their fathers (Rabinowitz, Drabick, Reynolds, Clark, and Olino, 2016). 3. Genetic measures of negative emotionality. The differential sensitivity pattern has been supported in recent genetic studies.When factors such as the short allele of the 5-HTTLPR gene (short-short and short-long genotypes) or the DRD4 allele are considered, there is evidence for differential susceptibility, particularly in European and European-American samples (Bakermans-Kranenburg and van IJzendoorn, 2006; van IJzendoorn, Belsky, and Bakermans-Kranenburg, 2012). The 5-HTTLPR gene, a serotonin transporter gene, has been found to moderate associations between maternal responsiveness and both child moral internalization and school competence. Children with short serotonin transporter gene alleles show a positive association between 304

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maternal responsiveness and moral internalization and school competence, with evidence for differential susceptibility for moral internalization (Kochanska, Kim, Barry, and Philibert, 2011). A similar pattern was seen in Bakermans-Kranenburg and van IJzendoorn (2006), in which a dopamine receptor allele generally associated with child externalizing problems was found to be associated with the highest levels of mother-reported externalizing problems when mothers were rated by observers as insensitive, but the least behavior problems when mothers were rated as highly sensitive (Bakermans-Kranenburg and van IJzendoorn, 2006). This result has since been replicated in research showing significant interactions between DRD4 alleles and responsive, supportive, and warm parenting to predict increases in child self-regulation in accordance with the differential susceptibility model (Cho, Kogan, and Brody, 2016) and fewer externalizing behavior problems (Propper, Willoughby, Halpern, Carbone, and Cox, 2007). 4. Paradoxical interactions. Beyond evidence suggesting that positive parenting helps children who are high in negative emotionality develop behavior that is as good or sometimes even better than their less reactive peers, there is also evidence to suggest that too much positive parenting may be problematic for children who are high in negative emotionality. For example, Danzig et al. (2015) reported that children observed to be high in anger, hostility, sadness, and pushiness on a structured observational measure of temperament showed less social competence at age 6 when exposed to higher levels of observed positive parenting. In a related way, the promotive effect of sensitive parenting was found by Paschall et al. (2015) only for children with low levels of negative emotionality. For low negative children, but not for more negatively reactive children, sensitive parenting, defined as high supportiveness and low negativity, predicted less preschool classroom aggression and better teacher-child interactions. How does this kind of pattern, so different from the previously discussed positive parenting X child negative emotionality interaction, occur? Perhaps, focusing on the high supportive mother and high negative child, this effect pertains to an inappropriate or ineffectual positivity, when the child may need some authoritative control. Or, thinking about the low negative children aided by sensitive parenting, perhaps it resembles the Kochanska (1997a; Kochanska, Aksan, and Joy, 2007) effect, in which fearless children become better socialized when they and their mothers experience a secure, fun relationship. Davis, Votruba-Drzal, and Silk (2015) also found this result with children whose mothers described them as displaying low levels of fear and distress in novel situations at 6 months. These low-fear children were positively affected by high levels of maternal sensitivity, whereas children rated as fearful were more likely to display moderate and increasing levels of internalizing symptoms across ages 4.5–11 if their mothers exhibited high warmth/sensitivity. Hartz and Williford (2015) similarly found this promotive effect of maternal sensitivity only for children low in negative emotionality when they tested a threeway interaction with child negative emotionality, maternal sensitivity, and teacher sensitivity. For children low in negativity, maternal sensitivity was negatively associated with internalizing problems regardless of teacher sensitivity levels. Waller, Shaw, and Hyde (2017) also showed that child fearlessness predicted callous-unemotional behaviors for children who experienced low levels of positive parenting, but not for children who experienced high levels of positive parenting, which is consistent with other diathesis-stress patterns and supports the special importance of positive relationships as a pathway to socialization for children whose lack of sensitivity to fear cues might impair socialization from negative parenting (Kochanska, 1995; Kochanska, Kim, Boldt, and Yoon, 2013). 5. Clinical modification of positive parenting X child negative reactivity. Experimental evidence for interactions between positive parenting and child negative emotionality comes from studies of interventions to change positive parenting that have also considered how these changes interact with child temperament or personality-like symptom patterns. Interventions allow for a relatively stringent test of the differential susceptibility model, because children are exposed to less positive 305

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environments prior to treatment and more positive environments after parents have adopted more effective ways to manage child behavior. Interventions targeting supportive parenting improve negatively emotional children’s attachment security (van den Boom, 1995). Klein and colleagues (2006) gave families several home visits during the child’s first year of life to promote supportive parenting practices. Children who were rated by their mothers as high in negative emotionality were shown to respond the most to the treatment, by having better attachment security post-intervention. This result was replicated by Cassidy and colleagues (2011) when infants with high levels of negative reactivity or irritability showed the greatest gains from a similar parenting intervention, as these highly irritable infants were again more likely to be rated as securely attached following the intervention. Similar results have been found by Scott and O’Connor (2012) and Rodriguez, Bagner, and Graziano (2014) in studies of interventions to help parents manage high levels of oppositionality in their young children, such as the Incredible Years program or Parent-Child Interaction Therapy. In the Scott and O’Connor (2012) study, children were classified on the basis of particular configurations of parent-reported symptoms of oppositional defiant disorder.We can think of these symptombased configurations as akin to a temperament classification, although we do not assume that the classifications were necessarily fully aligned with standard temperament dimensions. Children in the emotionally dysregulated group (based on the symptoms loses temper, touchy or easily annoyed, and angry) experienced greater reduction in conduct problems following the parenting intervention compared to children in the headstrong group (argues, defies rules, annoys others, and blames others) or the control group. This finding was not due to the parents of the emotionally dysregulated children changing more in response to the intervention, because the parents of the headstrong group showed equivalent increases in positive parenting (Scott and O’Connor, 2012). This differential susceptibility effect was also found by Rodriguez and colleagues (2014) for children displaying high levels of distress at baseline during observed parent–child interaction tasks (child directed play and toy clean-up). These negatively reactive children showed the greatest reduction in disruptive behavior following a similar parenting intervention (Rodriguez et al., 2014). Both results replicate earlier work indicating that children rated as high on negative emotionality showed decreased behavior problems following increases in supportive parenting after a parental education intervention (Blair, 2002). Thus, consistent with several correlational studies of parenting X temperament interactions, emotionally dysregulated, negatively reactive children tend to show the greatest treatment response and thus demonstrate greater susceptibility to the caregiving environment. Parents sometimes change in response to their children’s temperament. Relevant to the discussion of interventions to increase positive parenting, some changes that parents make in response to difficult child behavior are self-directed. Parents make conscious efforts to change their relationship with their children, independent of professional settings (Goodnight et al., 2008). Especially for children who were seen as temperamentally resistant to control (in very early childhood, failing to stop when told “no” or protesting when removed from a troublesome activity), parental increases in positive involvement and limit setting led to improvements in child behavior, whereas there was less improvement for the more tractable children (Goodnight et al., 2008).

Positive Parenting Practices X Positive Emotionality The links between positive parenting practices and child adjustment could theoretically be further amplified for children high on the positive emotionality dimension, who tend to be high in approach, impulsivity, sensation seeking, and reward sensitivity.These children may respond especially favorably to positive parenting practices like warmth and sensitivity. There is some evidence to support this hypothesis. For instance, conceptually consistent with earlier findings by Kochanska and 306

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others (Cipriano and Stifter, 2010; Kochanska, 1997a; Kochanska et al., 2007), exuberant children show the most moral competence when parents use positive forms of control, namely redirection, during observed parent–child interactions (Augustine and Stifter, 2015), and among children high on impulsivity/surgency, observed parental responsiveness predicts decreased externalizing behavior 2 years later (Slagt, Semon Dubas, and van Aken, 2016).

Positive Parenting Practices X Effortful Control Bates and Pettit (2015) concluded that children with low levels of temperamental self-regulation tend to be especially likely to develop later behavior problems when they experience low levels of positive parenting, such as in a study by Degnan and colleagues (Degnan et al., 2008). This kind of finding has been replicated in work showing that children who are low in effortful control show decreased externalizing behavior problems when exposed to highly responsive parenting (Slagt et al., 2016). Similarly, in an adoption study by Reuben et al. (2016), children who showed less effortful control during a Stroop task at 27 months had lower levels of teacher-reported externalizing behavior at ages 6–7 when their adoptive parents reported high warmth in their parenting than when their parents reported low warmth. Positive parenting also has been found to moderate the relation of children’s effortful control to internalizing problem outcomes. In a study by Kiff, Lengua, and Bush (2011), children with low levels of effortful control showed more depressed and anxious symptoms when they experienced low levels of parental guidance. An interesting contrasting result also emerged when autonomy-granting parenting, another form of positive parenting, was considered. Children who were in low in effortful control showed the most anxious symptoms (high levels relatively stable across time) if their parents were high in autonomy granting (Kiff et al., 2011). This result may indicate that, although poorly regulated children appear to respond well to positive forms of parenting, including responsiveness, guidance, and warmth, high levels of autonomy granting may not actually be optimal for the development of children with poor effortful control. In summary, interactions between child temperament and positive forms of parenting in predicting child adjustment are important to consider as a complement to interactions between child temperament and negative forms of parenting. Both need to be considered to understand more deeply the nature of moderator effects. To distinguish between different kinds of moderator effects, especially the old standard, diathesis-stress or vulnerability model, the vantage sensitivity model, or the newer, differential susceptibility model, it is useful to consider both positive and negative kinds of parenting. Several genetic studies have shown that children with risk genotypes have more favorable developmental outcomes compared to their peers when they are parented in positive ways, offering support for differential susceptibility. At the same time, more conventional correlational studies without systematic information about genetic factors show more evidence for the diathesis-stress or vantage sensitivity models. Whether negative emotionality in general is considered or the more specific dimensions of anger and fear are considered separately, research suggests that positive parenting helps negatively reactive children develop levels of adjustment that are comparable with their less reactive peers. However, there have also been some somewhat paradoxical but replicated findings with positive parenting X negative emotionality. In some studies, children with low levels of fear appear to have better outcomes when they experience more positive parenting, whereas highly fearful or negatively reactive children might have worse outcomes when exposed to high levels of positive parenting. This paradoxical pattern is in line with the idea of “not-too-nice” parenting (Bates, 2012), which suggests that such children may need to be encouraged to encounter and master initially fearful situations, rather than be overprotected from such situations by a parent who is overly sensitive and responsive. In addition to these important findings from genetic and other correlational designs, intervention studies in which positive parenting is purposefully targeted for improvements enable tests how 307

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children of various temperaments respond to such changes in parenting. These studies from clinical contexts have generally shown that children high in negative emotionality are more responsive to parenting interventions, both at early ages for building secure attachments and at older ages for the prevention and reduction of behavior problems.The same pattern has been found for temperamental unmanageability in a study of parental campaigns to reduce child behavior problems. Fewer studies have examined the interaction between positive parenting and child positive emotionality or effortful control. In general, however, the literature suggests that children high in positive emotionality benefit most from positive parenting.This pattern makes conceptual sense, because children’s positive emotionality could predispose to higher levels of sensitivity to rewarding events and objects, perhaps including the social reinforcement provided by a warm parent. Positive parenting also appears to help children who are low in effortful control, suggesting that supportive parenting helps to buffer these at-risk children from later developing adjustment difficulties.

Future Directions in Research on Temperament and Parenting in Social Development Research on social development seeks to chart a complex set of processes, including genetic, neurophysiological, emotional, cognitive, and relationship processes at multiple levels, from biological systems, such as arousal and stress response systems, to psychological systems, such as those involved in cognition, attachment, and empathy, to the even more complex systems of family and societal context. The present chapter illustrates the breadth and complexity of research on parenting and social development, even though it has been organized around only the constructs of parenting and child temperament. A broad overview suggests an area that is vital and still developing. How might this area of research develop further?

Methodological Directions First, because knowledge depends on methods, future research will continue to raise questions about methods, and there will be changes in what are considered best methods. There is a continual interplay between methods and questions in research. We have emphasized questions of how parenting and child temperament combine to explain individual differences in social development. Crosssectional studies can provide clues and insights into social processes, but longitudinal studies can provide exponentially more information about how these processes unfold, so the present chapter has highlighted the findings of longitudinal studies. In addition to using longitudinal designs, researchers have also increasingly used sophisticated statistical models that can show continuity, change, and the factors that account for continuity and change. Statistical designs include growth curve models and cross-lagged models (Bollen and Curran, 2006). Models that combine the two (Berry and Willoughby, 2017) are also starting to demonstrate useful distinctions between the kinds of associations between measures over time that are common across individuals and the kinds of associations between measures that differ from one individual to another over time. In other words, these models partition the variance into that which occurs between individuals and that which occurs within individuals over time. An advantage of within-individual, cross-lag effects, such as findings of relations between parenting and child temperament, is that they inherently control for the many ways in which individuals differ from one another. Doing so enables more confident conclusions that the linkage between parenting and child temperament is not just the result of another difference between children, such as socioeconomic status. Some of the questions raised in this chapter about how child and parent traits might shape social development could be refined by differentially modeling processes that represent families in general, as opposed to processes that represent change or development in individual families. 308

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The chapter has also emphasized studies of how parenting and temperament interact in forecasting development of children. The focus on the interactions between these two constructs has been a highly productive vein of investigation, as increasing numbers of researchers have addressed moderator effects. At the same time, the sophistication of the models of interaction has also grown, with increased numbers of studies evaluating the particular shape of the interaction effects and the parts of the predictor scale across which the interaction is likely to be non-spurious (i.e., regions of significance). Almost all of the studies of interaction effects we have found have presented interactions between two predictors. Given the complexity and statistical difficulties of interpreting even two-way interactions, this seems appropriate. However, as many recognize, nature probably does not limit itself to two-variable interactions. We have begun to see three-way interactions, such as the effect of family stress in predicting child externalizing behavior depending on the child’s early temperament profile of both unmanageability and novelty distress (Schermerhorn et al., 2013), or the effect of child negative emotionality on the prediction of internalizing problems depending on both parental and teacher sensitivity (Hartz and Williford, 2015). Further complexities can also be modeled. For example, it is now possible to evaluate models in which interaction effects explain mediation processes (Preacher, Rucker, and Hayes, 2007), such as a hypothetical process in which child difficult temperament predicts later behavior problems via the impact of temperament on harsh parenting, but only for children who are also temperamentally low in self-regulation. To investigate longitudinal, multifactor, interactive, nonlinear questions, studies need to have sufficient numbers of participants for statistical power and representativeness, and the frequency and extensiveness of the assessments need to be developmentally appropriate and feasible. Design and modeling are not sufficient, of course, without well-measured constructs. Even though we recognize important issues with all the measures of parenting and temperament (Bates, Schermerhorn, and Petersen, 2012), the present chapter de-emphasized measurement concerns. Instead, we emphasized the reasonably broad consensus on the dimensional meanings of measures of parenting and temperament. Now that the chapter is turning to the future, however, we must acknowledge that the consensus is probably a provisional agreement, because researchers will raise new questions of validity and develop new measures that overcome deficiencies of older ones. Parenting measures are assumed to represent the accumulating experience of the child, and there is considerable evidence that they do, with many small-to-moderate associations among parenting-relevant measures. However, the power of the measures to predict social development outcomes for children is limited. It seems likely that new measures will be developed, which will enable questions not currently studied. For example, it may be possible to better measure the chain of cognitions that a parent has in a naturally occurring conflict with a child. Perhaps this nuanced assessment could be done using a combination of a continuously worn device to measure a parent’s physiological arousal and an automatically triggered voice recording or a cell-phone prompt to describe the sequence just experienced (Trull and Ebner-Priemer, 2009). Or perhaps there will be measures of existing concepts that are adapted to underexplored contexts. For example, we are currently developing ways to measure the sense of security that the parent provides a child in the context of preparing the child for bed (Hoyniak, Bates, McQuillan, et al., 2017; McQuillan and Bates, 2017). Similarly, the apparent consensus on temperament dimensions (Rothbart and Bates, 2006; Zentner and Bates, 2008) is itself probably a waystation. Most studies in the area rely on caregiver reports, which have shown validity, but exciting other measures are being explored, including psychophysiological, biochemical, and molecular genetics measures of individual differences in autonomic functioning, HPA-axis functioning, and neural functioning (Cho and Buss, 2017; Hoyniak, Bates, Petersen, et al.,2017; Hoyniak, Petersen, Bates, and Molfese, 2018; Perry, Dollar, Calkins, and Bell, 2017; Roy et al., 2014). Such measures have not become standard yet. We expect to see further accumulation of findings on biological measures of temperament and hope that more studies will be completed with multiple biological measures of temperament, for the sake of conceptual organization and validation. 309

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Studies of biological measures with multivariate designs and longitudinal follow-through would be especially useful, as they would allow meaningful partitioning of variance and identification of traitlike qualities. However, biomarkers may not always lend themselves to the kind of organizational schemes that work with questionnaire and behavior observation measures, such as factorial dimensions, because many multivariate studies have found that individual differences on multiple psychophysiological measures often do not covary in the same way across individuals (Fahrenberg, 1991). We also recognize that we probably should not expect one-to-one correlations between behavioral dimensions and psychophysiological ones. As a final point of future methodology, we would emphasize replication. Initial discovery is encouraging, but not sufficient. The present chapter has sought, as past reviews have, to recognize patterns across studies. As patterns emerge with particular temperament and parenting measures in combination to predict social development, and as the main effects and moderator effects are shown to be robust across different measures of the constructs and different samples of children, theory will advance. Replication can be facilitated by teams of developmental researchers organizing to run the same study at multiple sites or comparing different longitudinal studies within the same paper (Broidy et al., 2003; Davis-Kean et al., 2008).

Theory Directions The chapter mentioned several developmental processes by which children’s temperament might affect parenting and the reverse. It still seems plausible that constitutional characteristics of children could influence parent emotional reactions (positive or negative), as well as reflective, tactical, and strategic parenting eventually influencing child development. Parenting, in turn, can influence the activation of child emotional reactions (positive or negative) as well as the cognitively based selfregulatory development that ultimately affects children’s self-management of emotion and attention, and thus social competencies. Given the prevalence of such process models in theoretical discussions and good statistical models for testing mediation, we would expect to see more mediation studies showing empirical examples of relevant mediation or cascades of associations involving temperament and parenting (Bates and Pettit, 2015). We have found three encouraging examples of studies showing that parenting mediates the link between child temperament and adjustment (Harold et al., 2013; van der Bruggen et al., 2010; van der Voort et al., 2013). We also found support for an alternative yet related mediation model in which child temperament mediates the link between parenting and adjustment (Dix and Yan, 2014; Kopystynska et al., 2016; Pitzer et al., 2017). The numbers of mediation studies in the area of parenting, temperament, and social development have been limited perhaps by design issues (e.g., the use of measurement intervals not conducive to detecting mediation processes), measurement issues (e.g., not assessing the right qualities of behavior or attitudes), statistical challenges in showing mediation effects (MacKinnon and Pirlott, 2015), or incorrect specification of the theoretical models themselves, perhaps because the reciprocity of influences is essentially simultaneous and cannot be disentangled by longitudinal and even finer-grained time series analyses. Nevertheless, as the methodological and conceptual issues are resolved, we think it likely that progress will be made in richly and accurately describing mediation processes involving parenting and child temperament in children’s social development. Another, complementary theoretical direction is toward understanding nonlinear interactions between temperament and parenting as predictors of social development. This has already become a vigorous area of inquiry in the past 20 years.The methodological and conceptual challenges foreseeable for growth in research on parenting X temperament interactions are as great as for productive use of mediational models. There are so many possible ways in which multiple child and family factors could interact in shaping developmental outcomes that systematicity in selection of factors to test, replications of findings, and theoretical models that can predict moderator effects in advance will 310

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be crucial, and this is even more crucial when contemplating higher-order interaction effects, say with a profile of two parenting traits in interaction with two child temperament traits. As the numbers of studies of temperament X parenting interaction have grown, it has become possible to focus theoretical attention upon the particular shape of temperament X parenting interactions. The area can now start to classify the interaction effects. The leading classifications of effects at this point include the time-honored standard pattern of diathesis-stress, such as when a vulnerability factor, including an adverse temperament trait, predicts a problem outcome more strongly for children in a less-than-ideal parenting environment and more weakly for children in a more-ideal parenting environment. Or from the complementary perspective, a less-than-ideal parenting environment predicts worse development particularly for difficult children and less so for children with less challenging temperaments. The second-most noted pattern is called differential susceptibility: Here, the supposed risk trait predicts not only a stronger negative effect from non-ideal parenting than shown by children without the risk trait, but also a stronger positive effect from more-ideal parenting. Further progress in theoretical understanding of temperament X parenting effects will be aided by the greater precision in description of development. This may also lead to the research becoming increasingly useful in clinical and educational practice (Bates, 2012). The trend we see is an accumulation of replicated findings delineating with increasing precision how specific temperament and parenting variables interact in particular ways. One kind of increase in precision, often mentioned as a goal in methodologically sophisticated work but demonstrated relatively rarely in studies of temperament and parenting, is a statistically and conceptually meaningful model of mediated moderation, or moderated mediation. We found one such study in our present review of the literature that showed evidence for moderated mediation. Kopystynska and colleagues (2016) found that at high levels of maternal sensitivity, the effect of maternal gentle control on later academic functioning was mediated by child effortful control. Although we did not find studies that explicitly examined mediated moderation, we reviewed two studies (Laukkanen et al., 2014; Xing et al., 2017) that tested possible processes by which temperament may affect parenting—through changes in maternal well-being and anxiety, respectively. Such studies are a first step at empirically testing possible hypotheses about how and why a moderator variable, namely child temperament, may differentially influence the link between parenting and adjustment. Ultimately, tests of mediated moderation will lead to improved theoretical models.

Conclusions Our overarching question has been how a developmental system representing both early-appearing, relatively stable child temperament traits and relatively stable parenting traits might account for children’s social development outcomes. Temperament and parenting constructs show evidence of playing transactional roles in children’s social development. This conclusion builds on previous advances that have established broadly meaningful dimensions of both temperament and parenting and established that individual families’ scores on these dimensions predict child social developmental outcomes.The conclusion also builds on newer work showing that dimensions of child temperament influence parenting traits and vice versa and that temperament and parenting often interact with one another in forecasting social development. The chapter highlighted longitudinal designs and those with autoregressive controls to facilitate inferences of change of either temperament or parenting. Several theoretically and practically useful findings have emerged. Longitudinal-correlational research and experimental-interventional research show that child temperament and adjustment phenotypes are influenced by parenting. For the most part, the influences are consistent with the positive versus negative valence of the parenting, with positive parenting leading to less negative and more positive child temperament traits, and negative parenting the reverse. Similarly, longitudinal findings show that child temperament traits predict changes in parenting traits, even though there are not as many 311

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such findings as for parenting predicting child temperament. Parallel to findings on the influence of parenting on the child, for the most part, the changes in parenting are consistent with the valence of the child temperament, with socially valued child traits, such as effortful control, predicting increased supportiveness and reduced restrictiveness, or angry-frustrated temperament predicting increased authoritarian parenting. Also emerging are patterns of statistical interactions between temperament and parenting in accounting for child outcomes. In general, adverse temperament matters more for the social development of children experiencing non-ideal parenting, or conversely, parenting matters more for children with adverse temperament. For example, positive parenting matters especially for children high on negative emotionality traits. However, there are also a few interesting effects in which children with fearful temperament appear to develop better when they receive more challenging, less supportive parenting. Finally, the chapter looked forward to advances in complexity of mediator and moderator effects. Such future advances are wished for, not only because of their value in building developmental theory, but also because of their value for improving the prevention and treatment of childhood problems and promotion of positive social development.

Acknowledgments Work on this chapter was facilitated by funding from the National Institute of Mental Health (Grant Number MH099437) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Grant Number HD073202). Caroline Hoyniak is supported by a Graduate Research Fellowship from the National Science Foundation (Grant Number 1342962). Maureen McQuillan was supported on training grants from the National Institute of Mental Health (Grant Number T32 MH103213) and the National Institute of Child Health and Human Development (Grant Number HD007475).

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10 PARENTING IN ADOPTIVE FAMILIES Ellen E. Pinderhughes and David M. Brodzinsky

Introduction Families in the twenty-first century are increasingly diverse, with respect to sociodemographics, family structure, and parenting tasks, raising questions for social science researchers about variations in parenting processes across different kinds of families. Adoptive families, historically a nontraditional family system, are becoming increasingly common, and like families in general, more diverse. In this chapter, we examine current challenges faced by adoptive parents and parenting processes that shape children’s development and adjustment. We begin with a discussion of contemporary trends in adoption practice, including new contextual realities that help shape adoption practices, characteristics of children and parents united through adoption, and pathways to adoptive family life. We then turn to examine common adoptive parenting processes and common challenges across adoptive families, with a focus on adoption socialization—the processes through which parents facilitate relationships, communicate about adoption, and promote identity formation and adjustment in the adoptive family. Unique challenges and adoptive parenting processes are discussed next, which include experiences faced by adoptive parents rearing children amidst racial or cultural differences within the family, by sexual minority parents, and by parents rearing children with special needs. In the final section of the paper, we consider how parenting processes enable adoption to serve as a protective function and discuss adoption services as a critical support for adoptive parenting. Because this chapter focuses on adoptive parenting processes, a detailed examination of research and theory on adoption adjustment is not presented; readers interested in this topic are referred to Brodzinsky, Smith, and Brodzinsky (1998), Grotevant and McRoy (1998, 2012), and Groza and Rosenberg (1998).

Adoption in the Twenty-First Century Historically, the practice of adoption served quite different purposes than it does today (Herman, 2008; Sokoloff, 1993). Going back as far as antiquity and continuing until the late nineteenth century, adoption was viewed primarily as a means of meeting the needs of adults (e.g., to ensure inheritance lines; for religious purposes; to meet requirements for holding public office; to secure additional labor for the family; to ensure maintenance and care in old age) as well as society (e.g., to strengthen alliances between separate, and potentially, rival social groups) rather than the needs of children (French, 2019). In the United States, prior to the 1850s, adoption existed only as an informal affair, 322

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without legal recognition of the transfer of care and custody of children from one individual to another (Sokoloff, 1993). Beginning in colonial times, children who were orphaned or abandoned were often placed with relatives or indentured to families to live, work, and learn a skill or craft. In the early 1800s, overcrowded conditions and growing poverty in large eastern cities resulted in the rise of orphan asylums, which typically were cold, inhumane institutions where children’s emotional needs were inadequately met. As a response to the conditions in these orphanages, Charles Loring Brace, the founder of New York Children’s Aid Society, began sending children westward on “orphan trains,” where unfortunately they often were exploited as cheap labor by families who were inadequately screened for their motives and suitability to rear these children. In 1851, Massachusetts passed the first adoption statute, which set forth the conditions for adopting a child. Thereafter, many states passed similar legislation, although it was not until 1929 that all states had statutes providing some form of judicial supervision regarding adoption. The development of adoption law (Bussiere, 1998) and the rise of the modern adoption agency system beginning in the early 1900s led to a gradual and important shift in the philosophy of adoption practice.The new focus centered on the “best interests of the child” (Goldstein, Freud, and Solnit, 1973) and, thus, the needs of children for families. As we move to discuss new contextual realities in adoption, we take this opportunity to introduce the terms we will use regarding adoptive parents and children’s cultural backgrounds, as well as parenting processes related to cultural backgrounds. In this chapter, we use the terms race and ethnicity to refer to individuals’ backgrounds and transracial and transethnic to refer to adoptive families who adopt across race or ethnicity, respectively. Although race is no longer considered a biological construct (Yudell, Roberts, DeSalle, and Tishkoff, 2016), as a social construct race continues to be an important way to understand individuals’ experiences (Frankenberg, 1993; Takaki, 2008). Many individuals are subjected to racialized experiences based on their phenotypic expression (Sue, 2010) that may be noticeable based on their background (e.g., Asian, African descent). Although these bias experiences must be navigated by all people of color, families rearing adoptees across race face particular challenges as the differences are linked to adoption. For example,White adoptive parents rearing a child adopted from Russia and White adoptive parents rearing a child adopted from Ethiopia are both adopting across ethnic groups. However, the issues of stigma that the latter families face are more complicated, given the phenotypic differences within the families; using the term transracial signals these differences within those adoptive families.When referring to characteristics or processes that might be racial and/or ethnic, we will use the term ethnic-racial.

New Contextual Realities That Shape Adoptive Processes With evolving societal mores through the latter decades of the twentieth century and the first two decades of the current century, new public laws and shifting public opinions have facilitated shifts in adoption practice. The earliest shifts, increasing acceptance of single parenthood in the mid to late 1900s and the development of family support programs, coupled with legalization of abortion and ready availability of contraception, resulted in a dramatic decrease in the number of healthy White infants available for adoption. This decrease led parents to consider other options, including domestic transracial or transethnic adoption. Typically practiced by European American parents adopting children of color, these placements dramatically declined after 1972 because of opposition from the African American and Native American communities (National Association of Black Social Workers, 1972; Papke, 2013). Twenty years later, the passage of the Multi-Ethnic Placement Act of 1994 and Interethnic Placement Act of 1996 enabled increases in transracial and transethnic placements, particularly of children from foster care (K. Bernard, Frost, and Kuzava, 2019). However, these laws did not require pre-adoptive training or preparation to assist parents seeking to parent children of a different race or ethnicity. Placements of children from foster care grew quickly following the passage of the Adoption Assistance and Child Welfare Act of 1980, which targeted finding nurturing permanent 323

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homes for children languishing in foster care. Most of these children were identified as having special needs—children whose history and personal characteristics (e.g., older age at placement, being a child of color, exposure to abuse and/or neglect, chronic medical, mental and/or psychological problems, or being members of a sibling group) had previously been seen as barriers to adoption. An important provision of this law was financial support—in the form of adoption subsidies for families who could not otherwise afford to rear an adopted child, and special needs subsidies to enable families adopting a child with chronic medical or mental health needs to access critical services. Pre- and postplacement services, which focused on preparing and supporting the child and the family to unite as a new adoptive family, often terminated with legalization of the placement. Subsequent federal laws reaffirmed this commitment to permanency planning and to supporting adoptive families with financial subsidies (e.g., Adoption and Safe Families Act of 1997, Keeping Children and Families Safe Act of 2003, Adoption Promotion Act of 2003, and Fostering Connections to Success and Increasing Adoptions Act of 2008). Alongside the changes in domestic adoption, intercountry adoption in the United States and around the world began to increase. Placements typically involved children from countries including China, Russia, Korea, Ukraine, Guatemala, and Ethiopia with families in Western, industrialized countries, including the United States, Netherlands, Spain, and Italy (Selman, 2009, 2012). The reasons that sending countries choose to place their children for adoption via intercountry arrangements have been complex and controversial (Bartholet and Smolin, 2012; Fuentes, Boechat, and Northcott, 2012). With increasing international concern about a lack of regulation of intercountry adoptions and unethical practices, notably whether children were really orphans, kidnapping, and/ or selling of babies, The Hague Convention on the Protection of Children and Cooperation in Respect of Intercountry Adoption (The Hague Convention) was issued in 1993. Each country was urged to pass its own laws to ratify the convention that established a uniform set of principles and safeguards for the protection of children, birth parents, and adoptive parents in the transfer of children for adoption. Passage of the Intercountry Adoption Act of 2000 provided for the implementation of The Hague Convention in the United States, ensuring more consistency in the services delivered for and procedures followed in intercountry adoptions. The United States ratified The Hague Convention in 2007, joining approximately 60 other countries that had already ratified it. At the zenith of intercountry adoptions in 2004, families in the United States adopted 22,884 children from other countries (Selman, 2009). Since then, placements have steadily declined, to a low of 5,648 in 2015 (US State Dept, 2016). The United States is not only a receiving country, but also a sending country. Since 2004, over 1,400 U.S.-born children have been placed in countries such as Canada and the Netherlands (Selman, 2012). Official U.S. State Department reports list considerably fewer children, totaling approximately 600, who have been placed outside the United States (U.S. State Dept., 2016). This discrepancy is likely due to the private placements that birth parents—increasingly African American—can arrange that may not be reported to the government (Groza and Bunkers, 2014). The reasons that U.S.-born children are placed outside the United States reflect some evolving contextual realities, including the use of the Internet to facilitate private placements and birth parent choice of adoptive parents, that have shaped adoption. A critical new family resource for children in need of permanent loving families are sexual minority adults and couples (Gates, Badgett, Macomber, and Chambers, 2007). There has been considerable controversy regarding parenting and adoption by lesbians and gay men (Patterson, 2019). Critics have argued that children need both a mother and father to develop normally, that sexual minority adults are unfit parents, and that children reared by these adults would be at greater risk for psychological problems (Regnerus, 2012; Wardle, 1997). Because of these concerns, many adoption agencies in the past refused to place children with gay men and lesbians (Brodzinsky, 2012). Despite these concerns and barriers, it has become increasingly common for sexual minority adults to adopt

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children, especially as policies, regulations, and laws preventing or discouraging them from adopting have been overturned (Appell, 2012; Pertman and Howard, 2012). Joint adoption by same-sex couples is legal throughout the United States and in 25 other countries (Carroll, 2017). Data from Census 2000 and the National Survey of Family Growth suggest that at least 65,000 adopted children, or 4% of all adopted children in the United States, are being reared by sexual minority adults (Gates, Badgett, Macomber, and Chambers, 2007). Since 2000, the number of adoptions by sexual minority couples has doubled, and they are now four times more likely than different-sex couples to adopt children (Gates, 2013).They are also more likely to adopt racial minority children and older children from foster care than are heterosexual adoptive parents (Brodzinsky, 2011b; Goldberg, Downing, and Richardson, 2009; Goldberg and Smith, 2009). The Internet is rife with adoption-related resources and possibilities for making connections. Aside from web pages featuring agency services and adoption statistics, one can access chat rooms and list servers that offer opportunities for dialogue about adoption. Numerous adoption blogs feature personal experiences with adoption. Prospective parents can share information about preadoption processes with different agencies and countries. Adoptive parents rearing children adopted from a specific country or children with certain special needs can share resources. A YouTube exploration reveals a variety of videos about adoption; for example, adopted persons share their reflections on their experiences in hopes of educating others; sexual minority adults recount the stigma they received as they sought to adopt a child; and news anchors debate about whether same-sex couples should be allowed to adopt. In short, the Internet offers unlimited opportunities to access information about adoption. Some sites vet or screen the information shared for accuracy, whereas other sites provide little oversight. These realities must be navigated by anyone seeking information about adoption. The Internet facilitates connections that lead to adoption. In recognition that birth parents now are empowered to select their child’s adoptive parents, some prospective parents post videos on YouTube and other sites that feature their stories, marketing themselves to birth parents or pregnant women considering making an adoption plan. Moreover, adoption agencies provide advice to prospective parents about how to create a compelling adoption video. The Internet also facilitates connections that lead to a reunion of birth parent and adoptee. Historically, search and reunion were often facilitated by adoption search professionals who knew how to discreetly find information. With the Internet, adoptees, adoptive parents, or birth parents can search on their own, often aided by suggestions or guidelines provided online by adoption organizations. Unassisted searches also take place, made possible through Facebook and other social media outlets (Black, Moyer, and Goldberg, 2016). In short, the Internet has such reach and offers such search possibilities that adoptive parents, adoptees, and birth parents need to be prepared for the possibility of contact, even when not initially planned (Howard, 2012). In addition to the possibility of unsolicited contact, Howard (2012) offers cautions about other risks associated with the Internet, such as misleading information, insensitive treatment, and the possibility of fraud or other unethical activities. Another activity made possible with the Internet is surveying large numbers of adoptive parents and adopted persons. As a result, web-based studies of adoptive parent and adopted persons have burgeoned—especially adolescents and adults. Unfortunately, few studies target birth parents (see Brodzinsky and Smith, 2014; Grotevant, McRoy, Wrobel, and Ayers-Lopez, 2013, as exceptions), leaving a gap in the field’s understanding of their experiences and, in particular among birth parents in contact with adoptive families, of their perceptions of adoption. In summary, evolving social mores, shifting public opinion, passage of several federal laws and an international treaty, as well as the explosion of social media have combined to facilitate shifts in adoption practices. These changes—all occurring in the last 50 years—have contributed to new complexities in adoption processes.

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Current Variations in and Patterns of Adoption Adoption in today’s world represents different pathways to family status that mirror the diversity in our world. Children are adopted at any age from birth through late adolescence. As the diversity in the world has become increasingly recognized and valued, adoptive parents have become increasingly diverse with respect to age, ethnic-racial background, religious background, sexual majority or minority status, marital status, and socioeconomic status. Pathways to adoption are varied and include private domestic placements, placements from foster care, and intercountry adoptions. Private domestic placements include arrangements mediated by an adoption agency or lawyer, stepparent, or other relative and placements within Indigenous Tribes. Placement from foster care is sometimes made possible through voluntary relinquishment of a child by a parent to the child welfare system, but more often follows involuntary termination of parental rights after a child has been removed from a parent’s custody for cause. Intercountry adoption is facilitated through adoption from sending countries to receiving countries. Sending countries are those that have not been able or have not chosen to provide domestic opportunities for children in need of homes. Receiving countries include those that make it possible for their citizens to adopt from outside the country. This chapter focuses on domestic adoptions (excluding those involving stepparent and other relative adoptions, as well as adoptions within Tribal communities), adoptions from foster care, and intercountry adoptions. Aggregating reliable statistics about these three pathways is challenging, due to different reporting mechanisms and structures for each pathway. Generally, more reliable information is available about placements from foster care and intercountry adoptions. A nationally representative survey covered a time span from approximately 1990–2007 found that private domestic placements (excluding stepparent adoptions) accounted for 38% (677,000), placements from foster care were 37% (661,000), and intercountry placements were 25% (444,000) of all adoptive families (Vandivere et al., 2009). Because of increases in adoptions from foster care and decreases in intercountry placements, currently, adoptions from foster care are the predominant type of placement today. Although adoptive families face common challenges, each pathway presents unique challenges for adoptive parenting. These will be discussed in detail below. Mirroring the increased diversity in the United States, the characteristics of adopted children vary substantially. The population of adopted children in the United States is more racially and ethnically diverse than the overall population of children in the United States. In 2009, non-Hispanic White adoptees represented 37% of all adoptees, whereas non-Hispanic Black adoptees were 23%, and Hispanic and Asian adoptees each were 15% (terms used in Vandivere et al., 2009). Adoptees meeting “Other” characteristics (for example, two or more races) were 9%. Within the adoptee population, children differ in their race/ethnicity according to the pathway through which they were placed, and these demographics change over time. In 2015, 53,459 children were adopted from foster care, almost two-thirds by non-relatives. Among children adopted from foster care, 48% were nonHispanic White, 22% were Hispanic, 18% were Black, and 8% were Multiracial (the remaining 3% were American Indian/Alaskan Native, Asian, or unknown.) Also in 2015, 5,648 children found homes through intercountry adoption; 57% were from Asian and South Asian countries, 23% were from countries in Africa or of predominantly African descent; 13% were from European countries, and 6% were from Central and South American countries. The top five sending countries to the United States were China, Ethiopia, South Korea, Ukraine, and Uganda. Adopted children tend to be older than the United States population of children (Vandivere et al., 2009), largely because many adoptees are adopted after age 2. Adoption pathway again accounts for some variation in age: the largest percentage of adoptees over age 5 are children adopted from foster care, followed by intercountry adoptees and children placed domestically. Children adopted from foster care have the

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broadest age range: Among the children who left foster care for adoption in 2015, 48% were under age 5, 42% were ages 5–12, and 9% were ages 13–17 (U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth, and Families, and Children’s Bureau, 2016). In summary, adopted children are diverse in their race/ethnicity, tend to be older than the general population, and within-group variation is linked to adoption pathway. Adoptive parents in the twenty-first century are also increasingly diverse, but less diverse than adoptees. Although most adoptive parents are White (73%), their ethnic-racial and socioeconomic characteristics vary across adoption pathway (Vandivere et al., 2009). In 2009, among domestic U.S. private placements, 71% of parents were White, 19% Black, and 7% Hispanic. Adoptions from foster care were slightly more diverse: 63% of parents were White, 27% Black, and 5% Hispanic. Families adopting from foster care also are more economically diverse. Almost all (92%) of intercountry adoptions are by White parents; Black and Hispanic parents account for 8%. Because these placements require more financial investment, virtually all families are middle to upper income. Thus, sociodemographic differences in parents’ characteristics across these three pathways reflect differences in resources and access to adoption opportunities and services. Black and Hispanic families, particularly those with modest incomes, are largely accessing the foster care system for adoption. Since 1970, sexual minority parents have been adopting in increasing numbers (Gates, Badgett, Macomber, and Chambers, 2007). Adoptive parents generally have similar goals in seeking to adopt—they want to provide a child a home and to expand their family (Malm and Welti, 2010). However, there are some differences in families’ motivations linked to the adoption pathway that families choose. Families choosing private domestic adoption are more likely to cite infertility as one reason for adopting and are more likely to want an infant and a healthy child. Parents adopting through foster care are more likely to seek to provide a child a home and find foster care a more realistic option financially, as well as the quickest pathway for adoption. Parents adopting internationally also seek to provide a child a home, view domestic adoption as too difficult, and often seek to have an adoption with no contact with birth parents (Malm and Welti, 2010; Pinderhughes, Matthews, Deoudes, and Pertman, 2013). Given that parents adopting through different pathways may have different motivations, it may be helpful to understand whether these motivations are linked in different ways to challenges that adoptive families experience. Further research may shed light on parents’ motivations to adopt and adoption challenges. Current adoptive practice also signals a dramatic shift from closed adoptions, where there was no contact between birth and adoptive parents, to placements that are more open, providing a more empowered role for birth parents. In dramatic contrast to adoption of the mid-1900s, when birth parents secretly placed their infants for adoption—often under duress—with an unknown couple, birth parents today often actively participate in making an adoption plan, including selecting the adoptive parents. Very often, adoption plans include contact with the adoptive parents, only during the transfer of the infant or following placement of the child (Grotevant and McRoy, 1998). Whereas adoption up through the late 1900s was largely characterized by placement of healthy children, an increasing trend in adoption is the placement of children with adverse backgrounds (e.g., prenatal complications, postnatal neglect and abuse) and identifiable special needs (Pinderhughes et al., 2013). Although adoption professionals seek to provide parents with comprehensive information about children’s pre-placement histories and implications for their functioning in their new homes (Brodzinsky, 2008; Smith, 2010), parents find themselves challenged, and sometimes poorly prepared, to support their adopted children’s needs. The number of families rearing adoptees with disabilities is increasing, largely due to adoptions from foster care and intercountry placements. An increase in the number of adoptions from foster care has led to increases in the number of families with children who have special needs. As fewer countries send healthy infants for intercountry

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adoption, the proportion of available children who have disabilities has increased. We discuss the nature of these special needs in detail later in the chapter.

Increased Emphasis on Importance of Post-Adoption Services With the increased variation and patterns of adoptions has come increased awareness about the opportunities and challenges of adoption. Such evolving awareness has fueled greater attention on providing post-placement services. In fact, post-placement services historically were limited to the period immediately after placement and before the adoption was legalized, a period that could vary from several weeks, as in the case of an infant placement, to years, as with adoptions from foster care. Adoptive families today, united through various pathways and facing common and specific challenges, have need for more nuanced post-placement services. Some families face challenges incorporating into their homes and rearing children from foster care or institutions who have experienced various types of pre-adoption adversity, including trauma, neglect, and/or multiple separations.Transracial and transethnic families face challenges supporting the healthy identity development of adoptees. Most importantly, adoptive families need available adoption-competent post-placement services throughout the child’s development (Brodzinsky, 2013; Dhami, Mandel, and Sothmann, 2007; Wind, Brooks, and Barth, 2007). As we discuss in more detail later in the chapter, these services now include education and information, support, clinical, and other specialized services. In summary, new contextual realities, such as social media and changes in public opinion, along with changes in formal and informal adoption practices, highlight various complexities in adoption that include common and unique challenges for adoptive families (Pinderhughes, Matthews, and Zhang, 2015). All adoptive families face some common challenges associated with adoption, including navigating the transition to adoptive family life and dealing with loss—for the adoptee, loss of the birth family, and if parents adopt due to infertility, their loss of the possibility of having a biological child. Adoptive parents face the tasks of facilitating communication about the child’s adoption story and managing whatever contact there is with birth family (Grotevant et al., 2007;Wrobel, Grotevant, Berge, Mendenhall, and McRoy, 2003), together with the goal of supporting the adoptee in developing a positive sense of self as an adopted person (Grotevant, Dunbar, Kohler, and Esau, 2000). Depending on the pathway to adoption and adoptees’ or adoptive parents’ characteristics, certain adoptive families also face unique challenges. Families rearing children amidst cultural differences— racial or ethnic differences within the family—face the added task of helping their adoptees develop a healthy identity given their race and ethnicity. Parents of children who have disabilities must provide support to enable adoptees to have as optimal development as possible. Sexual minority parents navigate external views about and possible barriers to their being adoptive parents. These common and unique challenges for adoptive parents are addressed next.

Adoption Socialization: Normative Adoptive Parenting Processes and Challenges Whether adopting a newborn infant, an older child from foster care, or a child placed from another country, adoptive parents encounter a variety of tasks and responsibilities in rearing their children, over and above those usually encountered by non-adoptive parents (Brodzinsky and Pinderhughes, 2002). These tasks are part of adoption socialization, a process by which parents introduce adoption information and experiences into the family in such a way as to promote healthy identity and psychological adjustment in their children and the family as a whole. Among the many facets of adoption socialization are deciding what type of child to adopt and from where; integrating the child into the family, promoting parent–child attachments (Cummings and Warmuth, 2019); sharing adoption information with the child, supporting curiosity about the child’s origins, and helping the child cope 328

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with adoption-related loss; promoting a positive view of the child’s birth heritage, supporting positive self-esteem, and helping the child integrate being adopted into a healthy and secure identity; and, in an increasing number of families, managing contact and relationships with members of the child’s birth family (Brodzinsky and Pinderhughes, 2002). These aspects of adoption socialization are common to all adoptive families; others are unique to specific types of adoptive families. Like all families, those formed through adoption transit various life cycle stages in which adoption issues are impacted by social, emotional, and cognitive developmental changes in their children, as well as by parental attitudes, beliefs, values, and expectations about the children themselves and their experiences of adoptive family life. Addressing adoption issues can be challenging for adoptive parents, sometimes creating uncertainty about the options available to them. As a result, adoptive parents often benefit from guidance and support from adoption and mental health professionals as adoptive families move from one family life cycle stage to another (Brodzinsky, 2008; Smith, 2010).

Becoming an Adoptive Parent: Parenting Adopted Infants Although people adopt for many reasons, infertility continues to be a primary motive for becoming an adoptive parent (Malm and Welti, 2010). Infertile couples often face years of medical testing and treatment in their struggle to conceive a child as well as emotional pain associated with the loss of their long-desired biological offspring (Burns, 2007; Harris, 2013). Unresolved infertility-related loss is an important factor in the emotional life of adoptive parents and has been linked by mental health professionals to difficulties in successful adoption socialization, especially sharing adoption information with children, acknowledging and validating children’s loss, and supporting children’s curiosity about and connections with their birth heritage (Brinich, 1990; Brodzinsky, 1997). The transition to parenthood can be challenging for any parent as they take on new roles and responsibilities and encounter unforeseen stressors and violated expectations (Ryan and Padilla, 2019). Adoptive parents also experience unique stressors as they navigate their way toward parenthood (Brodzinsky and Huffman, 1988; Goldberg, Kinkler, Moyer, and Weber, 2014; Goldberg, Smith, and Kashy, 2010; Moyer and Goldberg, 2017). Becoming an adoptive parent involves a complicated process of decision-making about the type of child to adopt (e.g., infant or older child, boy or girl, healthy child or one with a disability, or child of the same or different race or ethnicity), the type of adoption to pursue (domestic infant placement, domestic child welfare placement, or intercountry placement), and whether contact with birth family is desired. Because of the lack of cultural norms for many of these decisions, adoptive parents often find that their primary support systems (e.g., parents, siblings, extended family, and friends) do not understand what they are going through and/ or question some of the decisions they make. Adoptive parents also require the approval of others before they can become parents. They must apply to an adoption agency or seek the help of an independent adoption practitioner (e.g., a lawyer), undergo an in-depth and often stressful evaluation called a home study, and then wait for an uncertain period before a child is placed with them; even after placement, they must wait still longer for the court to finalize the adoption. In addition, for fost-adopt parents (i.e., foster parents who make the commitment to adopt the child in their care, should the biological parents’ rights be terminated), there is added stress regarding the legal uncertainty of whether the child will be freed for adoption. Because of these stressors, many adoptive parents report feeling uncertain, anxious, helpless, powerless, and depressed as they transition to adoptive parenthood. Adapting to unmet expectations can also be quite stressful for adoptive parents (Goldberg et al., 2010; Moyer and Goldberg, 2017).Troublesome child characteristics that were unforeseen or misunderstood (e.g., difficult temperament, attachment problems), unrealistic views regarding the demands of parenting a special needs child, post-placement changes in the couple’s relationship (e.g., less intimacy), coping with birth family contact, inadequate support from others, and problems encountered 329

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in working with adoption professionals can be challenging for adoptive parents, making the transition to parenthood even more stressful than anticipated. Post-adoption depression is not uncommon among adoptive parents, at rates (e.g., 10–15%) comparable to postpartum depression among biological parents (Foli, South, and Lim, 2012; Foli, South, Lim, and Jarnecke, 2016; Mott, Schiller, Richards, O’Hara, and Stuart, 2011). Post-adoption depression usually is linked to unfulfilled and unrealistic expectations related to self, child, and family, as well as unmet support needs (Foli, 2010; Foli et al., 2012). Despite these additional stressors, most adults make the transition to adoptive parenthood reasonably well. A number of factors help buffer adoptive parents from these unique stressors (Brodzinsky and Huffman, 1988; Goldberg et al., 2010). For example, compared to non-adoptive parents, those who adopt children typically are older when they first become parents and have been married longer. They also report high levels of marital satisfaction and relationship quality, at times even higher than non-adoptive parents (Calvo, Palmieri, Codamo, Scampoli, and Bianco, 2015; Leve, Scaramella, and Fagot, 2001; Pace, Di Folco, Guerriero, Santona, and Terrone, 2015) as well as less internalized adult attachment insecurity (e.g., low anxiety or avoidance; low idealization or derogation; Calvo et al., 2015; Pace et al., 2015). In addition, they are usually more settled in their careers and more financially stable. Furthermore, individuals and couples presumably at the greatest risk for succumbing to the challenges of adoptive parenthood (e.g., those with significant mental health problems and/ or serious marital difficulties) are likely to be screened out for adoptive placement during the home study process because of concerns about the risk for neglect, abuse, or a disrupted placement. When adoptive parents experience strong support from others, it significantly reduces stress during the transition to parenthood (Bird, Peterson, and Miller, 2002). Finally, most adoptive parents receive some pre- and post-placement preparation, education, and support from agencies during the transition to parenthood, which can be extremely beneficial in helping families develop appropriate knowledge, expectations, and skills that facilitate integrating a child into the family, especially one with special needs (Brodzinsky, 2008; Smith, 2010). Once a child has been placed for adoption, parents begin the process of creating a caregiving environment that promotes a healthy and stable parent–child attachment. Generally, adoptive and non-adoptive mothers and their infants are comparably responsive in their interactions (Suwalsky et al., 2012; Suwalsky, Hendricks, and Bornstein, 2008a), despite findings that non-adopted infants are more alert and explore more (Suwalsky et al., 2008a; Suwalsky, Hendricks, and Bornstein, 2008b) Importantly, the earlier a child is adopted, the greater the chances of facilitating a secure attachment. A meta-analysis of attachment studies in Europe, Australia, and the United States found that children placed before 12 months of age were as securely attached as their non-adopted peers; in contrast, those adopted after 12 months showed less attachment security (van den Dries, Juffer, van IJzendoorn, and Bakermans-Kranenburg, 2009). However, researchers have also reported a higher rate of disorganized attachment in some early-placed adopted children compared to non-adopted peers, which is believed to be due to the impact of maltreatment, deprivation, and neglect during the infant’s first weeks and months of life (Lionetti, 2014; van den Dries et al., 2009). Finally, in a sample of Italian adoptive families, secure attachment in adopted infants is facilitated when mothers have a secure attachment state of mind; maternal attachment security is also protective against disorganized attachment in adopted infants (Lionetti, 2014).We discuss impact of early experiences on late-placed adopted children later in the chapter.

Parenting Adopted Toddlers and Preschoolers The emergence of language and symbolic thought during the toddler and preschool years provides a foundation for parents’ initial efforts to share the story of adoption with their child (Brodzinsky, 2011a), often referred to as “adoption entrance narratives.” These narratives are the means by which 330

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parents promote the construction and maintenance of family relationships (Galvin and Colaner, 2013; Hays, Horstman, Colaner, and Nelson, 2016; Kranstuber and Kellas, 2011). They support children’s efforts to make sense of and represent the adoption experience in their emerging sense of self and family. Sometimes this process begins with a spontaneous question from the child about birth and reproduction (e.g., “Where do babies come from?”; “Did I grow in your tummy?”); in transracial and transethnic adoptive families, it may be in response to the child’s developing awareness of ethnicracial differences, both within and outside of the family (Juffer and Tieman, 2009); and in still other cases, it begins with parents reading adoption books to the child as a way of introducing the topic into family conversations. Regardless of how the process begins, talking with children about adoption often creates discomfort among adoptive parents (Barbosa-Ducharne and Soares, 2016). Whereas previously the goal of adoption socialization was integrating the child into the family and fostering secure attachments, now parents are tasked with the responsibility of acknowledging to the child that they are connected to two families—one that gave them life and one that is rearing them. This process of “family differentiation” sometimes creates confusion for parents regarding what information to share and when to share it, as well as worry that children will be distressed by their new reality or that the parent–child attachment will become less secure (Brodzinsky, 2011a). Unresolved feelings regarding infertility can add to a parent’s anxiety about sharing adoption information (Brodzinsky, 1997), leading parents to procrastinate and delay in beginning the telling process. Unresolved feelings can also result in parents adopting a “rejection-of-difference” attitude regarding adoptive versus non-adoptive parenthood (Kirk, 1964). In such circumstances, parents tend to dismiss inherent differences of forming a family through adoption compared to procreation, as well as minimize the unique socialization issues confronting their children and themselves. Such an attitude can compromise parents’ ability to share adoption information in a realistic, transparent, timely, and supportive manner, as well as their ability to help their children understand and cope with adoption-related loss. In contrast, parents who adopt an “acknowledgement-of-difference” approach to adoption are better able to validate and normalize the unique socialization issues confronting family members and support their children in navigating their understanding of and adjustment to being adopted (Brodzinsky, 1987, 2011a; Kirk, 1964). Preschool children generally have considerable interest in their adoption story, as well as positive feelings about being adopted (Brodzinsky, Singer, and Braff, 1984; Juffer and Tieman, 2009).They are especially interested in hearing their parents share the story of their adoption and seeing photographs taken during the adoption process (Juffer and Tieman, 2009). As the telling process unfolds, children readily label themselves as having been adopted and learn their adoption story. But their abilities to comprehend adoption and understand its broader implications are still very limited. Such cognitive limitations can be confusing for parents who often overestimate what their children comprehend when parents hear children use adoption language or repeat some version of their adoption story. Research by Brodzinsky and his colleagues (Brodzinsky et al., 1984; Brodzinsky, Schechter, Braff, and Brodzinsky, 1986) showed that for infant-placed children, it is not until 5–7 years of age that most boys and girls begin to clearly differentiate between birth and adoption as alternative ways of entering a family or begin to experience a sense of loss from being separated from birth family or a sense of marginality associated with adoption-related stigma. It is this growing awareness of the meaning and implications of being adopted that sets the stage for the emergence of adoption-related adjustment problems (Brodzinsky, 2011a; Brodzinsky and Pinderhughes, 2002).

Parenting the School-Age Adopted Child The school-age years are a time of rapid cognitive and social cognitive growth. Children’s ability to analyze life circumstances, alternative problem solutions, social situations, others’ points of view, as well as their own views deepens and become more complex during this developmental period 331

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(Collins and Madsen, 2019). Furthermore, these cognitive and social cognitive changes pave the way for adopted children to more fully understand the meaning and implications of the adoption narrative being shared by their parents (Brodzinsky, 2011a; Brodzinsky et al., 1984; Brodzinsky et al., 1986; Sherrill and Pinderhughes, 1999). The vast majority of children during middle childhood show considerable interest in their background and the circumstances of their adoption, especially when they have been placed transracially and from another country (Juffer and Tieman, 2009). Children’s emerging cognitive abilities allow them to imagine possible alternatives confronted by their birth parents, leading them to wonder why they had to be adopted, and, given that they were, what it means about their birth parents and themselves. As a result, the adoption story that was previously received in an unquestioning and positive manner now is viewed with more nuance, complexity, and emotional confusion. “If she didn’t know how to be a good mother, why didn’t she ask someone to teach her so that she could keep me . . . it just seems that she could have learned and then maybe she could have kept me” (Joshua, a 9-year-old boy adopted from Russia); “My parents told me that she was too young to take care of me . . . and she wanted me to have a good family . . . but I sometimes think that she just didn’t want me . . . didn’t want to bother with me . . . that I was too much trouble” (Lila, 10 year old girl adopted from Guatemala). For both Joshua and Lila, development has resulted in new ways of thinking about their adoption and the reasons why they were not kept by the birth family. The emergence of logical thinking also sensitizes children to the fact that they not only have gained a family through adoption, but have lost one as well. Loss is a central issue for adopted individuals and much more complicated than is often realized (Brodzinsky, 2011a). Children in closed adoptions lose connection with their birth parents and birth siblings and extended birth family. Many lose connections with previous non-biological caregivers and supports, such as foster parents, foster siblings, friends, teachers, coaches, orphanage staff, and others. The loss of early caregivers, whether biological parents or others, also means the loss of a “meaning-maker” who can provide the information necessary for children to understand their early life experiences and how they have been shaped by them. In addition, children sometimes experience status loss associated with adoption-related stigma, which is frequently experienced as microaggressions from others (Garber and Grotevant, 2015). Furthermore, when there are obvious dissimilarities between children and other family members in physical appearance (such as in transracial and transethnic adoptions), personality traits, or abilities, children may feel as if they do not “fit in” the family. For those placed across racial, ethnic, and cultural lines, there is also growing awareness of the loss of racial, ethnic, cultural, and sometimes linguistic connections. Finally, for many adopted individuals, there is a sense that part of the self has been lost, which can compromise identity development (Grotevant, 1997). As children develop a more nuanced view of adoption, they often begin to feel ambivalence about their life circumstances. Parents need to understand that the shift from a generally positive view of adoption during the preschool years to a more complex and ambivalent view during the school-age years is a very normal process. It represents neither a failure of parenting nor an indication of emotional problems in the child. Rather, in most cases, children’s ambivalence reflects a grief reaction that emerges in response to adoption-related loss. For many children, grief is subtle and only manifested in slight shifts in attitudes and feelings about being adopted. In such cases, unless children have been forthcoming with their feelings, parents may not even realize that they are experiencing confusion, sadness, or other negative feelings about their adoption. For other children, especially those placed at older ages who have been separated from previous attachment figures, grief is much more acute and obvious. One of the critical tasks for adoptive parents during this period is to create a caregiving environment that supports children’s growing curiosity about their origins, reinforces a respectful view of the birth family and their heritage, maintains open communication about adoption issues, validates and normalizes children’s reactions to adoption, and supports their grief work as they navigate 332

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through this process (Brodzinsky, 2011a). The ability to meet these challenges requires that parents recognize the inherent differences in rearing an adopted child compared to one that was born into the family and are open to listening to and respecting their child’s point of view about their adoption experience, which can be quite different from their own. In summary, the middle childhood phase of the family life cycle presents parents with a number of challenges in relation to adoption socialization. Of greatest importance is the need to facilitate openness in adoption communication within the family and to guard against creating a rigid, impermeable psychological barrier between the adoptive and biological families, which can present the child with a dilemma of divided loyalties. Although most parents appear quite successful in handling these socialization tasks, some are not. It is in the latter case that we are more likely to observe serious problems in children’s adoption adjustment.

Parenting the Adopted Adolescent Adolescence brings with it a host of developmental changes that have important implications for all family members as teenagers and their parents continue to cope with issues related to adoption (Soenens, Vansteenkiste, and Beyers, 2019). The emergence of abstract thinking allows adopted individuals to understand their unique family status in deeper and more complex ways, including the biological, sexual, relational, sociocultural, and legal implications of adoption (Brodzinsky, 2012; Brodzinsky et al., 1984). They have a more realistic and perhaps a more empathic understanding of the circumstances confronting their birth parents, as well as recognition of the societal role of adoption in meeting the needs of neglected, maltreated, and abandoned children. In addition, their increasing awareness of the perceptions, attitudes, and values of others sensitizes them to the fact that many people see adoption as a “second-best” route to parenthood and do not necessarily envy them for their adoptive family status. In short, the complexity with which adopted teenagers are able to understand adoption informs their emerging sense of self. Developing an adoptive identity revolves around a number of questions, some global and others quite specific (Grotevant, 1997; Grotevant and Von Korff, 2011): “Who am I as an adopted person? What does being adopted mean to me? How does being adopted fit into my understanding of self, relationships, family, and culture? Who are my birth parents and why didn’t they keep me? What is my genetic heritage? Do I have any siblings?” Although issues of identity do not begin in adolescence, this is a time in which such questions receive more focused attention as the teenager constructs meaning about their family status, their connection to their birth heritage, and how being adopted fits into other aspects of their self. There is considerable variability among individuals regarding the salience they attribute to their adoptive status. For some it is relatively unimportant, no more than a fact of life; for others, it is so fundamental to their sense of self that it colors virtually everything they experience. For most people, however, adoption appears to occupy a meaningful but more balanced place in their emerging identity, neither an aspect of self that is ignored, nor one that overshadows other parts of the self. The personal meaning of being adopted is highly influenced by the many contexts impacting the person, including culture, community, family, peers, and school (Grotevant, Dunbar, Kohler, and Esau, 2000). When adopted individuals experience positive views about adoption from others, whether at the broader cultural level or at the more immediate levels of family, peer, and school relationships, they find it easier to integrate this life experience into a healthy and positive sense of self. Families that create a more open communicative environment regarding adoption issues and support their children’s curiosity about their origins are more likely to foster positive self-esteem in their boys and girls (Brodzinsky, 2006). Integrating the past into the present and imagining oneself in the future is another aspect of identity formation that can be complicated for adopted teenagers. Being cut off from one’s origins or 333

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being prevented from obtaining information about one’s history by restrictive laws or social service regulations can be extremely frustrating for those who are intent on knowing about their heritage and the reasons for their adoption. As previously noted, those who have been separated from previous caregivers lose their “meaning makers,” people who knew them when they were younger and who could have helped them understand what happened to them. Adolescence can also be especially difficult for youth placed transracially or transethnically, especially for those who have had inadequate role models and experiences that would allow them to explore the personal meaning and importance of their ethnic-racial minority status. Adoptive parents often need guidance and support in helping their teenagers navigate the complexities of adolescent adoption issues. They need to recognize the normality of their children’s interest in their heritage and support their efforts in searching for answers that can fill “identity gaps” related to adoption. Maintaining an open communicative environment is essential in achieving this goal. So too is ensuring that teenagers understand that they have their parents’ support in deciding if, and when, they will seek to contact birth family members.

Openness in Adoption There has been a growing trend toward increased openness in adoption. Open adoption has two meanings. Structural openness involves the extent of direct and indirect contact that exists between the adoptive and birth families. Communicative openness refers to the extent to which families are able to discuss adoption information with their children in an honest, comfortable, empathic, and supportive manner. Although conceptually and empirically related, they constitute two distinct aspects of the adoption experience (Brodzinsky, 2005, 2006).

Structural Openness in Adoption Structural openness ranges from fully confidential adoptions, in which there is no sharing of identifying information between the families and no contact, to mediated adoptions, in which contact is through an intermediary such as the adoption agency, to fully disclosed adoptions, in which the families are aware of each other’s identity and meet face to face and/or have indirect contact (e.g., by email, telephone, social media, and other communication methods) at the time of placement and/ or in the post-adoption years (Grotevant and McRoy, 1998). The frequency and nature of contact between adoptive and birth families are quite fluid and often change over time as the needs and life circumstances of the parties change (Grotevant et al., 2007). In addition, open adoption varies considerably from one type of adoption to another. For example, data from the National Survey of Adoptive Parents found that 68% of private domestic adoptions involved some post-adoption contact, whereas only 39% of domestic foster care adoptions and 6% of intercountry adoptions involved such contact (Vandivere, Malm, and Radel, 2009). These figures may underestimate the extent of direct and/or indirect contact for all three types of adoption (Brodzinsky and Goldberg, 2016; Brodzinsky and Goldberg, 2017). There has been some concern among adoption professionals that structurally open adoptions could create difficulties for members of the adoption kinship system (e.g., adoptive parents, birth parents, and adopted individuals), leading to destabilization of the adoptive placement and/or the adoptive parent–child relationship. However, research has not supported these concerns. Although contact with birth family does not appear to necessarily enhance post-placement adjustment of adoptive parents, it does not undermine it either (Ge et al., 2008). Furthermore, other benefits of contact have been noted (Berry, 1991; Ge et al., 2008; Grotevant, McRoy, Elde, and Fravel, 1994; Grotevant and McRoy, 1998; Hollenstein, Leve, Scaramella, Milfort, and Neiderhiser, 2003;Von Korff and Grotevant, 2011). For example, adoptive parents report having more positive relationships with 334

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birth family and being more satisfied with the placement arrangement when they have contact with birth family members. They also feel more entitled to their children, have less fear of birth parents’ attempts to reclaim their boys and girls, and report more acceptance of their children’s curiosity about their origins. Adoptive parents are also more satisfied with open adoption when they have control over the nature and extent of contact with birth family. In contrast, when adoptive parents feel pressured into an open adoption arrangement, whether by the agency or because they believe it’s the only way they can adopt, they are likely to report less satisfaction with open adoption (Berry, Dylla, Barth, and Needell, 1998; Grotevant, Perry, and McRoy, 2005). Adopted children who have contact with birth family members also appear to benefit from the experience (Berge, Mendenhall, Wrobel, Grotevant, and McRoy, 2006; Grotevant and McRoy, 1998; Hawkins et al., 2007; Mendenhall, Berge, Wrobel, Grotevant, and McRoy, 2004; Von Korff and Grotevant, 2011; Wrobel, Ayers-Lopez, Grotevant, McRoy, and Friedrick, 1996). Greater openness results in more opportunities for family discussions about adoption, increased curiosity on the part of children regarding their heritage and the circumstances leading to placement, more interest in searching for background information and birth family members, and a better understanding of the meaning and implications of being adopted. Adopted teenagers in open placements also report more satisfaction with the information and contact they have than those in closed placements, as well as a clearer sense of their adoptive identity. Finally, most research suggests that contact with the birth family neither enhances nor undermines children’s psychological adjustment and self-esteem (Brodzinsky, 2006; Ge et al., 2008; Von Korff, Grotevant, and McRoy, 2006). What appears more important for children’s adjustment is their satisfaction with openness rather than a specific type or level of contact (Grotevant, Rueter,Von Korff, and Gonzalez, 2011). In summary, research generally supports the view that contact with birth family is associated with more benefits than drawbacks. However, this conclusion should not be interpreted to suggest that families do not experience challenges related to contact. Structural openness is a dynamic process that changes over time. Determining whether it is safe to have contact with specific birth family members (e.g., those who have histories of mental illness, substance use, or criminality), establishing appropriate “boundaries” regarding frequency and the nature of contact, gauging the impact of contact on family members, and resolving inevitable conflicts with birth family members regarding contact issues are ongoing responsibilities faced by adoptive parents (Black et al., 2016; Grotevant, 2009; Neil and Howe, 2004).

Communicative Openness in Adoption Adoption communicative openness involves the process of sharing adoption information with children, validating their connection to birth family, honoring their heritage, and respecting children’s unique perspectives and feelings about their adoption experience. It also involves the sharing of adoption-related feelings and the development of emotional attunement about adoption issues between parent and child (Brodzinsky, 2005). In discussing adoption communication, Rueter and Koerner (2008) distinguished between conversation orientation versus conformity orientation. The former is characterized by family interactions in which all members co-discover the meaning and social reality of their adoption experiences, and in which parents respect and support their children’s unique perspectives and feelings about being adopted. In contrast, the latter is characterized by family interactions in which the meaning of adoption is defined primarily by parents, with children expected to conform to their parents’ points of view. This distinction highlights the importance of recognizing that talking with children about adoption is not inherently the same as adoptive communicative openness. The latter, which is consistent with their notion of conversation orientation, reflects not only sharing adoption information with children but also being willing to listen, respect, and affirm children’s unique points of view and feeling states. 335

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Research generally supports the benefits related to adoption communicative openness (BarbosaDucharne and Soares, 2016; Brodzinsky, 2006; Horstman, Colaner, and Rittenour, 2016; Howe and Feast, 2000; Kohler, Grotevant, and McRoy, 2002; Rueter and Koerner, 2008; Skinner-Drawz, Wrobel, Grotevant, and Von Korff, 2011). For example, youth who experience more open and supportive family communication about adoption report more trust of their parents, fewer feelings of alienation from them, better family functioning, and more efforts to discover information about their origins. Adults who reported feeling more comfortable raising adoption questions with their parents when they were younger also reported feeling more positive about their adoption experience and closer to their parents than those who described discomfort in family discussions about adoption. Communicative openness is associated with better psychological adjustment among adopted individuals, including more positive self-concept and self-esteem (Brodzinsky, 2006; Hawkins et al., 2007; Levy-Shiff, 2001), more positive adoption identity (LeMare and Audent, 2011), and fewer behavior problems (Brodzinsky, 2006). However, Neil (2009) and Grotevant, Rueter,Von Korff, and Gonzalez (2011) failed to find a relation between communicative openness and children’s and adolescents’ psychological adjustment. Overall, research suggests that when children are reared in a home environment in which they feel comfortable in expressing their thoughts and feelings about being adopted, and when their unique adoption experiences are understood, respected, and supported by parents, they are much more likely to internalize their adoption experience in a way that reflects a positive sense of self.This is especially true when parents foster a conversation orientation to adoption discussions and provide an appropriate level of structure and guidance to adoption family narratives (e.g., helping to interpret background information, correcting obvious misperceptions on the part of their children, supporting search interests and activity, and so forth) (Rueter and Koerner, 2008).

Unique Adoptive Parenting Processes and Challenges Adoptive parents face rearing children amidst cultural differences, which can pose certain unique challenges for adoptive families. Those differences may be reflected between parents and adopted children, as in transracial, transethnic, and intercountry adoptions, or they may be reflected in parents’ characteristics that situate them as different from many adoptive families, as in sexual minority parents who adopt. Historically, little attention was paid to cultural differences, except regarding family formation. In the mid-1900s, when adoption served the needs of middle-class couples seeking to become parents, adoptive placements focused on matching children and families on physical characteristics. The message to rear adopted children “as if ” they were biological children was given to adoptive parents even when they were adopting across race, ethnicity, or culture. Furthermore, until recently, sexual minority parents were prohibited from fostering or adopting. Today, adoptive parents must consider the cultural differences that they and their children navigate as they work to support their child’s adoptive identity and identity as a cultural being. Parents rearing children with pre-adoption adversities and/or special needs also face unique challenges in supporting the child’s placement adjustment and development.

Parenting Children From Different Racial or Ethnic Backgrounds Typically, transracial, transethnic, and/or intercountry adoptive families are headed by parents from the dominant host culture (in the United States, European American parents), and adopted children are of Hispanic/Latinx, African, or Asian descent. Early research on domestic transracial adoptions generally found that these youngsters were well adjusted, had positive relationships with parents, and did not suffer from psychological/behavioral problems (Bagley, 1993; Brooks and Barth, 1999; Feigelman and Silverman, 1983; McRoy and Zurcher, 1983; Simon, Altstein, and Melli, 1994;Vroegh, 336

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1997). Moreover, in a meta-analysis of research on self-esteem, Juffer and van IJzendoorn (2007) found that transracial adoptees do not suffer from low self-esteem.Yet, early studies on racial identity and racial attitudes among transracially adopted children and youth yielded contradictory findings. Some researchers reported reasonably positive racial identities (Brooks and Barth, 1999; Feigelman and Silverman, 1983;Vroegh, 1997), whereas others indicated confused, ambivalent, or negative racial identity among youngsters and adults placed across racial lines (McRoy and Zurcher, 1983; Shireman and Johnson, 1986). The coming-of-age of adults around the world who were transracially or transethnically adopted has enabled their voices to enrich the field’s understanding of the complexities they experienced as children and continue to experience as adults (Baden, Treweeke, and Ahluwalia, 2012). Whether anecdotal reflections (Trenka, Oparah, and Shin, 2006), research-based qualitative (Haenga-Collins and Gibbs, 2015; Hübinette and Tigervall, 2009; O. Kim et al., 2017), or quantitative accounts (Basow, Lilley, Bookwala, and McGillicuddy-DeLisi, 2008; McGinnis, Smith, Ryan, and Howard, 2009), many adult adoptees articulate their struggle to navigate issues of belonging and exclusion, as well as probing questions from others that prompt exploration of their cultural, ethnic, or racial identity (Garber and Grotevant, 2015; O.M. Kim, Hynes, and R. M. Lee, 2017). Lee (2003) aptly coined the term “transracial paradox” to describe the complexities that transracial adopted persons face. He noted that transracial adoptees receive the benefits conferred to their families based on their parents’ statuses (typically White and ethnically European), but contend with other, often negative experiences linked to their lower status of being adopted (Baden, 2016), an ethnic-racial minority (Sue et al., 2007), and/ or an immigrant (Lee, 2003). The experiences articulated above point to the complexities in navigating the transracial paradox for adoptees, and that adoptees perceive whether and how their parents address adoption, and race/ethnic differences, as consequential (Docan-Morgan, 2011; McGinnis et al., 2009; Samuels, 2009). Indeed,Tuan and Shiao’s (2011) qualitative study of 59 Korean American adopted adults reflecting on their socialization experiences and current life experiences illustrated the importance to adoptees of how transracial adoptive parents navigate ethnic-racial differences. For adoptees, parents’ acknowledgment of ethnic-racial differences was critical but insufficient in helping the adoptee feel supported. Rather, whether parents actively provided support and advocacy when children faced difficult situations outside the home were key in shaping adoptees’ felt experience of coping alone and feeling misunderstood or being supported. We turn now to discuss transracial and transethnic adoptive parents’ support of their children’s identity development, referred to as ethnicracial socialization, after briefly summarizing the literature on the types of ethnic-racial socialization (Hughes et al., 2006).

Ethnic-Racial Socialization The support of identity development in transracial and transethnic families typically includes multiple types of ethnic-racial socialization. Here, we use the definition and subtypes offered by Hughes and colleagues regarding these processes, which parents use to provide “information, values and perspectives about ethnicity and race to children” (Hughes et al., 2006, p. 747), whether biological or adopted. Cultural socialization is designed to provide adopted children exposure to their birth culture; preparation-for-bias helps prepare children to deal with experiences of stigma; egalitarian socialization promotes the idea of a level playing field for all and the importance of hard work; and color-blind messages minimize or deny the importance of race. Most research on adoptive families has centered on cultural socialization and preparation-for-bias. A new focus is emerging regarding transracial and transethnic families, bicultural socialization, in which parents provide cultural socialization and promote connection to the family’s and adoptive country’s culture. Adoption professionals encourage families to provide cultural socialization to support adoptees’ ethnic identity development, which can include their interest in their culture, connection to their 337

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cultural group, pride in their background, or ethnic self-label (Baden, 2007; Bebiroglu and Pinderhughes, 2012; Goldberg, Sweeney, Black, and Moyer, 2016; Huh and Reid, 2000; Mohanty, Keoske, and Sales, 2006; Pinderhughes, Zhang, and Agerbak, 2015). Cultural socialization can range from providing books, clothing, and ethnic foods to language lessons or culture lessons—often delivered through culture camps—and having a cultural mentor who typically is an older person from the same racial or cultural background.This range of approaches can be viewed on a continuum of depth of cultural socialization, with parents providing some activities that reflect deeper cultural exposure than other activities (Zhang and Pinderhughes, 2018). Preparation-for-bias conveys messages about discrimination and can offer suggestions for coping with such experiences (Hughes et al., 2006). Parents will discuss stereotypes of the adoptee’s racial group, others’ assumptions about the adoptee, as well as discrimination—both observed and experienced. Preparation-for-bias can be more challenging to engage in than cultural socialization, as it typically requires that parents address negative messages or assumptions about the adoptee’s racial group. These processes can take place in two types of situations. First, parents can plan preparation-for-bias conversations proactively, when they feel emotionally ready to have these difficult conversations. There also are those situations that provide in-the-moment opportunities for preparation-for-bias. These situations often take place when adoptive parents and adoptees are out together, and the adoption is publicly visible (Wegar, 2000). Parents and children often receive unwelcome questions and comments from strangers that reflect assumptions about adoption (Baden, 2016; Farr, Crain, Oakley, Cashen, and Garber, 2016) and race (Sue et al., 2007). Other times, children come home with stories about their experiences, for example being called racial slurs, being teased about their skin color or shape of their eyes, being bullied for looking different, or treated insensitively by teachers (Docan-Morgan, 2011; Tuan and Shiao, 2011;Vashchenko, D’Aleo, and Pinderhughes, 2012). When any of these situations occur, parents must navigate a conversation, typically unanticipated. During these conversations, emotions often can be charged, and parents may struggle with what to say and how to say it. These conversations thus can be very uncomfortable and parents can find themselves limiting or avoiding them (Goar, Davis, and Manago, 2016; Tuan and Shiao, 2011). It is important for parents to remain aware that, as they make choices to engage in or avoid talking about challenging situations, they are modeling for their children choices about dealing with bias. Taking the opportunity to practice these discussions, as well as to reflect on one’s views about ethnic-racial differences, can help parents make more effective choices when these conversations arise (Pinderhughes, Matthews, and Zhang, 2016; Stevenson, 2014). Notably, transracial adoptive parents who have experienced stigma themselves, such as sexual minority parents, are more likely to have these conversations (Goldberg and Smith, 2016). Across development, parents provide more cultural socialization than preparation-for-bias (Johnston, Swim, Saltsman, Deater-Deckard, and Petrill, 2007), perhaps reflecting the challenges with having conversations about bias and stigma. Johnston and colleagues (2007) offer the only data on age trends in these processes. Cultural socialization, actively provided as early as age 4, seems to peak around age 12 and decline through adolescence. Preparation-for-bias becomes evident somewhat later and peaks around age 14, with just a slight decline across adolescence. Emerging patterns in research on cultural socialization and preparation-for-bias suggest that the role that adoptive parents play in these processes, for example, how they think about ethnic-racial differences or their approach to providing cultural socialization and preparation-for-bias, is critical.

Parent’s Role in Socialization Processes The provision of cultural socialization and preparation-for-bias does not occur in a vacuum, but rather is thought to be linked to parents’ beliefs and attitudes (J. Lee,Vonk, and Crolley-Simic, 2015). Pinderhughes (2013) suggested that these processes are linked to parents’ attitudes about cultural and 338

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ethnic differences, beliefs about the value of providing these forms of ethnic-racial socialization, as well as the parents’ or family’s ethnic identity. Parents are more likely to acknowledge cultural background differences, whereas they are less likely to acknowledge ethnic-racial differences (Bebiroglu and Pinderhughes, 2012; Tuan and Shiao, 2011). When parents acknowledge cultural differences, value the importance of providing exposure to their child’s culture of origin, or frame the adoptive family’s ethnicity as multicultural, they are more likely to provide cultural socialization (Berbery and O’Brien, 2011; O. M. Kim, Reichwald, and Lee, 2013; R. M. Lee, Grotevant, Hellerstedt, Gunnar, and Minnesota International Adoption Project Team, 2006; Pinderhughes, Zhang, et al., 2015). Parents who acknowledge ethnic differences, see these differences from not only their own but also their children’s viewpoints, or believe in the value of preparing children for stigma are more likely to provide preparation-for-bias (Berbery and O’Brien, 2011; Crolley-Simic and Vonk, 2011; R. M. Lee et al., 2006). Parents’ approaches to providing cultural socialization or preparation-for-bias can range from taking the initiative to provide activities and discussions, proposing activities to children for their consideration and choice, waiting until children express interest or ask, and offering no experiences (Bebiroglu and Pinderhughes, 2012; Goldberg et al., 2016; Harf et al., 2015; Tessler, Gamache, and Liu, 1999).When parents take the initiative to provide cultural socialization, adoptees are more likely be very interested in and enjoy their activities (Bebiroglu and Pinderhughes, 2012). In contrast, when parents avoid conversations, especially about bias experiences, adoptees may come to feel that they cannot seek help to deal with these types of experiences (Docan-Morgan, 2011). As adoptive parents provide cultural socialization or preparation-for-bias, they may reflect on their own views and feelings about race/ethnicity, culture, and adoption. Adoptive parents who have expanded their definition of the family’s ethnicity to include the adoptee’s background (for example, “White parents with Chinese daughter”; “Multicultural family”) are more likely engage in these self-reflections than parents who do not expand their family ethnic description (Pinderhughes, Zhang, et al., 2015). Some adult adoptees, reflecting on their family experiences, encourage adoptive parents to examine their own identities in the hopes that such self-reflection will enable parents to provide better cultural socialization (Palmer, 2011). Harrigan (2009) observed that adoptive parents personally navigate contradictions, including the degree to which their role is similar to and different from other parents, as well as their similarity to and difference from the adoptee. In this process, adoptive parents may experience tension balancing similarity and difference. How parents manage this contradiction—acknowledging or rejecting it, embracing or avoiding discussion—can leave adoptees feeling supported or isolated. Adoptive parents must balance the vast array of potential cultural socialization and preparationfor-bias activities, along with the anticipated benefits of these activities, as well as any contextual considerations that might affect the availability or accessibility of these activities. Parents rearing transracially or transethnically adopted children in urban settings are likely to have access to a greater variety of interpersonal resources to support their child’s ethnic-racial identity than are parents rearing children in small towns or rural communities. In these latter circumstances, parents may have to navigate among resources on the Internet that vary in their quality in search of activities or information appropriate for their child. These processes may differ across urban and rural settings and internationally. Differences in cultural socialization in families in the Netherlands, Norway, and the United States was related to differences in the country-based sociopolitical realities, such as percentage of ethnic minorities in the population and experiences of stigma (Riley-Behringer, Groza, Tieman, and Juffer, 2014).Thus, an understanding of parents’ engagement in cultural socialization should consider the prevailing views and practices regarding ethnic and cultural differences in one’s country. In keeping with a focus on how parents support their adopted child’s ethnic identity, we turn briefly to the impact of ethnic-racial socialization on children’s functioning. Some studies have found that when parents provide cultural socialization, their children are more likely to have positive 339

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self-esteem, feel connected to their culture of origin, and have fewer externalizing behaviors (Huh and Reid, 2000; Johnston et al., 2007; Manzi, Ferrari, Rosnati, and Benet-Martinez, 2014; Pinderhughes, Zhang, et al., 2015; Yoon, 2004). Hu, Anderson, and R. M. Lee (2015) studied adolescents’ and parents’ reports of cultural socialization, along with the general parenting environment—parental involvement and parent–child conflict—and youth ethnic identity. They found that whereas parentreported cultural socialization was related to ethnic identity, general parenting environment was not. In short, parents who want to support their children’s ethnic identity should incorporate cultural socialization into their parenting processes. Although less is known about the impact of preparationfor-bias, research has found that children who received messages preparing them to deal with stigma were more likely to have higher self-esteem and less depression (Mohanty, 2010; Mohanty and Newhill, 2011). Other studies illustrate complexities in relations between preparation-for-bias and adoptees’ functioning. Preparation-for-bias can serve a protective role when adolescents experience high levels of discrimination—they are less likely to feel stress related to the stigma they experienced (Leslie, Smith, Hrapczynski, and Riley, 2013). However, too little or too much preparation-for-bias might undermine school engagement: adopted Korean adolescents who reported moderate levels of preparation-for-bias had positive connections with school, whereas those reporting low or high levels of preparation-for-bias had negative connections (Seol,Yoo, Lee, Park, and Kyeong, 2016). Finally, Anderson, Lee, Rueter, and Kim (2015) observed three patterns of family communication about ethnic-racial differences in adoptive families with South Korean adoptees and their links to adoptee delinquent behaviors. In families where all members either acknowledged differences or rejected differences, adolescents had lower levels of delinquent behaviors than adoptees in families where there were discrepant views about differences and the importance of differences. The researchers suggest that the cultivation of shared views about race and ethnic differences within the family may support adoptee adjustment.

Bicultural Socialization An emerging focus is on adoptees’ bicultural identity—how they view themselves and/or their connections to their cultural group of origin and to their family’s cultural group or, in the case of intercountry adoptees, their adoptive country. Bicultural identity integration—identification with one’s birth cultural group and one’s adoptive family’s cultural group—may be positively linked to well-being among adolescents and young adults (Baden, 2002; Ferrari, Rosnati, Manzi, and BenetMartínez, 2015; Manzi et al., 2014). For example, among Italian youth, ethnic and national identities were linked to bicultural identity integration, which, in turn predicted more positive well-being 1 year later (Ferrari et al., 2015). Thus, when youth are able to integrate their identities related to their ethnic background and their connection to their adoptive country, they report more confidence, self-acceptance, personal growth, and relationships with others. Youth who were not able to integrate their ethnic and national identities—being “caught between two cultures,” so to speak— were more likely to have externalizing problems (Manzi et al., 2014, p. 898). Thus, having some balance in their bicultural identities is linked to more positive adjustment. Little is known about the role of parents in promoting bicultural identity integration.Youth who receive cultural socialization are also more likely to feel connected to the family’s national identity (Manzi et al., 2014), suggesting that parents also actively support processes of learning about and connecting to one’s adoptive country. In a recent small interview-based study, parents explicitly talked about working to minimize tensions between their children’s Asian American heritage and the European American heritage of the adoptive family (Chen, Lamborn, and Lu, 2017). As greater attention is directed to parents’ role in supporting bicultural identity integration, there will be greater understanding of the complexities that transracially and transethnically adopted children experience, and more guidance can be provided to parents about how to support their adopted child. 340

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In summary, although professionals encourage adoptive parents to provide cultural socialization and preparation-for-bias, the impact of these processes on adopted children’s adjustment and functioning appears to be complex and not yet fully understood. As researchers are better able to capture the complexities in these processes in research designs, the impact of ethnic-racial socialization processes will be better understood.

Parenting Late-Placed Children and Those With Special Needs Another set of unique challenges confront adoptive parents who are rearing children placed at older ages (late-placed adoptees) and those with special needs or disabilities. Although researchers differ in their definition of late-placed adoptees (Hawk and McCall, 2010), in this chapter, late placement is defined as being adopted after infancy, at approximately or after 18 months. This is a period when the accumulation of adverse early experiences, especially neglect, can undermine later development (Merz and McCall, 2010, 2011).Very often, late-placed children also have special needs. In fact, having a disability can create long waits for children who need adoption. However, not all children with disabilities have been placed after infancy. Some early-placed children—those placed as infants—also have disabilities, and in some cases these disabilities are not identified until after placement. Given the overlap between late-placed adoptees and adoptees with special needs, we discuss both groups in this section. Adoptions of children with special needs can be classified into two groups—those involving children with disabilities that have reasonably predictable manifestations (i.e., physical and developmental disabilities, mental retardation, and chronic medical conditions) and those involving children with disabilities that have unpredictable manifestations (i.e., emotional or behavior problems). (For more on parenting children with disabilities, see Hodapp, Casale, and Sanderson, 2019). Generally, adoptions of children with disabilities who have more predictable manifestations tend to be quite successful, as indicated by relatively low rates of placement disruption, when the child is removed from the home prior to the legal finalization of the parent–child relationship (Rosenthal, 1993). In addition, among intact placements of children with developmental or physical disabilities, parents’ satisfaction is usually high and family adjustment is positive (Glidden, 1991, 2000; Rosenthal, 1993). In fact, when compared with a group of birth families of children with developmental disabilities, adoptive parents of developmentally disabled children report less stress in parent, family, and child functioning (Glidden, 1991). Adoptive parents of children with developmental disabilities are more likely to have their needs for post-adoption services met than are parents of children with emotional and behavioral disabilities (Hill and Moore, 2015). Of greater concern regarding placement outcome are adoptions of children who manifest serious emotional and behavioral problems. Placement disruption rates for these children range from 10% to 20% (Rosenthal, 1993; Festinger, 2014). Older age at the time of placement, lack of or insecure attachment, and/or the presence of severe problems, such as chronic stealing, aggressiveness, fire setting, sexual acting out, and suicidal behavior, are the most frequent correlates of adoption disruption (Barth and Berry, 1988; Festinger, 2014; Partridge, Hornby, and McDonald, 1986; Rosenthal, 1993; Selwyn, Wijedasa, and Meakings, 2014). Other factors commonly associated with adoption disruption, as well as post-placement adjustment difficulties, include early environmental adversity, such as neglect, physical abuse, sexual abuse, multiple foster placements, and time in institutions (Festinger, 1990; Merz and McCall, 2010; Pinderhughes, 1998; Selwyn et al., 2014; van den Dries, Juffer, van IJzendoorn, and Bakermans-Kranenburg, 2009). Despite the higher disruption rates and adjustment problems, the large majority of placements of children with special needs are successful, as measured by family intactness, by parents’ and children’s reports of satisfaction with the adoption, and by caseworkers’ evaluations of placements (Groze, 1996; Matthews, Tirella, Germann, and Miller, 2016; Paulsen and Merighi, 2009; Pinderhughes, 1998). Some parents proactively choose to adopt children with special needs, viewing their choice as an important altruistic step for a child in need who might otherwise not find a permanent, loving family. 341

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Other parents initiate adoption with the intent of rearing a healthy infant but opt to adopt a child with special needs when they find healthy infants are rarely available. Among these parents, some may feel pressured (whether within themselves or by others) to adopt a child with special needs to be able to adopt. This especially has been the experience for sexual minority parents (Goldberg, 2010; Moyer and Goldberg, 2017). Once children are placed, some parents realize that they did not fully understand all the adoptees’ limitations or challenges linked to the special needs. Parents adopting children with behavior or emotional disabilities often find that the adoptee’s functioning is inconsistent, making it difficult to anticipate and plan for how to respond and support her. These parents face the task of adjusting their expectations. And still other parents adopt children who they believe to be reasonably healthy, only to find out that their son or daughter has one or more special needs or disabilities that were not identified before placement but emerge after the child joined the family. This unfortunate pattern is increasing among adoptions, especially among intercountry placements, where birth country assessments and record keeping of children’s functioning are often not comprehensive. In a survey of over 1,000 parents who adopted internationally, 493 were rearing a child with special needs (Pinderhughes, Matthews, Deoudes, and Pertman, 2013). In almost three quarters of these families, the adoptee received a new diagnosis after placement. For some families, the diagnosis was the first identification of any special need, whereas for other families the diagnosis was an additional special need. Further compounding the stress of discovering the special need after placement, almost two-thirds of parents discovered the special need years later, when problems emerged as children grew older, attended school, and faced demands that revealed their limitations. In other cases, children had challenges that were mis- or undiagnosed in their birth country, delaying their chances to receive intervention. Thus, parents adopting children through intercountry adoption may need to be prepared to encounter new challenges for their adopted children after placement. The special needs that children struggle with often are due to prenatal adversities and/or experiences of neglect or trauma in their pre-adoptive settings, which include birth families, foster families, and institutions. Children placed from other countries often have experiences in institutions, which vary widely in how well caregivers meet children’s needs for safety, physical nourishment, and emotional and intellectual stimulation (McCall, 2011). Consequently, children adopted after just a few months of age may have experiences that constitute some type of adversity. Until the 2000s, due to limited knowledge about the neurobiology of trauma effects, professionals only understood and focused on the behavioral consequences of trauma and neglect and prepared parents for typically inconsistent behavioral manifestations of emotional and behavioral maladjustment (Brodzinsky and Pinderhughes, 2002). Since 2000, research on the neurobiological consequences of trauma and neglect, particularly for children adopted from institutions, has dramatically increased (Hart and Rubia, 2012; Loman et al., 2013; McDermott, Westerlund, Zeanah, Nelson, and Fox, 2012; Mehta et al., 2009; Nelson, Bos, Gunnar, and Sonuga-Barke, 2011; Pollak et al., 2010) and has painted a much more complex picture of the devastating but often unpredictable impact of early trauma on human development and functioning. In short, converging findings point to the possibility of important delays in cognitive, language, and social development or limitations in children’s functioning in these areas (see review by Palacios, Román, Moreno, León, and Peñarrubia, 2014). These limitations may vary depending on the nature of the trauma or neglect, as well as when it occurred and how long it lasted during the child’s pre-adoptive life (Merz and McCall, 2010).With the potential impact of early experiences on children’s special needs, preparation for adoptive parents is critical.

Preparation for Parenting Children With Special Needs Although a majority of families who adopt through licensed agencies receive some formal preparation and education prior to the placement of the child in the family, this process generally is more

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involved and more crucial when families decide to take on the responsibility of adopting a child with special needs (Sar, 2000). Pre-adoption preparation usually begins with the home study, which among other things is likely to involve an exploration of the prospective adoptive parents’ motivation for adopting a special needs child, along with parents’ expectations regarding what life with the child will be like. Attendance at group meetings, along with others who are planning to adopt a child with special needs, is also typically part of the preparation process and can be quite useful for discussing common issues associated with these types of placements, including separation and loss, attachment, family communication issues, reaction of others to the adoption, behavior problems and discipline strategies, utilization of supports, and so forth. The final component of preparation occurs when a specific child has been identified for adoptive placement with the family and the agency shares the unique history of the youngster with the prospective parents, in anticipation of initial visitations and integrating the child into the family. The importance of preparation and education for families who adopt children with special needs cannot be overemphasized. Sharing background information with parents is not sufficient; professionals need to explain to parents the relevance of the information for both short-term and longterm adjustment, as well as its implications for parenting these children. Research has found that the more thorough the preparation, the more realistic are the parents’ expectations regarding the adoption, which in turn, is likely to reduce the chances of placement disruption and increase the chances of positive adjustment among family members (Barth and Berry, 1988; Moyer and Goldberg, 2017; Partridge et al., 1986; Sar, 2000). Pre-placement education and support also prepare prospective parents for the many unique parenting challenges they will encounter in rearing their special needs child.

Integrating a Late-Placed Child Into the Family Any time a child enters a family, the family system must modify its patterns of functioning to integrate the new member (Kerig, 2019). Parents assume new roles and responsibilities, children’s roles are transformed as their ordinal positions in the family change, dyadic relationships are newly created or altered, and family interactions and routines are disrupted or revised. Although a similar transition occurs when infants are born or adopted into a family, these processes are less predictable and more intense among families adopting special needs children. Most special needs adopted children have a history of living in family systems that did not work and, consequently, may be skeptical of attempts to build family cohesion and connection. Pinderhughes (1996) described a sequence of readjustment through which the family moves as its members shift to incorporate a child with special needs. Before placement, family members and the child form expectations and fantasies about what adoptive family life will be like. After placement, each family member may find themselves rethinking the expectations they formed prior to the placement, particularly with testing of limits by the adoptee. In some families, parents or children may experience ambivalence about the placement and feel reluctant to change attitudes and behaviors, despite signs that they are dysfunctional. The family moves to restabilize with a new equilibrium in the way that its members interact. Typically, at this point there is a better fit between expectations and reality for all family members. Integration is facilitated by helping children identify the daily routines, family traditions, and family patterns from former placements that gave them comfort and incorporating those into the life of the new family. In addition, parents can help children by focusing on similarities between the child and family members, and by modifying nuclear and extended family traditions and rituals to include the child. Finally, new family rituals that focus on adoption, such as celebrating the day the child entered the family, can be created. These efforts can be useful in helping the child to feel integrated into the family and in facilitating emotional bonds between the child and other family members.

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Forming Attachments and Supporting the Grief Process The development of an attachment bond between parents and their special needs adopted child is often complicated by the impact of disrupted relationships from earlier periods in the child’s life, as well as by heightened parental anxiety or a mismatch between parental expectations and the child’s characteristics and behavior. A meta-analysis of studies of attachment and age at adoption showed that whereas children adopted within the first 6–12 months of life tend to show normative patterns of secure attachment with adoptive parents, those youngsters placed after 12 months may be at risk for attachment problems and developmental difficulties (van den Dries et al., 2009). Related to the issue of attachment is the experience of separation and loss, which usually is more acute and obvious in adoptions of late-placed children compared to infant adoptions (Nickman, 1985). Parents of late-placed adoptees must help their children grieve the loss of earlier attachment relationships with birth parents, birth siblings, extended birth family, previous foster family members, and so forth. Many adoption professionals believe that learning to cope with these losses is critical for the development of healthy attachments in the adoptive family. Yet, for many adoptive parents, the child’s emotional connections to previous birth family and foster family members can be experienced as a threat to the integrity and stability of the family.These emotional connections can be further complicated when adoptive families have contact with birth families or prior families after placement. Because contact with birth families after placement from foster care is increasingly common (Brodzinsky and Goldberg, 2016), adoptive parents may need professional support in navigating issues that can arise regarding type and amount of contact and roles of birth family members (Jones and Hackett, 2012; Maynard, 2005). Studies from Britain and Ireland demonstrate that when adoptees from foster care have birth parents who did not consent to the adoption, interactions between adoptive and birth families can be tense and challenging (Jones and Hackett, 2012; Logan and Smith, 2005; MacDonald, 2017; Neil and Howe, 2004). However, some researchers have found that when regular contact facilitates positive connections, or cooperation is high between birth and adoptive families, both families can better understand the other’s experiences and perspectives (Logan and Smith, 2005; MacDonald, 2017). This reciprocity can make it possible for the adoptee to be more supported. Sometimes adoptive parents tend to minimize the importance of the birth family in the child’s life and provide little opportunity for youngsters to discuss their feelings about being separated from birth family members. In such cases, the chances of coping effectively with adopted-related loss is compromised, leading to increased risk for problems in the adoptive family (Brodzinsky, 1987, 1990; Brodzinsky, Schechter, and Henig, 1992; Brodzinsky, Smith, and Brodzinsky, 1998; Nickman, 1985; Reitz and Watson, 1992). As children grieve the loss of former relationships, and begin to test out new attachments in the adoptive family, their behavior may become unpredictable and confusing and present considerable difficulty for adoptive parents.

Managing Troublesome Behaviors Even when adoptees with special needs are able to form attachments to new parents, difficulties in individual and interpersonal functioning may persist for years after placement (Groze, 1996; Kay, Green, and Sharma, 2016). Behavioral problems, such as hyperactivity, aggression, stealing, fire setting, and sexual acting out, can be particularly detrimental to placements. Because of their histories with dangerous, unpredictable family situations or neglectful institutions, late-placed children often enter new adoptive placements with expectations that relationships are not nurturing and may be unsafe. As a result, late-placed children may manifest behaviors that, while adaptive in previously unsafe situations, differ substantially from the adoptive family’s style and expectations. Late-placed children may withdraw from relationships because they have learned that it is not safe to interact with adults.They

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may be aggressive as a defense against the belief that the world is a place where adults hurt children. They may constantly “test” their new parents with acting-out behavior—in effect asking, Do you really love me? Will you leave me, too? They may display inappropriate sexual behavior because that is how they received attention from adults in the past. They may demonstrate excessive self-reliant behavior, rejecting attempts by parents to nurture them because they have learned to take care of themselves or younger siblings in previous neglectful environments. Children’s behavioral problems may be linked to views that caregivers are unpredictable and may reflect problems in social information processing. Children may show a persistent and exaggerated fear response and may have difficulty discerning when they are safe, viewing a non-threatening situation as possibly dangerous (Jaffee and Christian, 2014). In their interpersonal interactions, children may be more drawn to angry (than sadness or distress) cues, for example. Children may be constantly ready to react to perceived danger and this preoccupation may interfere with their ability to focus on learning.They also might be highly sensitive to and misinterpret nonverbal cues, which can affect their social interactions with others and ability to adapt to changing social situations. (For a synthesis of the literature on the neurobiological impact of abuse and neglect, see Jaffee and Christian, 2014.) Adolescents are vulnerable to internalizing symptoms, such as depression and anxiety (Festinger and Jaccard, 2012). In addition, typical adolescent impulsive behavior may be magnified, and higher-level thinking may be delayed, leaving adoptees with special needs more vulnerable to serious risk-taking. For example, information-processing challenges and limited social skills put Finnish adopted adolescents at risk for being bullied, especially among children adopted internationally (Raaska et al., 2012). Parenting a child with these often entrenched “survival behaviors” requires special skills. Caregivers often find that parenting techniques that were effective with other children may not work with these youngsters. Among the characteristics of adoptive parents often cited as contributing to successful special needs placements are tolerance for ambivalent and negative feelings, a sense of entitlement to care for the child, ability to find happiness in small increments of improvement, flexible expectations, good coping skills, tolerance for rejection, ability to delay parental gratification, good listening skills, a sense of humor, flexible family roles, strong support network, and availability of post-placement social and mental health services (Katz, 1986; Rosenthal, 1993; S. L. Smith and Howard, 1999). Mental health and child welfare professionals offer a number of helpful guidelines for how parents can support their adopted children (American Academy of Pediatrics, n.d.; Child Welfare Information Gateway, 2014). Parents can actively listen to and be available for adoptees to help them feel understood. Parents should learn to focus on the child’s needs and functioning and less on their own reactions or needs, keeping in mind the possible impact of pre-placement experiences. Clear limit setting also is important. As children may have different responses to trauma and to healing from trauma, it is essential for parents to learn to identify triggers that might unsettle or destabilize their adopted child and help him develop strategies for self-calming and relaxing. In contrast, negative power assertive strategies, such as scolding, highly controlling behavior, threats, and physical punishment (McRoy, 1999), as well as parental inability to maintain warmth and sensitive attitudes in the face of child opposition and/or withdrawal (Rushton, Dance, and Quinton, 2000), are related to less stable placements.

Maintaining Realistic Expectations Realistic parental expectations have been linked consistently to more positive adoption outcomes (Barth and Berry, 1988; Foli, Lim, South, and Sands, 2014; Glidden, 1991; McRoy, 1999). Parents’ ability to develop and maintain realistic expectations about the child’s current functioning and potential, their own ability to help the child overcome previous problems, and the time frame for integrating the child into the family are among the most important factors in successfully parenting special needs

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adopted children. Expectations formed during the pre-placement preparation process are crucial and reflect a level of understanding of the child attained by parents prior to the youngster’s actual arrival (Moyer and Goldberg, 2017; Sar, 2000). Unexpected problems are the most stressful for parents (S. R. Smith, Hamon, Ingoldsby, and Miller, 2009; for discussion of stress and parenting, see also Crnic and Coburn, 2019) and increase the chances of adoption disruption or dissolution (Brodzinsky and Pinderhughes, 2002). These problems can be exacerbated when parents have received insufficient preparation, when they hold unrealistic expectations, and when there is inadequate flexibility in family functioning (Moyer and Goldberg, 2017; Reilly and Platz, 2004; Rosenthal, Groze, and Morgan, 1996). The importance of realistic expectations and understanding the child is underscored by research on adoption of children with developmental disabilities or chronic medical conditions. With predictable manifestations of the disability, parents who are fully informed about their adopted child’s condition can more realistically anticipate problems and tend to report more satisfaction and more positive family adjustment than parents who are less informed about their child’s condition, as well as those who are rearing children with less predictable manifestations of their disability (Glidden, 1991, 2000). Adoptive parents also report less stress in parent, family, and child functioning than a comparison group of birth parents of children with developmental disabilities (Glidden, 1991). When parents choose to adopt a developmentally disabled child, they can prepare for the entrance of the youngster into the family with the assistance of a readily available resource—the adoption agency. In contrast, when a developmentally disabled child is born into a family, there is often shock among family members, followed by efforts to readjust expectations regarding the child and the parenting experience (Hodapp et al., 2019). Parents must also grieve the loss of their “ideal” child and begin to learn about the special caregiving needs of their youngster and the resources available to assist them. In this regard, adoptive parents of developmentally disabled children are often a step ahead of their non-adoptive counterparts. For parents to enter into an adoption with realistic expectations, they must be provided with accurate child-specific background information prior to placement (Moyer and Goldberg, 2017; Sar, 2000), coupled with appropriate explanations of the implications of the information for child adjustment and parenting challenges. Unfortunately, many parents do not feel sufficiently prepared by adoption agencies to rear their child with special needs (Nelson, 1985; Reilly and Platz, 2003; Rosenthal et al., 1996). This can occur when parents are so eager to have the adoptee join their family that they do not fully appreciate what adoption professionals have shared, or when adoption professionals present a more positive picture of the child’s functioning than is the reality. Even when parents have unrealistic expectations at the time their child first joins the family, parents’ flexibility in changing expectations can facilitate placement success. Flexibility of adoptive fathers, in particular, as assessed by their sense of humor and creative discipline strategies, has been linked to more stable placement outcomes. However, parents can find it quite challenging to modify initial expectations (Moyer and Goldberg, 2017; Pinderhughes, 1996). For example, parents must appreciate that their perceptions of a child’s need for close and nurturing family ties may not match the child’s readiness to accept such closeness. In such situations, parents who are looking to satisfy their own needs through close parent–child ties may feel thwarted by the lack of reciprocity in the relationship, as well as by the behavior problems manifested by the child. In their qualitative, longitudinal study of families adopting children from foster care, Eheart and Power (1995) observed that parents’ failure to change expectations to be more consonant with the child’s actual functioning increased the chances of the adoptive placement disrupting.

Maintaining Pre-Existing Relationships Successful parenting of a special needs adopted child is closely intertwined with maintenance of positive relationships among other dyads in the family and with the integrity of the family itself. Maintaining a harmonious marital relationship is critical, particularly during the early phases of 346

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adoption when little gratification is coming from the adoptee. Both parents need to communicate effectively and to be able to offer support and respite for each other.When the adoptive mother takes on the primary responsibility for day-to-day care of the child, and thus becomes the primary target for the adoptee’s unpredictable behavior, the role of the adoptive father in supporting the mother is extremely important. Westhues and Cohen (1990) found that the affective, supportive, and active involvement of the adoptive father was associated with lower rates of adoptive placement disruption. In contrast, insufficient marital communication has been linked to higher disruption rates (McRoy, 1999). Post-placement supports are an important support for the marital relationship (Mooradian, Hock, Jackson, and Timm, 2011). The impact of a special needs adoptive placement on children already in the home is likely to be substantial (Phillips, 1999). In the course of integrating an older adopted child into their family, parents face the challenge of providing support, and in some cases protection from physical or sexual abuse by the adoptee, to their other children. It is not unusual for biological, foster, or adoptive children already in the home to be affected negatively by the entrance of a new special needs adopted youngster into the family system. Emotions such as jealousy, resentment, anger, and fear can persist for months, and even years, after placement (Groze, 1996; McRoy, 1999; S. L. Smith and Howard, 1999).To reduce family conflict and support the well-being of the other children in the home, adoption professionals encourage parents to include siblings in the preparation process and maintain open and clear communication among all family members, and when necessary, seek professional support from a family therapist.

Managing External Stressors and Utilizing Supports Parents in adoptions of children with disabilities also face the challenge of helping their youngster negotiate new relationships with peers and cope with new school settings. Although there are few empirical data on the dynamics involved in friendship formation and maintenance among special needs adopted children, with their histories of harsh and inconsistent parenting and multiple losses or institutional neglect, these children are very likely to have difficulties with peers (Raaska et al., 2012). Indeed, special needs adoptive parents often report peer problems among their children as a major source of concern (Smith and Howard, 1999). Furthermore, Barth and Berry (1988) noted that involvement with deviant friends and peer problems was linked with adoption disruption. Ironically, the task of facilitating developmentally appropriate peer relationships, a normal component of the process of individuation from parents (Ladd and Kochenderfer-Ladd, 2019), may run counter to initial goals of adoptive parents, who are often preoccupied in the first few years following placement with facilitating strong and secure attachments between themselves and their children (Pinderhughes, 1996). Adoptees are disproportionately represented among children who receive special education services (Brodzinsky and Steiger, 1991) and require residential treatment programs (Brodzinsky, Santa, and Smith, 2016). This is especially the case for late-placed adoptees, whose emotional and behavioral problems may compound learning difficulties. How school personnel respond to adoptees with multiple needs is critical. For example, a small study of Norwegian teachers of elementary students diagnosed with reactive attachment disorder and who were late-placed adoptees illustrated the importance of balancing consistent structure and positive attention with strategies for helping children calm down (Rijk, Hoksbergen, and Laak, 2008). Teachers reported greater success reaching students with these strategies than when resorting to those like shouting or getting angry. Notably, having supports from other school personnel was critical.Yet, parents often note that school personnel are poorly informed about the needs of children adopted at older ages and frequently view them in negative and stereotyped ways (Goldberg, Frost, and Black, 2017; Groze, 1996). To contend successfully with the stressors associated with adoptions of children with disabilities, parents need to rely on informal and formal supports, such as extended family, friends, neighbors, 347

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other adoptive families, former foster families, birth families, therapists, and previous caseworkers (Leung and Erich, 2002; Moyer and Goldberg, 2017; Wind et al., 2007). Barth and Berry (1988) found that families whose adoptive placements were disrupted have fewer relatives within visiting distance and less contact with them compared with families that remained intact. Similarly, other researchers have found that various positive indices of placement outcome are associated with greater approval and support from family and friends and greater involvement with other adoptive families (Groze, 1996; Groze and Rosenthal, 1991; Rosenthal, Groze, and Morgan, 1990).The benefits of such contact include normalization of feelings; alleviation of a sense of isolation and alienation; fostering a sense of belonging in the adopted child; empowerment of adoptive parents; sharing of advice, information, and skills; and increasing the likelihood of seeking professional help when needed. Professional support of placements of children with special needs is critical both before and after placement. Miller, Pérouse de Montclos, and Sorge (2016) recommended that adoption medicine professionals—medical professionals who have knowledge about adoption processes and impact of pre-adoption experiences on children’s development—have an important role to play in supporting parents who adopt children with special needs. Adoption medicine professionals should provide consultation to help prospective parents consider the kinds of disabilities they might be able to work with and to review medical records of a specific child who has been proposed by adoption professionals as a match for the family. Adoption-competent mental health professionals also can help parents before placement emotionally prepare for and, after placement, cope with the challenges their children pose (Brodzinsky, 2013). This type of pre-adoption support will enable parents to have as complete an understanding of their child as possible and to form realistic expectations about challenges that lie ahead. Financial and medical subsidies are another critical factor in adoptions of children with special needs. In fact, families view these supports as essential for coping with the stress of rearing their troubled children (Reilly and Platz, 2004; Rosenthal et al., 1996). Moreover, financial and medical subsidies have been credited with making adoption accessible to ethnic-racial minority, low-income, and foster families—groups that typically adopt older and special needs children. Without these subsidies, many youngsters with special needs, rather than being adopted, would linger in foster care or end up in institutional placements (Barth and Berry, 1988). Other service needs that have been identified as being important for successful special needs placements include advocacy for specialized and individualized educational services; individual, group, and family therapy; specialized training of mental health professionals regarding the dynamics of adoptions of children with special needs; parenting skills classes emphasizing behavior management and working with traumatized and attachment disordered children; identification of community resources; respite care; life planning for developmentally disabled youth; intensive family preservation services; and availability of services over the life of the family (Kramer and Houston, 1998; Rosenthal et al., 1996; S. L. Smith and Howard, 1999). In summary, rearing adopted children with special needs and late-placed children presents individuals and couples with several interrelated parenting challenges. Unlike infant adoptions or rearing birth children, these challenges are linked to the adoptee’s previous history in other families or institutions and present both internal and external pressures on the family concurrently. When parents can maintain high levels of commitment to their adopted child and the placement and manage troublesome child behaviors, adoptions of children with special needs are more likely to succeed (McRoy, 1999; Partridge et al., 1986). Adoptive parents can support these adoptees through interactions that affirm and validate the adoptee and structured but flexible rules. Informal and formal supports are critical; we will discuss supports in greater detail after turning our attention to parenting among sexual minority parents and adoption as risk or protection.

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Adoptive Parenting as a Sexual Minority Although sexual minority adults adopt for many of the same reasons as heterosexual adults (e.g., desire to form a family and have children; desire to nurture a child in need), they are significantly less likely to do so because of infertility (Farr and Patterson, 2009; Patterson, 2019). Sexual minority adults also appear to place less importance on being a biological parent than do heterosexual adults, and consequently are more likely to choose adoption as their first choice in considering parenthood (Goldberg et al., 2009). In transitioning to adoptive parenthood, lesbians and gay men experience not only the challenges faced by heterosexual parents (e.g., decisions about the type of child and adoption to pursue, home study assessment, uncertain waiting periods, and other challenges), but some additional ones as well. Too often they encounter negative stereotypes, misconceptions, and discrimination from adoption professionals, birth parents, and others in the community, which can create anxiety and challenge their confidence in their adoption decision (Brodzinsky, 2012; Kinkler and Goldberg, 2011; Mallon, 2012). Despite the added stress, lesbian and gay parents adjust to adoptive parenthood very well, in ways comparable to their heterosexual counterparts (Goldberg and Smith, 2009). This is especially true when they perceive greater social support and have a strong couple relationship (Goldberg and Smith, 2011). Sexual minority adoptive parents are confident, competent, and emotionally healthy caregivers in ways that are similar to heterosexual parents (Farr, 2017; Farr, Forssell, and Patterson, 2010; Goldberg and Smith, 2008; Lavner,Waterman, and Peplau, 2014;Tornello, Farr, and Patterson, 2011). Regarding adoption-specific issues, they are particularly sensitive to their children’s curiosity about their origins and are supportive of contact with the birth family at a level comparable to, and at times greater than, heterosexual adoptive parents (Brodzinsky and Goldberg, 2016, 2017). In addition, no group differences have been found in adjustment patterns between children adopted by sexual minority parents and those adopted by heterosexual parents (Farr, 2017; Farr et al., 2010; Lavner, Waterman, and Peplau, 2012; Tan and Baggerly, 2009), despite the fact that the former group is often subjected to teasing and bullying regarding parental sexual orientation (Cody, Farr, McRoy, Ayers-Lopez, and Ledesma, 2017). The preparation and attention to socialization issues among sexual minority adoptive parents appear to successfully buffer stresses experienced by these children from teasing and other types of microaggressions (Goldberg and Smith, 2016; Oakley, Farr, and Scherer, 2017). In summary, although sexual minority adoptive parents encounter additional challenges in the transition to adoptive parenthood, and their children sometimes experience teasing regarding their parents’ sexual orientation, these experiences do not lead to increased adjustment problems. Like the findings from other areas of family research, those related to adoption indicate that family and developmental outcomes have much more to do with family process variables (e.g., quality of parenting and relationship quality) than family structural variables (same-sex versus different-sex parents; Golombok and Tasker, 2015).

Adoption as Risk or Protection Considerable attention has been focused on adoption by child welfare professionals and mental health professionals.The perspectives of these two groups, however, have often differed. Child welfare professionals generally have viewed adoption as a solution to a variety of societal problems. As such, these individuals have emphasized the benefits associated with being adopted. In contrast, mental health professionals have been more concerned with the psychological risks associated with being adopted. Although they may appear contradictory, these two faces of adoption represent “two sides of the same coin.” Moreover, both perspectives appear valid.

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Within the social sciences, interest in problems associated with adoption can be traced to the work of Schechter (1960) and Kirk (1964), who were among the first researchers to point out that adoption, although a reasonable option for children in need of out-of-home placement, is itself linked to increased risk for adjustment difficulties. Three sources of data address this issue: (1) epidemiological studies on the incidence and prevalence of adoptees in mental health settings; (2) studies of presenting symptomatology of clinical samples of adopted and non-adopted children; and (3) research on psychological characteristics and adjustment patterns of adopted and non-adopted children in non-clinical, community-based settings. Detailed discussion of the literature on risk is beyond the scope of this chapter (see Brodzinsky and Pinderhughes, 2002); findings will be briefly summarized. Since the focus of this chapter is on parenting adopted children, greater attention will be devoted to how parenting processes in adoptive families help adoption to serve a protective function.

Adoption as Risk Questions about adoption as a risk factor for children’s development historically centered on comparisons of adoptees with children from the same type of community or socioeconomic level that currently characterizes the adoptive family. Various studies from different national health surveys have reported that adopted children are significantly overrepresented in out-patient and in-patient mental health settings (Miller, Fan, Christensen, Grotevant, and Van Dulmen, 2000; Warren, 1992). These early national studies are corroborated by meta-analyses of different studies in the literature (Behle and Pinquart, 2016; Juffer and van IJzendoorn, 2005). These differences exist even though adoptive parents are more likely to seek services for their children than are non-adoptive parents, even when problem levels are the same. Studies focused on the functioning of adopted persons in many European countries, Australia, New Zealand, Canada, and the United States also demonstrate that adoptees are at risk for more externalizing and, in some studies, internalizing problems, mental health diagnoses, and more school-related problems and likelihood of placement in residential treatment centers (Askeland et al., 2017; Behle and Pinquart, 2016; Bimmel, Juffer, van IJzendoorn, and Bakermans-Kranenburg, 2003; Brodzinsky et al., 2016; Juffer and van IJzendoorn, 2005; Miller et al., 2000). A U.S. census-based study of children ages 5–15 found that adoptees had twice the rate of disabilities as non-adoptees (Kreider and Cohen, 2009). Unpacking patterns among adoptees, Howard and colleagues found the highest rates of problems among children adopted from foster care (Howard, Smith, and Ryan, 2004); in a meta-analysis that excluded children placed from foster care, Juffer and van IJzendoorn (2005) found fewer referrals and problems for intercountry adoptees than domestic adoptees. In summary, although the majority of adopted children are within the normal range of functioning, they are more likely to manifest psychological and academic problems than their non-adopted peers are. Importantly, these difficulties appear to have more to do with pre-adoption risks (e.g., genetic vulnerability, prenatal complications, and pre-placement adversities such as neglect, abuse, relationship disruptions, and orphanage life) than with the experience of adoption per se.

Adoption as Protection for Recovery From Adversity Two important considerations must be kept in mind when addressing the question of adoption as a protective factor: First, most children move up the socioeconomic ladder when they are adopted. In other words, adoptive parents, on average, are financially and materially more advantaged than are the birth parents of adopted children. In turn, these advantages may well provide opportunities for adopted children that they are unlikely to experience if they continued to live with their biological family. Second, most children who are adopted move from a home/caregiving setting characterized by insecurity, instability, and a lack of adequate stimulation and nurturance to an environment more 350

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often characterized by greater security, stability, stimulation, and nurturance. Therefore, in examining whether adoption is a protective factor, one must compare long-term outcome for adoptees with youngsters from backgrounds similar to those characterized by the adoptees’ birth families, as well as to youngsters who remain in foster care or grow up in institutional environments. A number of studies from England, France, India, Scotland, Spain, Sweden, and the United States have compared the adjustment of adopted children to several other groups of youngsters living under more adverse social conditions, including children residing in long-term foster care or institutional environments or children living with biological parents who come from disadvantaged backgrounds similar to that of the birth families of the adoptees (Bharat, 1997; Bohman, 1970; Bohman and Sigvardsson, 1990; Dumaret, 1985; Hodges and Tizard, 1989; Jimenez-Morago, Leon, and Roman, 2015; Maughan and Pickles, 1990; Palacios, Moreno, and Román, 2013; Scarr and Weinberg, 1983;Triseliotis and Hill, 1990;Weinberg, Scarr, and Waldman, 1992).The results of these studies are consistent and telling. First, in each of the studies where the appropriate comparison was made, adopted children fared significantly better than children who resided in long-term foster care or in institutional-type environments. This result is not surprising and forms the rationale for the emphasis on permanency planning within the child welfare system. Adopted children also fared better than children who were reared by biological parents who either did not want them or showed ambivalence about keeping them. In addition, adopted children display better adjustment than youngsters living with biological parents whose disadvantaged socioeconomic status was similar to that of the adoptees’ own birth families. Although the latter finding should not be interpreted to suggest that children be removed from their birth families simply because they are living in conditions of poverty, it does suggest that one benefit of adoption is that it can, when appropriate, provide a more advantaged environment for children, which in turn, may well have positive effects on development and adjustment. Taken as a whole, these research studies provide clear and convincing evidence that adoption can, and usually does, serve as a protective factor in the life of the child whose biological parents cannot or will not provide an appropriate childrearing environment. However, it is no longer sufficient to state that adoption can serve as a protective factor for children who lack an appropriate caregiving setting. The key question that has emerged is how does adoption serve a protective function for these children? More specifically, what are the parenting processes that enable adoptive families to help children recover from pre-adoptive adversity and thrive, relative to their peers reared in institutions or birth families, and to function in ways that approximate or match their peers in their new communities? Multiple studies demonstrate the power of sensitive parenting from adoptive parents who have secure attachment models themselves. Among early-placed domestic and intercountry adoptees, mothers’ secure attachments were linked to more secure attachment in infants (Lionetti, 2014). However, infants who had a difficult temperament were less able to respond to sensitive caregiving, suggesting the importance of supports for sensitive caregiving for these children. In two important longitudinal studies of Italian adoptees placed between ages 4 and 7, Pace and colleagues (C. S. Pace and Zavattini, 2011; C. S. Pace, Zavattini, and D’Alessio, 2012) found that adoptees’ attachment patterns can shift from insecure working models to secure working models—even within 8 months of placement—aided by parenting from adoptive mothers who have secure attachment models. Notably, adoptees with insecure internal working models who were placed with adoptive mothers who had insecure attachment models did not change, highlighting the importance of maternal sensitivity for late-placed children. Pace and colleagues (2015) then followed up a small sample of Italian adolescents who were placed between ages 4 and 9 and their mothers to examine concordance of adoptees’ and parents’ internal working models. With eligibility criteria designed to ensure a homogenous sample—teens had to be in the home at least 4 years and could not have special needs, parents were moderately to highly educated and in an intact marriage, and families lived in urban areas—they found 70% concordance in internal working models between mothers and their teens.Thus, sensitive 351

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caregiving is critical to support the development of a secure attachment among adoptees, especially those in need of reversing an insecure attachment. Other signs of the importance of maternal sensitivity in adoptive families come from longer longitudinal studies. For example, Jaffari-Bimmel and colleagues (2006) followed 160 early-adopted youth and their Dutch families over three time points from infancy through middle childhood to adolescence, with a focus on whether early experiences or concurrent experiences were linked to social functioning in adolescence. They found that maternal sensitivity and attachment measured in infancy predicted social competence, friendliness, and social esteem among adolescents, and that children’s social development in middle childhood and maternal sensitivity of adolescents mediated this relation (Jaffari-Bimmel, Juffer, van IJzendoorn, Bakermans-Kranenburg, and Mooijaart, 2006).Thus, maternal sensitivity appears to help shape children’s social development, which, along with sensitive parenting of adolescents, affects current social functioning in adolescence. Further illustrations of the importance of sensitive caregiving from adoptive parents come from evidence-based video feedback interventions with adoptive families (Juffer and Steele, 2014; Steele et al., 2011). For example, Juffer and her colleagues (Juffer, Bakermans-Kranenburg, and van IJzendoorn, 2005) offered one group of Dutch parents a personalized book with tips on sensitive parenting and another group of parents a personalized book and a three-session home-based video feedback of their interactions with their children at 6 and 9 months of age. Comparisons with a control group that received a brief booklet on adoption issues showed that children of the parents who received the video-feedback-plus-book were less likely to receive disorganized attachment classification or have low scores on a disorganized attachment rating scale at 12 months of age. The book-only intervention was not as effective. The intervention targeted parents’ sensitive responses to their children, and the researchers were able to demonstrate that parents improved in their sensitivity to and cooperation with their adopted infants. Thus, improving parents’ sensitivity and cooperation enables parents to help their adopted infant develop a secure attachment. Several evidence-based interventions designed initially for foster families also hold promise for adoptive families.These interventions promote therapeutic parenting that fills the compensatory experiences which children with trauma histories need (Bernard, Dozier, Bick Lewis-Morrarty, Lindhiem, and Carlson, 2012; Fisher and Chamberlain, 2000). For example, Attachment and Biobehavioral Catch-Up (ABC; Bernard et al., 2012) provides careful detailed feedback to parents about their interactions with their child. ABC helps parents nurture their children through distress, follow their children’s lead when children are not distressed, and avoid acting in ways that would frighten children (see Bernard et al., 2019, and Powell, 2019, for more on foster parent interventions and parenting interventions, respectively). Although more is known about how parenting processes facilitate adopted children’s recovery and development, parents continue to face challenges providing those processes and supports that children need.These challenges are due to two sets of issues. First, although pre-placement preparation is critical, sometimes parents cannot adequately process the information that professionals tell them during the home study and early preparation period. They may be too focused on having the child in the home. Moreover, some implications of children’s pre-adoptive adversities do not emerge until later in the child’s development (e.g., learning and school adjustment; identity) (Matthews et al., 2016). By the time children are older and their vulnerabilities begin to emerge, the earlier preparation/education may not be relevant anymore. Thus, post-adoption support is critical. The second issue is that postadoption support provides insufficient and, in some cases, ineffective services for adoptive families.

Post-Adoption Services There is a growing trend toward promoting adoption competencies among professionals (Atkinson, Gonet, Freundlich, and Riley, 2013;Brodzinsky, 2013). This trend has responded to two clashing realities—adoptive families need competent mental health support and the limited accessibility of 352

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services provided by adoption-competent providers (Hill and Moore, 2015; Pinderhughes et al., 2013; Reilly and Platz, 2004). Despite the increased awareness that adoption is a lifelong process, this understanding apparently has not yet translated into enhanced training of professionals and students about adoption-related issues that need attention during the immediate post-placement period, at different developmental periods when children face new tasks, and linked to stressful situations well into adulthood. The lack of such training as a core element in mental health training programs (Koh, McRoy, and Kim, 2015) has heightened the demand for ongoing professional development. One creative response to this demand, the federally funded National Adoption Competency Mental Health Training Initiative (NTI), targets two distinct professionals—child welfare professionals and mental health professionals—with 20 or more hours of online training (Center for Adoption Support and Education; n.d.). In addition, several post-graduate adoption competency training programs are available around the country (see Brodzinsky, 2013, for a summary of these programs). These programs, geared to increase the number of adoption-competent mental health professions available for adoptive families, offer classroom-based and sometimes in-home training for licensed mental health professionals. Importantly, and in line with our earlier discussion about the power of the Internet, professionals can receive some training online. Aside from insufficient adoption-competent services, other barriers to successful adoptions include adoptive families’ lack of knowledge of available and accessible services, issues of cost, and adoptive parents’ reluctance to seek formal services, sometimes preferring to access informal services. These parent-related barriers must be addressed by adoption professionals. The common and unique challenges facing adoptive families can be addressed through a spectrum of services, including education and information, clinical services, material support, support networks and other specialized supports, as well as supports that cut across different areas of need. Sponsored by the federal government, the Child Welfare Gateway website provides a helpful framework for this spectrum of services (Child Welfare Information Gateway, 2012). Education, information, and referral services typically address parenting concerns, impact of the placement on the marital relationship, and the adoptee’s pre-placement history. Professional services provided to children, parents, and families are most likely enhanced by adoption-competent providers, including clinical, educational, medical, and legal services. Material support provides adoptive families with financial resources to support rearing children (adoption subsidies) and to enable families to address adoptees’ special health or mental health needs. These supports are especially important for families that are rearing late-placed adoptees who cope with the ongoing impact of pre-adoption adversities. Support networks provide peer support for parents and for adoptees, whereas specialized supports address certain needs that adoptive families have, such as for respite care. Either support can aid transracial or transethnic adoptive families in helping their adopted children develop healthy ethnic, racial, and adoptive identities or families who need respite care to rear children with substantial physical or mental health needs. Finally, services that cut across these areas include advocacy or training for advocacy with service providers, schools, and other settings in which adopted children’s and their families’ challenges need better understanding, as well as case management services that assist families in obtaining needed services (Child Welfare Gateway, 2012). In summary, adoption serves as a protective factor through the functioning of adoptive parents. Parenting processes that are sensitive and responsive to young children’s needs, based on their preadoptive experiences, that provide support for the development of a positive identity, that promote open conversation about adoption, and that can flexibly address children’s emotional distress and behavioral problems serve to help children recover from pre-adoptive adversity and grow optimally. Most adoptees can and do function at levels comparable to their non-adopted peers in new settings. However, adoption-competent supports are critically needed, first as a normative support for families as children move through development and face new developmental tasks, and second to help those families whose challenges outweigh their parenting skills or resources. Continued development of adoption-competent services will enable the field to support the increasing needs of adoptive families. 353

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Conclusions Adoption increasingly mirrors the diversity in the world and is a complex set of processes—legally, socially, and psychologically. Adoption offers different pathways to family life for children lacking permanent parents and for adults seeking to adopt.Yet, adoption is a complex set of processes that do not end with placement or its legalization. Rather, adoption is a lifelong set of processes that children and parents must navigate. Changes in adoption practices make it difficult to generalize about the average adopted child or the average adoptive family. The degree to which families are successful in adoption is highly related to the pre-adoptive experiences children have, and most importantly, the parenting processes that adoptive parents can provide. The keys to successful parenting of adopted children include good preparation, realistic expectations, effective behavior management skills, good communication, and adequate supports—all of which are common to other families as well. Yet, adoptive parents face numerous adoption-related challenges that compound normative parenting challenges (Brodzinsky, 1987; Brodzinsky et al., 1992; Kirk, 1964; Reitz and Watson, 1992). Acknowledging the inherent differences of adoptive family life, creating a rearing environment that is conducive to open and supportive dialogue about these differences, maintaining a respectful and empathic view of the child’s birth family and heritage, and supporting the child’s search for self are critical tasks faced by adoptive parents (Brodzinsky et al., 1992). Moreover, some adoptive parents also face unique challenges that can include supporting children who have experienced trauma, who continue to function with delays in development or disabilities, who are from a different cultural background than their adoptive parents, or as a sexual minority parent. When adoptive parents are successful in meeting these challenges, as most are, they find the experience of rearing adopted children to be personally rewarding and successful in terms of their children’s adjustment. When these adoption-related challenges, whether common or unique, outweigh families’ skills and resources, adoption-competent services need to be available and accessible. With such supports, adoptive parents can provide critical compensatory processes that enable adoptees to recover and thrive, thus joining the large percentage of adoptive families who are successful.

Acknowledgments Research from the Pinderhughes’s lab was supported by the William T. Grant Faculty Scholars Program.

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11 FOSTER PARENTING Kristin Bernard, Allison Frost, Sierra Kuzava, and Laura Perrone

Introduction Children are born biologically prepared for consistent and responsive parenting. Children placed in foster care have usually experienced just the opposite—histories of caregiving characterized by neglect or abuse that significantly undermine their safety and well-being. Furthermore, children in foster care have endured a separation from their parents, which reflects another significant trauma and threat to healthy development. Foster parents provide substitute care to these vulnerable children. Foster parents vary in their reasons for becoming foster parents, whether they are related to the foster children they care for, how many foster children they care for at a given time and across their tenure as a foster parent, and in their perceptions about their roles as substitute caregivers. These differences in experiences and expectations influence the quality of care that they provide to foster children.The primary shared feature that distinguishes foster parenting from other forms of parenting is that the foster parent–child relationship is expected to be temporary. In this chapter, we consider the unique role of foster parents. First, we provide an overview of the child welfare system broadly, including a brief history of how foster parenting has changed over time, a discussion of the key individuals involved in and served by the child welfare system (i.e., foster children, birth parents, child welfare agency caseworkers, and foster parents), and a consideration of relationships among these individuals. Second, we discuss attachment in the context of foster care, examining issues such as how infants form attachment relationships with foster parents and the characteristics of foster placements that support the formation of secure and organized attachment relationships. Third, we consider foster parent commitment, defined as a foster parent’s emotional investment in an enduring relationship with the foster child. After considering the challenging of commitment for foster parents (e.g., temporary nature of care, professional role of the foster parent, lack of biological relatedness), we discuss research examining predictors and outcomes associated with foster parent commitment. Fourth, we review several programs and practices designed to support effective parenting among foster parents, along with evidence for their efficacy in improving parenting and enhancing outcomes among foster children. Fifth, we discuss controversies in foster care, such as maltreatment perpetrated by foster parents and ethnic/racial disparities in child welfare involvement. Finally, we offer recommendations for future research and clinical and policy efforts that may help us understand and enhance the experience of foster parents and the vulnerable children they care for.

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The Child Welfare System From Early Substitute Care to the Child Welfare System Today: A Brief History The placement of children with substitute caregivers was a necessary social practice before formal legislation for child welfare practices were in place. In colonial America, orphaned or poor children were placed into others’ homes to provide indentured service or labor. In the 1800s, dependent children who were orphaned in urban areas were often sent west by way of “orphan trains” to work for farm families who provided care; this system for placing children into homes, started by Charles Loring Brace, served the primary goal of protecting society from these problematic children, rather than to protect the vulnerable children themselves. In the late 1880s, Charles Birtwell, overseeing efforts of the Boston Children’s Aid Society, shifted the practice of placing children in others’ homes in two major ways: enhancing prevention efforts and promoting goals of reunification of children with their families. In the early twentieth century, several national initiatives increased attention to children’s safety and well-being. In 1912, for example, the Children’s Bureau was founded; although its initial focus was on issues related to infant mortality and infant health, foster care and child welfare practices became a focus of the Children’s Bureau’s efforts over time. By the 1960s and 1970s, the number of children in foster care increased, likely due to the increase in federal funding to support foster care systems and a heightened awareness of child abuse.This shift coincided with the Child Abuse Prevention and Treatment Act of 1974, which required states to enact procedures of child abuse reporting and investigation. Several policies in the 1980s and 1990s addressed a growing concern that children were experiencing lengthy stays in foster care and/or not being returned home at all. With growing evidence that disruptions in care had negative consequences for children, legislative changes focused on family preservation, permanency, and reunification. The Adoption and Safe Families Act of 1997 also emphasized the importance of child safety and well-being, which continue to be prioritized today. The child welfare system today can be thought of as several intersecting organizations, including public agencies (e.g., departments of social services), private foster care agencies, and communitybased providers that share a common goal of promoting child safety and well-being.The responsibilities of the various entities within the child welfare system include screening and investigating reports of child maltreatment, arranging and overseeing out-of-home placements (e.g., with non-relative foster caregivers or relative foster “kinship” caregivers), providing preventive services, and coordinating reunification, adoption, or other permanency plans. Although the child welfare system exists to ensure child protection and safety and prioritize child well-being, it has several characteristics that pose inherent challenges for children, foster parents, birth parents, and child welfare staff. Placement into foster care, although serving the immediate purpose of protecting children, can pose threats to children’s healthy development, as children’s relationships with primary caregivers are disrupted. For birth parents, the removal of a child from their care is often experienced as a traumatic loss, resulting in feelings of resentment, hostility, and despair; in addition to the reasons for child removal (e.g., inability to provide safe care, perhaps due to psychopathology, substance abuse, involvement in abusive partner relationships, homelessness), such overwhelming feelings may make it difficult to engage effectively with required service plans to regain custody and may make relationships with children, case planners, and foster parents strained and difficult. For example, birth parents may feel rejected by their children or judged by foster parents, which may lead them to miss visits with their children, avoid services (e.g., parenting classes), or engage in problematic coping strategies (e.g., substance use). Case planners and other workers at foster care agencies have the challenging jobs of prioritizing the well-being of children while managing the needs of birth parents and

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supporting foster parents, often for between 10 and 20 children at a time. Finally, foster parents, who are the focus of this chapter, are challenged to provide optimal care in the context of relationships that are, by definition, temporary, to children who are often harder to parent due to emotional, behavioral, or developmental problems. Foster parents must also navigate often tense relationships with children’s biological parents and satisfy the demands of case planners and foster care agencies. Before exploring the unique challenges of foster parents in their role providing care, we consider each of the individuals involved in or served by the foster care system in more depth.

The Child Welfare System: Considering the Individuals Involved Foster Children In 2015, approximately 428,000 children were in foster care in the United States, with approximately 40% of children between 0 and 5 years old (U.S. Department of Health and Human Services, 2016). The average length of time a child was in foster care was approximately 20 months, demonstrating the inherently temporary nature of the foster parent–child relationship. Children enter into the child welfare system for a variety of reasons, often due to concerns related to maltreatment (i.e., child abuse or neglect) that threaten a child’s safety and well-being in their home. Whereas child abuse refers to threatening experiences reflecting acts of commission (i.e., acting in a way that is harmful toward a child), such as physical abuse, emotional abuse, or sexual abuse, child neglect refers to failures to provide adequate care or acts of omission (e.g., failing to meet the child’s medical, education, or basic physical needs). Neglect is the most common reason for removal from the home, but many children experience multiple types of maltreatment before being placed into foster care (U.S. Department of Health and Human Services, 2016). In addition to experiences of maltreatment, children in foster care are often exposed to a number of other risks before they are removed from their parents’ homes, including prenatal risks (e.g., substance exposure), parent psychopathology, parent substance abuse, domestic violence, and povertyrelated risk factors (English, Thompson, and White, 2015). Placement into foster care, of course, represents an additional risk, given that children experience a separation from primary caregivers. Taken together, experiences of maltreatment, exposure to prenatal and postnatal risk factors in the family, and separation from caregivers threaten healthy development, placing children at elevated risk for a number of emotional and behavioral issues, including anxiety, depression, posttraumatic stress disorder, and oppositional defiant disorder (Garland et al., 2001). Indeed, children in foster care are about three times more likely to develop a psychiatric disorder compared to children not placed in foster care (Briggs-Gowan, McCue Horwitz, Schwab-Stone, Leventhal, and Leaf, 2000). Children placed in foster care can also show several difficulties related to self-regulation. Studies of stress system functioning have shown that children in the foster care system show irregular production of cortisol, a stress hormone serving a number of important functions in the body (Dozier et al., 2006; Fisher, Gunnar, Dozier, Bruce, and Pears, 2006). Children in foster care also show deficits in executive functioning and inhibitory control, which may impact their school performance and socioemotional development (Bruce, McDermott, Fisher, and Fox, 2009). Finally, children in the foster care system often show difficulties in relationships starting as early as infancy. Infants in foster care are more likely to show disorganized attachment, and school-aged foster children have poorer peer relationships (Leve, Fisher, and Degarmo, 2007; van den Dries, Juffer, van IJzendoorn, and Bakermans-Kranenburg, 2009). Whereas infants may adjust relatively quickly to relying on the foster parent as a primary caregiver, children and adolescents may struggle with accepting the foster parent in this role, due to feelings of loyalty to their parents, resentment about placement into foster care, yearning to return home, and distrust of the foster parent or the child welfare system (Baker, Creegan, Quinones, and Rozelle, 2016). 370

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Thus, children entering foster care bring with them a host of previous experiences that have shaped their socioemotional, behavioral, and biological development—often in ways that pose significant challenges to parenting.

Birth Parents Parents whose children are removed from their care and placed into foster care often struggle with the traumatic loss of their child as well as the issues that led to that loss. Maltreatment can be best conceptualized using an ecological transactional model (Cicchetti and Toth, 2005), with many factors contributing to its occurrence. Within the parent, risk factors for perpetrating maltreatment include mental health problems (Windham et al., 2004), substance abuse (Cash and Wilke, 2003), and stress (Pereira et al., 2012). Within the family, risk factors include domestic violence (Hartley, 2002), lack of social or partner support (Price-Wolf, 2015), and low income (Jonson-Reid, Drake, and Zhou, 2013; Maguire-Jack and Font, 2017). Additionally, maltreatment may be transmitted across generations, with estimates of continuity ranging widely from 7% to 70% (Berzenski, Yates, and Egeland, 2014). Maltreatment occurs at higher rates in communities characterized by concentrated poverty or elevated violence (Coulton, Korbin, and Su, 1999; Drake and Pandey, 1996; Eckenrode, Smith, McCarthy, and Dineen, 2014), although these neighborhoods may also be subject to more reporting or investigation for maltreatment (Coulton, Crampton, Irwin, Spilsbury, and Korbin, 2007). Taken together, maltreating parents are often overwhelmed by a host of risk factors at the individual, family, and community level that undermine their ability to provide safe and optimal caregiving, especially in the absence of protective factors. In 2015, the identified placement goal for children in foster care was reunification with birth parents for about 55% of children in foster care in the United States (U.S. Department of Health and Human Services, 2016). When reunification is the plan, birth parents must meet several requirements to have their children returned to their care. Such requirements may include participating in mandated services, such as parenting programs, mental health treatment, substance abuse treatment, as well as securing safe and stable housing. A visitation schedule is usually established, allowing birth parents to visit with their children, with these visits often initially supervised at an agency. Over time, these visits may become more frequent, with children transitioning to weekend visits at the birth parent’s home until the child is reunified. Birth parents’ past experiences, characteristics, and current circumstances influence foster parents directly and indirectly. Although some birth parents and foster parents have supportive relationships and effectively coparent, many relationships between birth parents and foster parents are conflictual. Birth parents may interact with foster parents in hostile ways, due to feelings of anger, jealousy, or resentment; alternatively, they may withdraw, miss visits, or fail to maintain consistent communication (Chateauneuff,Turcotte, and Drapeau, 2017; Haight, Kagle, and Black, 2003). Conflicts between foster parents and birth parents can result in placement disruptions. Indirectly, birth parents’ past experiences and behaviors, particularly those that have contributed to the foster child being placed out of home, may influence foster parents’ perceptions and feelings about the birth parent or their foster child.

Child Welfare Caseworkers Foster care agencies are responsible for finding foster care placements when children are removed from their parents’ care. In addition to placing children and monitoring the quality of care provided in foster homes, foster care agency staff are responsible for providing or coordinating services for children. Given that foster children have elevated mental and physical health problems, they often require psychological and medical treatments as part of their service plans. Although child welfare 371

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caseworkers are often responsible for ensuring that foster children receive services to meet their mental health needs, they are often undertrained in assessing those needs and identifying appropriate services, especially services that are evidence-based (Dorsey, Kerns, Trupin, Conover, and Berliner, 2012). Finally, child welfare caseworkers coordinate and supervise visitation between birth parents and their children in foster care and oversee the process of reunification when children return home. In addition to the high number of responsibilities, child welfare caseworkers intersect with many other professional systems, including law enforcement, the court system, and schools. Furthermore, they directly interact with foster children, birth parents, and foster parents. Turnover rates for child welfare caseworkers are high, with low pay, lack of experience, lack of peer, supervisor, and organization support, limited training, and safety risk predicting turnover (Scannapieco and Connell-Carrick, 2007). Child welfare caseworkers often have high caseloads, requiring them to coordinate care and services for between 10 and 20 children at any given time. High caseloads among child welfare caseworkers and high rates of turnover can interfere with foster children and foster parents getting the support and services that they need (Hayes, Geiger, and Lietz, 2015). Additionally, when child welfare caseworkers are unresponsive to foster parent needs, the likelihood of foster parents discontinuing fostering is increased (Rhodes, Orme, Cox, and Buehler, 2003). Thus, foster parents rely on child welfare agencies for training and educational resources, case management, and emotional support (Chipungu and Bent-Goodley, 2004; Geiger, Piel, and Julien-Chinn, 2017).

Foster Parents Foster placements include non-relative foster homes (45%), relative or “kinship” foster homes (30%), group homes (6%), institutional settings (8%), pre-adoptive homes (4%), and other categories, such as supervised independent living, runaways, or trial home visits (U.S. Department of Health and Human Services, 2016). Studies examining demographic characteristics of foster parents find that foster parents are, on average, in their early to mid-40s, married, and have low to mid socioeconomic status (Ahn, Greeno, Bright, Hartzel, and Reiman, 2017). Following screening and selection procedures, which typically involve thorough investigation of their backgrounds, home and financial situation, mental health, and parenting capacities, foster parents receive mandated training to prepare them to provide care to children removed from their homes. Foster parents are paid for their service as caregivers, although the stipends they receive are not substantial, and typically foster parents work outside of the home. When a foster child is placed in a foster parent’s home, the foster parent assumes a role much like any other parent. The foster child is integrated into the foster parent’s family, which may include additional caregivers and additional children (e.g., biological children and/or related or unrelated foster children). Foster parents assume responsibility for caring for the child’s basic physical and nutritional needs, as well as their social and emotional needs.Thus, the foster parent provides food, shelter, and clothing for the child. The foster parent may impose rules and routines for the foster child and implement discipline strategies, as well as offer comfort or other forms of support (e.g., help with schoolwork) as needed. Although many parenting decisions are made by the foster parent him- or herself, the foster parent shares his or her authority over the child with the child’s birth parent as well as with the foster care agency. Foster parents have a unique role for several reasons. First, attachment theory and research highlight several differences between foster parenting and other forms of parenting. Children are born biologically prepared to expect consistent and responsive caregiving. Maltreatment and subsequent separations from primary caregivers pose significant threats to children forming attachment relationships. Foster parents, then, serve a role in supporting foster children as they form attachment expectations following serious threats to attachment relationships, including loss, separation, and trauma. Second and related, the role of foster parents is unique because, by design of the child welfare 372

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system, they serve as temporary parents to children. This is unlike care provided by biological parents, for which an ongoing relationship is assumed. The temporary nature of the relationship poses challenges to foster parents committing to, or emotionally investing in, the children in their care. Other challenges to commitment may include the professional nature of their caregiving role and lack of biological relatedness to the foster child.

Summary of the Child Welfare System The child welfare system serves to protect children and promote child well-being, and primarily serves children who have experienced threats to their safety such as abuse and neglect. Foster parents care for children who have been removed from their homes and placed into temporary, out-of-home care. In addition to their relationships with foster children, which are challenged by issues related to attachment and commitment, foster parents must navigate potentially complex relationships with their foster children’s birth parents as well as child welfare agency caseworkers.

Attachment in Foster Care Next, we turn attention to parent–child attachment in the context of foster care. Attachment theory offers a useful framework for considering the unique role of foster parents, given that foster care poses a direct threat to children’s relationships with primary caregivers. Furthermore, foster parents, in taking on the role of primary caregiver to foster children, may face several attachment challenges themselves, such as providing care that supports children’s attachment despite knowing that the relationship may be temporary.

Overview of Attachment Theory Originating from the work of John Bowlby and Mary Ainsworth (Ainsworth and Bowlby, 1991), attachment theory proposes that infants are oriented to form bonds with their primary caregivers and that the quality of their attachment has implications for children’s development. The quality of an infant’s attachment relationship is assessed empirically through the Strange Situation Procedure developed by Ainsworth, which involves a series of increasingly stressful separations and reunions between the infant and the caregiver (Ainsworth, Blehar, Waters, and Wall, 1978). Infants whose attachments are classified as secure can use the caregiver as a secure base from which to explore and as a source of comfort in times of distress. In contrast, infants with an insecure-avoidant attachment classification are not likely to seek out their caregiver in times of distress, instead ignoring him or her, while those with an insecure-resistant/ambivalent attachment classification are likely to show a mixture of seeking contact with and rejecting the caregiver without being fully comforted by the caregiver. Later, Main and Solomon (1990) developed a fourth classification, disorganized, to capture those infants who lack a consistent attachment strategy with their caregiver. The quality of attachment in infancy is important because it has been associated with a variety of outcomes. In particular, disorganized attachment is a risk factor for negative outcomes, including externalizing problems, dissociative behavior, and increased risk for psychopathology (Carlson, 1998; van IJzendoorn, Schuengel, and Bakermans-Kranenburg, 1999). As a result, forming an organized and secure attachment is considered ideal. In addition to characterizing interactions with caregivers in infancy, attachment theory extends into adulthood. Attachment representations, or internal working models, are formed based on experiences with caregivers over time and shape individuals’ expectations of relationships with close others (Main, Kaplan, and Cassidy, 1985). The Adult Attachment Interview (AAI; George, Kaplan, and Main, 1985) was developed to assess these internal attachment representations through a series 373

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of questions about past and current relationships with one’s parents and questions about any experienced loss or trauma. Based on the AAI, adults are classified as secure-autonomous if they discuss attachment-related experiences in an open and coherent manner that shows a valuing of attachment relationships; insecure-dismissing if they minimize the importance of attachment by describing attachment figures in an idealizing way or deny memories of attachment experiences; insecurepreoccupied if they show anger and preoccupation with past attachment experiences; or unresolved/ disorganized if they show lapses in their thinking or discourse when discussing loss or abuse. Parents’ AAI classifications predict their infants’ attachment classifications, suggesting that parents’ own attachment representations play a role in their ability to respond to their infant, and in turn, in their infants’ development of attachment expectations (van IJzendoorn, 1995). Although attachment is of relevance to any infant-caregiver dyad, it is of particular interest in the foster parent–child dyad given the unique nature of their relationship. Attachments are generally formed with one’s primary caregivers and require the presence of a consistent caregiving relationship. The potentially frequent disruptions in relationships with primary caregivers experienced by foster children are not conducive to developing an attachment relationship, raising important questions as to how to provide foster children with the best opportunities to develop organized and stable attachments. In addition, foster children may be predisposed to insecure or disorganized attachments because of their early environments, as maltreatment or neglect are associated with increased likelihood of disorganized attachment (Carlson, 1998). In contrast to these potential challenges to attachment security for foster children, foster care itself may provide an opportunity for forming improved attachment relationships with a new caregiver, particularly if that caregiver is sensitive to the child’s needs and consistently present. Therefore, it is important to consider some of the unique challenges and potential benefits of attachment in the context of foster care.

Maltreatment as a Threat to Attachment Early maltreatment is one factor that has been consistently related to insecure or disorganized attachment patterns. Early studies utilizing the Strange Situation Procedure indicated an association between maltreatment and insecure attachment, with somewhat inconsistent findings. For example, within a low socioeconomic status sample, infants who had been maltreated were less likely to be securely attached at 12 months than those who had received good maternal care (Egeland and Sroufe, 1981). However, this difference was no longer significant at 18 months, as more than half of the maltreated infants’ classifications changed between the 12- to 18-month assessments, with increases in avoidant and secure classifications. Thus, early differences in attachment classification between maltreated and non-maltreated low socioeconomic status infants did not seem to hold constant as infants aged. The association between maltreatment and insecure attachment was replicated in a study comparing maltreated and non-maltreated infants in a poverty sample ranging from 8 to 31 months of age, with the additional finding that only maltreatment by the mother, and not maltreatment by another person, was associated with significant differences in attachment classification (Lamb, Gaensbauer, Malkin, and Schultz, 1985).This finding suggests that the impact of maltreatment may be specific to infants’ attachment with the perpetrator of maltreatment, allowing the potential of forming secure relationships with other caregivers. Such studies provided preliminary evidence for maltreatment as an antecedent of insecure classification. The development of the disorganized classification for the Strange Situation Procedure (Main and Solomon, 1990) further clarified the association between maltreatment and attachment status by identifying many infants as disorganized who had previously been coded with forced organized attachment classifications. In one of the early applications of the disorganization classification system, low socioeconomic status infants who were maltreated had a much higher prevalence of disorganized classifications (82%) than those who were not maltreated but matched for similar demographic 374

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characteristics (19%; Carlson, Cicchetti, Barnett, and Braunwald, 1989). The association between maltreatment and disorganized attachment was further supported by a meta-analysis of samples from 55 studies indicating that maltreated children were more likely to demonstrate disorganized attachment and less likely to demonstrate secure attachment than other high-risk children (Cyr, Euser, Bakermans-Kranenburg, and van IJzendoorn, 2010). However, this meta-analysis also demonstrated that children who had experienced five or more socioeconomic risk factors (e.g., low income, single mother, minority) were similarly likely to have disorganized attachment as maltreated children. This finding suggests that the differences in attachment between maltreated and non-maltreated children diminishes as the quantity of other risk variables increases among non-maltreated children. Adding additional insight to the maltreatment-attachment association, a study examining ethnically diverse preschoolers with low socioeconomic status found that the severity of maltreatment was not related to differences in attachment classification, suggesting that both low-severity and high-severity maltreatment may have as impact on attachment quality (Pickreign Stronach et al., 2011). Taken together, there is substantial evidence supporting early maltreatment as a predictor of disruptions in attachment. The association between maltreatment and attachment has implications beyond early childhood. For example, childhood experiences of physical and sexual abuse or maltreatment have been associated with increased likelihood of an unresolved classification on the AAI among at-risk adolescent mothers (Bailey, Moran, and Pederson, 2007). In addition, the association between early maltreatment and attachment may contribute to outcomes later in life. For instance, disorganized attachment as measured by the Strange Situation Procedure in infancy mediates the association between early experiences, such as maltreatment, and adolescent psychopathology and dissociation (Carlson, 1998). In addition, self-reported current insecure attachment mediates the association between childhood emotional maltreatment and current depressive symptoms in adults (Hankin, 2005). Such findings suggest that attachment may be one mechanism through which early maltreatment is associated with negative outcomes later in life. As a result, attempts to nurture secure attachments may be of importance in populations at high risk for maltreatment, including foster children.

Forming Attachment Relationships in Foster Care Because of disruptions in care and potential exposure to maltreatment, infants and children in foster care may find it particularly challenging to form secure attachments. At the same time, foster care may provide these infants with a new opportunity to form new attachments. As a result, it is important to understand the nature of forming attachment relationships in foster care. The Bucharest Early Intervention Project (Nelson, Fox, and Zeanah, 2014) is a randomized control trial of foster care as an intervention for Romanian children who lived in institutional care early in life. For this study, children were randomly assigned to care as usual (staying in the institution, at least initially) or high-quality family foster care. Given the unique experimental design, the Bucharest Early Intervention Project offers insight into the role that foster care can play in children’s development of secure attachments, among many other outcomes across various domains of functioning. Children’s attachment was assessed at the age of 42 months (Smyke, Zeanah, Fox, Nelson, and Guthrie, 2010). Whereas only 17.5% of children in the institutionalized care as usual had developed secure attachments, 49.5% of children in the foster care group had developed secure attachments. Furthermore, children who were placed in foster care before the age of 24 months were more likely to have secure attachments and less likely to have disorganized attachments than children placed in foster care after the age of 24 months. In addition, girls showed greater differences in attachment between foster care and institutionalized care than boys. Institutionalized children randomly assigned to care as usual also had more signs of attachment disorder and disinhibited social engagement at 12 years of age than both children receiving high-quality foster care and never-institutionalized comparison 375

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children (Humphreys, Nelson, Fox, and Zeanah, 2017). These findings suggest that it is possible for children to form secure attachments in the context of foster care and that they are more likely to form secure attachments in foster care than in the context of institutionalized care. Although children have the potential to form secure attachments in foster care, a variety of variables likely moderate the likelihood of doing so. One factor that may contribute to the likelihood of forming a secure attachment in foster care is age at placement. Stovall-McClough and Dozier (2004) found that infants who were younger than 1 year old at placement had higher levels of secure behavior, lower levels of avoidant behavior, and more coherent attachment strategies early in their placement than those placed at an older age; however, differences in attachment based on age at placement may not last, as such differences were not found when attachment was assessed after at least 3 months of placement (Dozier, Stovall, Albus, and Bates, 2001). Although younger age at placement may be associated with greater attachment security and coherence early in placement, this factor seems to have diminishing importance as the length of foster placement increases. Another factor that may play a role in the formation of attachment relationships is the quality of foster care received. Children of foster parents who show more sensitivity toward their foster child display higher levels of attachment security at home than children of foster parents who show less sensitivity (Oosterman and Schuengel, 2008), suggesting that the quality of parenting influences foster children’s attachment patterns, similar to findings in intact, biologically related dyads. The association between the quality of parenting and children’s attachment is further supported by the outcomes of interventions targeting the quality of care received by foster children (described below). Multidimensional Treatment Foster Care Program for Preschoolers, for example, which focuses on improving multiple aspects of the foster child’s environment including sensitive, responsive, and consistent parenting, is associated with increases in secure behavior and decreases in avoidant behavior compared to control children receiving foster care as usual (Fisher and Kim, 2007). Similarly, Attachment and Biobehavioral Catch-up, which promotes responsive and sensitive caregiving among foster parents, is associated with less avoidance behavior in foster children compared to a control educational intervention (Dozier et al., 2009). Such intervention results indicate that increasing quality of parenting among foster parents helps reduce insecure attachment behaviors, aiding in the formation of secure attachment relationships in foster children. Furthermore, given the experimental designs employed in these randomized clinical trials, these studies support a causal association between foster parent quality of care and foster children’s attachment security. Taken together, foster care provides children with an opportunity to form new attachment relationships that may improve on previous caregiving environments. While in the care of foster parents, the likelihood of developing a secure attachment appears to be impacted by the quality of caregiving provided.

Foster Parent Attachment State of Mind Given the strong association between parents’ attachment states of mind and their children’s attachment styles (van IJzendoorn, 1995), consideration of foster parents’ attachment states of mind is also important to understanding what may support the quality of foster parent–child relationships. Studies examining foster parents’ attachment states of mind in comparison to adoptive or community parents have not found significant differences in categorizations or scores (Jacobsen, Ivarsson, Wentzel-Larsen, Smith, and Moe, 2014; Raby et al., 2017), suggesting that those who choose to become foster parents do not significantly differ in attachment states of mind. Furthermore, foster parents have been found to have lower scores on the preoccupied dimension and fewer preoccupied categorizations than a low-income group of biological parents referred to child protective services (Raby et al., 2017). Like any typical sample of parents, foster parents vary in their attachment state of mind. In a sample of foster care dyads in which the infant entered foster care between birth and 20 376

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months of age, all non-secure/autonomous foster mothers were categorized as dismissing, which the authors suggested may be adaptive given the possibility foster parents face of having to give up their foster child (Bates and Dozier, 2002). Foster parent attachment state of mind also plays a role in the foster parent–child relationship. For example, foster parent attachment state of mind has been associated with foster parent–child interaction, with insecure parents showing more atypical interaction behaviors, such as role confusion, intrusiveness, and disorientation (Ballen, Bernier, Moss, Tarabulsy, and St-Laurent, 2010). Thus, a secure attachment state of mind may promote parent–child interactions likely to promote a secure attachment and positive outcomes in foster children. In addition, foster child age at placement plays a role in the association between foster parent attachment state of mind and interactions with the foster child. Foster mothers with an autonomous state of mind whose foster child was placed before the age of 12 months reported more acceptance and belief in their ability to influence their child than autonomous mothers whose child was placed after 12 months of age (Bates and Dozier, 2002). The authors of this study proposed that the age-related differences in foster mothers’ beliefs in their ability to influence their child may be an effect of mothers’ awareness of expression of needs in younger foster children or of the difficulty of overcoming the increasing challenges faced by older foster children. Regardless of the mechanism, there is evidence that foster parents’ attachment states of mind are associated with the caregiving they can provide to their foster child, which in turn may be influenced by other factors of the foster parent–child relationship. In addition to influencing the foster parent’s interactions with their foster child, foster parent attachment state of mind has been associated with foster child outcomes. Foster parent attachment state of mind is related to infant attachment quality with a correspondence like that of biologically intact dyads when assessed between 12 and 24 months of age (Dozier et al., 2001).This finding indicates that attachment state of mind may play a similarly important role in foster and biologically intact dyads. When assessed between 2 and 3 years of age, the correspondence between foster parent attachment state of mind and foster child attachment was somewhat lower than when assessed a year earlier, but also somewhat higher than the correspondence found in a study of late-adopted children (Jacobsen et al., 2014). Additionally, promising associations have been found between autonomous foster parent states of mind and child outcomes. Based on an assessment of attachment diary data, children who were placed before the age of 12 months with an autonomous parent were likely to show secure behaviors in diary reports of daily situations that elicited distress, as well as in the Strange Situation Procedure (Stovall and Dozier, 2000). Similarly, the foster children of autonomous parents have been found to demonstrate more secure and coherent behavior and less avoidant behavior in the first week of placement than those with insecure parents (Stovall-McClough and Dozier, 2004). An autonomous attachment state of mind appears to benefit the foster parent’s ability to form a secure attachment with their child and therefore provides an additional factor to target among foster parents.

Summary of Attachment in Foster Care Attachment likely plays a significant role in the foster care environment. Children in foster care face multiple challenges to their ability to form secure attachments, including potentially frequent changes in primary caregivers and an increased likelihood of early maltreatment. However, foster care also provides these infants with new opportunities to form secure attachments. The formation of secure attachments among foster dyads is possible and may be more likely than in other care contexts, such as institutional care. In particular, foster parents who are more sensitive or who have a secure-autonomous attachment state of mind themselves may be especially likely to foster secure attachments in their foster children. Overall, efforts should be made to provide foster infants with opportunities to develop secure attachments, with particular attention paid to the potential role of the foster parent in nurturing such attachments. 377

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Foster Parent Commitment In this section, we discuss factors that influence a foster parent’s commitment, or their investment in having a lasting relationship with a particular child. Foster parents’ beliefs about their roles and motivation to take on the responsibility of fostering are central to the study of foster care and the factors that influence its success. Reasons individuals may decide to become foster parents range from the altruistic (i.e., providing care to at-risk children) to the practical (i.e., securing employment), and foster parents may view their role as that of an employee providing time-limited assistance, or they may see themselves as permanent sources of love and support in their foster children’s lives (Ackerman and Dozier, 2005; Bates and Dozier, 2002; Rodger, Cummings, and Leschied, 2006). Indeed, a number of researchers have examined variability in foster parents’ levels of commitment and emotional investment in their foster children in relation to outcomes such as placement stability, foster parents’ neurobiology, and children’s behavioral and emotional development (Ackerman and Dozier, 2005; Bick, Dozier, Bernard, Grasso, and Simons, 2013; Dozier and Lindhiem, 2006; Rodger et al., 2006). General measures have been developed to quantify foster parents’ attitudes about their role as a foster parent, such as the Casey Foster Parent Inventory (Orme, Cuddeback, Buehler, Cox, and Le Prohn, 2007) and the Foster Parent Attitudes Questionnaire (Harden, Meisch, Vick, and Pandohie-Johnson, 2008). However, the This Is My Baby Interview (TIMB; Bates and Dozier, 1998; Dozier and Lindhiem, 2006), a semi-structured interview for foster parents, most directly and specifically measures foster parent commitment and has been used in the largest share of research examining associations between foster parent commitment and foster parent and child outcomes. The TIMB interview produces three scores: parents’ acceptance of the child, commitment to the child, and belief in their influence on the child’s psychological development. The commitment subscore is of greatest interest and use in research examining foster parents’ commitment to their foster children. For our purposes, we utilize the same definition of foster parent commitment as Dozier and colleagues: the caregiver’s investment in an enduring relationship with the foster child. The concept of parental investment is motivated by both attachment and evolutionary preparedness theories. Given that humans infants are highly reliant on caregivers for survival, parents’ longterm emotional investment in their offspring is critical (Harden et al., 2008). Furthermore, attachment theory holds that infants have an innate need to maintain proximity to their caregivers, a need that is almost certainly fulfilled in part by caregivers’ commitment to the caregiver-child relationship (Cohn and Tronick, 1989). Among biological parent–child dyads, parental investment has been assessed using the Parental Investment in Child scale (PIC; Bradley, Whiteside-Mansell, Brisby, and Caldwell, 1997), a self-report questionnaire with items that assess parental delight, sensitivity to needs and cues, acceptance of the role of parenting, and distress at being separated. However, foster parent commitment is conceptually distinct from parental investment among biological parents, in that the definition of commitment involves the caregiver’s willingness to have an enduring relationship with the child.This interest in an enduring relationship is assumed to be present among most biological parents. Given the often short-term and fractured nature of foster care, the structure of the foster care system, the lack of biological relatedness to foster children, and the challenges of providing care to children with behavioral and emotional problems, commitment may be an especially relevant concept to be studied in foster parents. We now consider several factors that may interfere with foster parents’ feelings of commitment to foster children.

Commitment Challenges for Foster Parents Temporary Care The temporary nature of foster care is perhaps the most immediately apparent challenge to foster parents’ ability to develop a sense of commitment to their foster children. Given that commitment is defined as the caregiver’s investment in an enduring relationship with the foster child, fostering a child 378

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whose placement future is uncertain is—nearly definitionally—a commitment obstacle. In such a situation, foster parents may view lack of commitment to their foster child as adaptive, particularly if they have experienced giving up foster children in the past (Dozier, 2005; Dozier, Grasso, and Lindheim, 2007). The foster care system in the United States is designed with temporary, time-limited care in mind: in 2015, approximately 45% of children who left foster care were in care for less than 1 year (U.S. Department of Health and Human Services, 2016). Foster parents’ challenge, then, is to develop a sense of commitment to their foster child despite the reality of a likely impermanent relationship.

Structure of Foster Care Other aspects of the structure of the foster care system may place additional burdens on foster parents’ commitment to their foster children. Foster care placements are frequently ambiguous and the product of crisis situations, communication between various members of the foster system team is often strained or confusing, and foster parents may feel they have not received adequate training (Bass, Shields, and Behrman, 2017; Rodger et al., 2006). Much like other public service or helping professions, there is also a great imbalance between children in need of foster care services and highquality, intrinsically motivated foster parents able to provide them (Bass et al., 2017).Therefore, foster care must be partially presented as a form of employment, and one that is not often perceived of as high status or requiring expertise (Bass et al., 2017; Rodger et al., 2006). Some have criticized the “professionalizing” of foster care and argued that conceptualizing the role of foster parent as a job inherently contradicts the task of forming attachment and commitment to foster children (Dozier, 2005). Unfortunately, these system-level issues are not easily remediable; those responsible for making decisions about removing children from their biological parents must act quickly and prioritize basic child safety. Nonetheless, interventions may be effective in changing foster parents’ cognitions and behaviors toward their foster children (Dozier, Bick, and Bernard, 2011), although evidence-based parenting interventions have not yet directly targeted commitment.

Lack of Biological Relatedness Lack of biological relatedness to one’s foster child may also pose a challenge to foster parents’ sense of commitment. From an evolutionary perspective, new mothers become biologically prepared for caregiving during pregnancy and postpartum, with hormones secondary to pregnancy and early caregiving experiences likely contributing to observed structural and functional brain changes organized around caregiving (Kim et al., 2010; Swain, Lorberbaum, Kose, and Strathearn, 2007). Imaging studies have identified unique patterns of neural responding in mothers when they are exposed to own-child specific stimuli, such as the sound of their infant crying or their own infant or child’s photograph, compared to photos and cries of unfamiliar infants and children (Bornstein et al., 2017; Bornstein, Arterberry, and Mash, 2013; Doi and Shinohara, 2012; Grasso, Moser, Dozier, and Simons, 2009; Noriuchi, Kikuchi, and Senoo, 2008). However, similar research has also demonstrated that parents—compared to non-parents—show a unique pattern of neural response to infant stimuli regardless of whether the infant is related to them (Proverbio, Brignone, Matarazzo, Zotto, and Zani, 2006; Seifritz et al., 2003; Strathearn, Li, Fonagy, and Montague, 2008). These bodies of literature converge to suggest that both biology and caregiving experience are important factors shaping parents’ neural responses to the children in their care. Indeed, brain imaging research comparing foster and biological parents has demonstrated that foster parents and biological parents show similar patterns of heightened neural response to a photo of their own child, and that this enhanced neural activity is related among both types of caregivers to caregiving attitudes, such as awareness of infants’ need for nurturance and pleasure in parenting children (Grasso et al., 2009). However, commitment 379

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has not been found to be associated with enhanced foster or biological parent neural activity to child cues (Grasso et al., 2009). It is possible that more targeted neuroimaging tasks that are specifically designed to elicit feelings of commitment may better differentiate neurobiology associated with commitment among foster parents. The question of biological relatedness is also interesting to consider given that a great number of foster parents are the biological relatives of their foster child. So-called “kinship care” accounted for 30% of foster care placements in 2015 (U.S. Department of Health and Human Services, 2016). Some research has indicated that kinship caregivers may have a more positive perception of their foster children and feel more responsible for facilitating foster children’s emotional development compared to non-related foster parents (Beeman and Boisen, 1999; Gebel, 1996; Rubin et al., 2008), but whether kinship caregivers feel a stronger sense of commitment to their foster children has yet to be examined and is a compelling target for future research.

Foster Child Factors Given the bidirectional nature of parent–child interaction, it is hardly surprising that foster children’s own characteristics can pose challenges to foster parent commitment. Children entering foster care frequently have severe developmental and behavioral problems that may challenge parents, increasing foster parent stress (Gabler et al., 2014). Indeed, children who enter foster care with externalizing problems are more likely to experience disruptions in care (Oosterman, Schuengel, Slot, Bullens, and Doreleijers, 2007), and foster children who have physical disabilities, are older, and require more services (e.g., mental health treatment, early intervention) are more likely to elicit negative or less nurturing caregiver behavior and less likely to achieve placement stability than their counterparts (Barber, Delfabbro, and Cooper, 2017; Dozier and Lindhiem, 2006; Stovall-McClough and Dozier, 2004; Stovall and Dozier, 2000). Research specifically examining commitment has similarly indicated that foster parents tend to feel greater commitment toward children who have lower levels of caregiver-reported behavior problems, particularly externalizing problems (Dozier and Lindhiem, 2006). Furthermore, there is some evidence that older foster children may themselves feel ambivalence about a permanent relationship with a foster parent, and may understandably struggle to feel a sense of belonging to both a foster family and a biological family (Biehal, 2014). Ambivalence on the part of the foster child can then be seen as an additional commitment challenge for foster parents and may explain, in part, why foster parents are more likely to commit to younger foster children. Taken together, the task of foster parents is to develop a sense of commitment to foster children who may exhibit challenging behavior, have uncertain placement futures, and are not (always) biological relatives, with little training and often strained communication within the foster care system. There are also challenges for foster children (particularly older foster children) who often feel ambivalent about the notion of foster parent commitment and may not be able to reconcile permanently belonging to both their foster family and biological family (Biehal, 2014). These tasks may seem unrealistic or overly demanding; however, the presence of a committed caregiver in a foster child’s life yields substantial benefits, so much so that some experts consider it to be as vital as any other basic necessity, such as food and shelter (Dozier et al., 2007; Dozier and Lindhiem, 2006). We discuss both predictors and outcomes of foster parent commitment, as well as the relation between commitment and parenting, in the following sections.

Predictors of Foster Parent Commitment Several studies have identified factors that predict foster parents’ ability to commit to their foster children. Not surprisingly, predictors of foster parent commitment are related to the commitment challenges that foster parents frequently face. Specifically, foster parents endorse higher levels of 380

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commitment toward their foster children when foster parents perceive that the relationship is likely to be permanent (Dozier and Lindhiem, 2006), when there are lower levels of foster child, toddler, and infant externalizing behavior (Koren-Karie and Markman-Gefen, 2016; Lindhiem and Dozier, 2007), and when foster children enter care at a younger age (Dozier and Lindhiem, 2006). Foster parent education, age, and income have not been found to predict foster parent commitment nor has match between caregiver and child ethnicity (Bernard and Dozier, 2011; Koren-Karie and Markman-Gefen, 2016; Lindhiem and Dozier, 2007). However, foster parents who have fostered more children previously have been found to show lower levels of commitment compared to those who have fostered fewer children (Dozier and Lindhiem, 2006). This may be due to self-selection (that foster parents who feel more committed are likely to stop fostering children after experiencing losing them) or to foster parents’ need to protect themselves emotionally against the prospect of impermanent relationships with children in their care. Foster parents also generally show higher levels of commitment compared to group care providers, which may be due in part to the fact that foster parents care for relatively fewer children compared to group care workers and provide care in their own home, similar to biological parents (Lo et al., 2015). Finally, there has yet to be evidence that biological factors, such as foster mothers’ neural responses to photos of their foster child’s face and oxytocin levels after cuddling with their foster child, are related to foster parent commitment (Bick et al., 2013; Grasso et al., 2009). More research is needed to uncover whether other neurobiological factors may contribute to foster parents’ ability to commit to their foster children. However, one optimistic interpretation of the lack of identified biological substrates of commitment is that commitment is not specific to certain neurobiological profiles, and therefore that interventions aimed to enhance commitment may be successful among a variety of foster parents.

Commitment and Parenting Quality There is relatively little research examining the specific ways in which foster parent commitment affects parenting practices and cognitions. It should not necessarily be assumed that parents who are nurturing or responsive are also committed, or vice versa, especially among foster parents who may view provision of care to children as their job. Among non-foster families, parents’ socioemotional investment in their children—defined broadly as acceptance of their parenting role, delight in their child, parenting knowledge, and separation anxiety—has been linked to higher levels of sensitive caregiving, social support, and marital support and lower levels of parental neuroticism, anxiety, and depression (Bradley et al., 1997). However, the definition of socioemotional investment used by Bradley and colleagues is much broader than that used by Dozier and colleagues (Bates and Dozier, 1998) in their research on foster parent investment, and it is possible that a more specific definition of commitment may be related to a unique set of parenting behaviors—especially when examined in a foster parent population. In a study specific to foster parents, Bernard and Dozier (2011) used the TIMB interview to examine associations between foster parent commitment and behavior in a play interaction, and found that foster parents with higher levels of commitment displayed significantly more delight toward their foster children during play than foster parents with lower levels of commitment (Bernard and Dozier, 2011). This finding was replicated in a later study by the same group (Bick et al., 2013). More research is needed, however, to understand the relation between foster parent commitment and the full range of caregiving behavior.

Commitment and Child Outcomes The task of caregivers to form enduring relationships with foster children is challenging for many reasons, and foster parents’ commitment to their foster children may enhance a number of child outcomes. Ackerman and Dozier (2005) found that children whose foster mothers were more 381

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committed, as assessed by the TIMB interview, displayed more adaptive coping responses when separated from their caregiver and had more positive self-representations as assessed by a projective puppet interview than children whose foster mothers expressed lower levels of commitment. The importance of this finding cannot be overstated; children in foster care have experienced significant early adversity and are therefore at increased risk for developing maladaptive coping strategies and more negative representations of themselves, in addition to other behavioral and emotional problems (Simmel, Brooks, Barth, and Hinshaw, 2001; Toth and Emde, 1996). Commitment has also been found to predict placement stability, such that foster children with committed caregivers are more likely to be adopted or to have a long-term placement (Dozier and Lindhiem, 2006). Placement instability is associated with a number of other outcomes, such as conduct problems and other externalizing disorders and poor academic functioning (Aldgate, Colton, Ghate, and Heath, 1992; Barber et al., 2017). Therefore, findings that commitment predicts placement stability suggest that foster parent commitment is an important mechanism in shaping foster children’s long-term outcomes. It warrants mentioning again, however, that caregivers are less likely to commit to children and toddlers with externalizing problems as well as children who are older (Koren-Karie and Markman-Gefen, 2016; Lindhiem and Dozier, 2007), and thus associations between commitment and placement stability are moderated by child factors. Finally, qualitative research suggests that children’s sense of permanency and belonging to their foster family is a major factor affecting the quality of their experience in long-term foster care (Biehal, 2014). Although not a long-term outcome, this qualitative finding is equally important and suggests that other factors, such as foster child happiness and life satisfaction, may be affected by foster parent commitment.

Summary of Foster Parent Commitment Foster parent commitment, defined as a foster parent’s investment in an enduring relationship with their foster child, has received relatively little attention in the foster care literature compared to other caregiver cognitions and behaviors. Committing to a foster child may be uniquely challenging to foster parents, given that they are faced with the prospect of a likely impermanent relationship with their foster child, must care for children with significant behavioral and emotional problems, may care for older, more ambivalent children, and must contend with lack of support from or strained communication with others within the foster care system. Foster parent commitment is associated with a range of positive child outcomes, from enhanced placement stability to decreased externalizing problems. Evidence suggests that the challenge of committing is made easier for foster parents when they have fostered fewer children, when they provide care in a non-group home setting, and when their foster children are younger and have fewer behavioral problems. More research is needed to uncover the ways in which the foster care system can promote commitment among foster parents, including predicting which potential foster parents may be able to commit more easily as well as which foster children may benefit most from a committed caregiver.

Interventions for Foster Parents Foster parents face many challenges given their unique role, including parenting children who may have behavioral, emotional, and developmental issues, committing and emotionally investing in what is likely to be a temporary relationship, supporting children’s transitions between homes, and navigating relationships with children’s birth parents. After defining and reviewing these challenges that highlight the need for foster parent support, we discuss programs and practices designed to address the unique needs of foster parents.

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The Need for Foster Parent Support Children enter foster care having typically experienced abuse or neglect, exposure to other risk factors, and the added challenge of separating from their primary caregivers. Collectively, these traumatic experiences threaten development in ways that have lasting consequences for children’s social, emotional, behavioral, and biological functioning. Thus, when children enter foster care, they may behave in ways that make it difficult for foster parents to provide sensitive, consistent, and effective caregiving. Foster children’s behavioral problems have been shown to increase stress among foster caregivers and further increase the likelihood of disruptive placements (Chamberlain et al., 2006). Interventions that help caregivers navigate the many emotional, behavioral, and social challenges faced by children in the foster care system can be a powerful tool for improving child outcomes. Children in foster care can exhibit vulnerabilities that demand a supportive, structured, and sensitive parenting style, as well as a strong attachment between the caregiver and child. However, the temporary nature of foster placements can undermine the parent–child relationship and make it more difficult for parents to implement effective parenting strategies. For instance, foster parents are often under the impression that they should not get “too close” to their foster children to ease children’s transition out of the home. Foster parents may believe that limiting the attachment relationship may protect children from pain on separation from the foster caregiver, but research suggests that low levels of commitment interfere with providing sensitive and stable care to foster children (Bernard and Dozier, 2011; Dozier and Lindhiem, 2006). Foster parents may also play a role in their foster child’s transition from their home to either another foster family or back to their birth family. The transition itself can represent a traumatic experience for a child, and the changes in rules, discipline strategies, and family routines may cause conflict between caregivers and children. Communication between foster caregivers or between foster caregivers and birth parents may be strained or inconsistent, which makes it more difficult to ensure a smooth transition between placements. Interventions aimed at foster parents can address this challenge by facilitating communication between caregivers. Interventions providing education, training, and support to foster caregivers are essential to helping them provide the best possible care for their children. Several parenting interventions are developed specifically for children in foster care. These interventions, which are often dyadic in nature, target a range of ages from infancy (e.g., Attachment and Biobehavioral Catch-up) to adolescence (e.g., Multidimensional Treatment Foster Care for Adolescents). In addition, some general parenting interventions aimed at child behavior problems have been adapted for use with foster care families (e.g., Incredible Years). These interventions all show promising results to suggest that foster families can greatly benefit from extra support and education (Hambrick, Oppenheim-Weller, N’zi, and Taussig, 2016; Leve et al., 2012).

Attachment and Biobehavioral Catch-up (ABC) Attachment and Biobehavioral Catch-up (ABC; Dozier, Bick, and Bernard, 2011) is an intervention aimed at increasing sensitive parenting and decreasing frightening behavior among parents of infants and toddlers.The intervention focuses on helping foster parents respond to infants’ cues in a sensitive and nurturing way. By creating a safe, responsive, and warm environment, foster parents can promote children’s development of secure attachment behaviors and improved self-regulatory capacities. ABC is a relatively brief (10-session) home-based intervention that includes both parents and children. The program is administered by parent coaches, who use video feedback and in-themoment commenting to point out positive parenting behaviors and gently shape negative parenting behaviors. ABC is also a manualized treatment in which each session focuses on one of the three

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parenting targets, including nurturance to distress, following the child’s lead with delight during nondistress interactions, and frightening behavior. ABC has been evaluated for infants in foster care, infants living with their birth parents following child protective services involvement, infants adopted internationally, and toddlers in foster care. In randomized clinical trials, ABC has been compared to a control intervention, which was also 10 sessions delivered in the home, but focused on educating parents about children’s cognitive, language, and motor development, rather than enhancing sensitivity. Bick and Dozier (2013) found that foster mothers who participated in ABC showed greater improvements in their sensitivity toward their foster children from pre- to post-intervention than foster mothers who participated in the control intervention. ABC has also been found to have positive effects in several key outcomes related to children’s physiological and social development. Children who receive ABC show higher rates of secure attachment and lower rates of disorganized attachment compared to children receiving a control intervention (Bernard et al., 2012). In addition, infants receiving ABC showed more normalized production of diurnal cortisol immediately following treatment, an effect which persisted into early childhood (Bernard, Dozier, Bick, and Gordon, 2015; Bernard, Hostinar, and Dozier, 2015). ABC has also shown effects on children’s expression of negative affect. Lind, Bernard, Ross, and Dozier (2014) examined young children’s negative affect during a frustrating task and found that those who received ABC during infancy expressed less anger overall, less anger toward their caregiver, and less global negative affect than children who received a control intervention during infancy. Beyond socioemotional outcomes, ABC has been shown to enhance children’s executive functioning and school readiness. Specifically, preschool-aged foster children who received ABC as infants had higher cognitive flexibility on a set-shifting task and better theory of mind than children who received a control intervention (Lewis-Morrarty, Dozier, Bernard, Terracciano, and Moore, 2012). These results were replicated in a sample of foster children who received a toddler model of ABC, which included an additional parenting behavior target. In the toddler model of ABC, in addition to targeting the ABC-infant targets of nurturance, following the lead, and frightening behavior, parent coaches help foster parents implement strategies to help calm their foster children when children become emotionally and behavioral dysregulated. Toddlers in foster care who received ABC showed better executive functioning, specifically better cognitive flexibility and lower parent-reported attention problems, than did toddlers in foster care who received a control intervention (Lind, Raby, Caron, Roben, and Dozier, 2017). Finally, foster children who received ABC showed higher levels of receptive vocabulary than foster children who received a control intervention (Bernard, Lee, and Dozier, 2017). These results suggest that intervening during infancy to enhance the quality of care provided by foster parents can have positive effects on foster children’s emotional, social, and physiological development.

Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) Multidimensional Treatment Foster Care for Preschoolers (MTFC-P; Fisher, Kim, and Pears, 2009) is a family-based intervention aimed at young children in foster care. In this intervention, parents are taught to create a warm, consistent environment for children in which positive behavior is encouraged and negative behavior is limited. This approach incorporates a 12-hour intensive training for foster parents prior to the child’s placement, access to trained consultants throughout the placement, and weekly group therapy for parents and children. Importantly, this program includes additional support and training for foster families around transitions, such as acquainting the new placement family with the rules and discipline strategies of the original foster care family to ensure that the child encounters similar expectations, rewards, and consequences across settings.

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Similar to ABC, MTFC-P has been evaluated through several randomized clinical trials, with foster children randomly assigned to receive MTFC-P or care as usual. In one study, foster parents receiving MTFC-P reported lower parenting stress over time compared to those in the control group; in fact, foster parents in the control group showed increases in parenting stress over time and elevated stress reactivity to child behavior problems (Fisher and Stoolmiller, 2008). Furthermore, MTFC-P showed effects on placement permanency. Children receiving MTFC-P had fewer placement changes over a 2-year period compared to those in regular foster care, suggesting that this approach helped children stay in placements longer (Fisher, Burraston, and Pears, 2005). Given evidence that placement disruptions can negatively affect children’s developmental outcomes, MTFCP’s effect on placement stability has implications for enhancing other child outcomes. MTFC-P has shown promising results for several child outcomes. First, children receiving MTFC-P show more secure attachment-related behaviors compared to children receiving care as usual (Fisher and Kim, 2007). Children receiving MTFC-P also show more normative daily cortisol output over time. Fisher, Stoolmiller, Gunnar, and Burraston (2007) examined daily cortisol output in children who received MTFC-P, children who received care as usual, and children who had never been placed in foster care. At the beginning of the study, both foster care groups showed abnormal cortisol output (i.e., a blunted pattern of diurnal output). However, over the course of 12 months, the treatment group showed cortisol output that was more normative (i.e., similar to the community sample), whereas the care-as-usual group showed increasingly aberrant cortisol production. This finding suggests that intervening with parents and children can reverse dysregulation of physiological stress systems in children.

Keeping Foster Parents Trained and Supported (KEEP) Keeping Foster Parents Trained and Supported (KEEP; Price, Chamberlain, Landsverk, and Reid, 2009) uses a similar approach to MTFC-P to target children during middle childhood. KEEP is composed of intensive group training sessions for parents as well as support and supervision from consultants. As with MTFC-P, training is focused on behavior management skills, including positive reinforcement, consistent use of non-harsh punishment, and close supervision of the child and his or her peer relationships. In particular, training sessions focus on increasing positive attention relative to discipline, such that children receive positive reinforcement four times for every one correction or disciplinary action. This shift toward positive attention is meant to help improve children’s selfesteem and create a warm environment in the home, while encouraging positive behavior. KEEP has shown promising effects on child and parent functioning. Chamberlain and colleagues (2008) found that children receiving KEEP showed fewer behavior problems than those in a control condition immediately after the intervention. They found that this effect was mediated by positive parenting behaviors, or the ratio of parents’ positive comments to negative comments. These results showed that targeting parenting was an effective way to reduce problem behaviors among children in foster care (Chamberlain et al., 2008). Similar to MTFC-P, KEEP also reduced placement disruptions. The intervention increased the chance of positive exits (e.g., reunification with birth parent) and mitigated the risks of multiple placements. In a control group, for every additional placement, there was an increased risk of subsequent placement disruption, whereas in the treatment group there was no such association (Price et al., 2008).

Middle School Success (MSS) Middle School Success (MSS; Smith, Leve, and Chamberlain, 2011; Kim and Leve, 2011) specifically targets foster children and foster parents during the transition from primary school to middle school.

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As with MTFC-P and KEEP, parents are given behavior management training focused on encouraging positive behavior in youth and using consistent punishment, such as short-term loss of privileges, when necessary. During the summer before middle school, parents take part in six training sessions. Then, after middle school begins, foster parents and foster children both attend weekly meetings. For foster parents, the meetings are in a group setting and focused on increasing behavioral management skills. For foster children, the meetings are individualized and incorporate skill-building techniques. Studies of MSS have pointed to a number of beneficial effects. Girls who received MSS showed fewer internalizing and externalizing problems than girls in a control group, and this effect persisted 6, 12, and 24 months after completion of the program (Kim and Leve, 2011; Smith et al., 2011). In addition, girls who completed the program showed increased prosocial behavior 12 months later and decreased substance use 36 months later, with stronger effects for marijuana and tobacco use (Kim and Leve, 2011). These results show that a parenting intervention for foster parents can have beneficial effects for foster children as they progress through middle school.

Multidimensional Treatment Foster Care for Adolescents (MTFC-A) Similar to MTFC-P, Multidimensional Treatment Foster Care for Adolescents (MTFC-A; Smith and Chamberlain, 2010) incorporates a number of different intervention components to support foster parents and adolescents. Adolescents in the foster care system are more likely to engage in risky behavior, which can adversely impact their development and functioning. Thus, this parenting program incorporates a focus on the importance of close parental supervision. The program advocates for foster parents to serve as mentors for their adolescent foster children, in addition to setting limits and providing positive reinforcement. Parents in this program receive special training prior to placement and are offered supervision and support from consultants throughout the placement. This intervention involves a coordinated effort in the home, in the educational setting, and among peers to create a safe and supportive environment for adolescents. Research on MTFC-A has shown that adolescents receiving this treatment have fewer placement disruptions and higher school engagement compared to those in regular foster care (Leve, Fisher, and Chamberlain, 2009). In addition, this program impacts a number of risky behaviors common in adolescence.Those receiving MTFC-A have fewer arrests and a lower pregnancy rate (Chamberlain and Reid, 1998; Kerr, Leve, and Chamberlain, 2009; Leve et al., 2009). MTFC-A also reduces antisocial behavior among adolescents by improving family management strategies. Eddy and Chamberlain (2000) found that boys with a history of juvenile delinquency who received MTFC-A showed less antisocial behavior compared to boys who received regular foster care. This effect was mediated by improved family management strategies and lower deviant peer relationships (i.e., associations with peers who engage in criminal behavior). Such evidence of mediation suggests that MTFC-A works by helping parents better manage behavior and influencing adolescents’ social circles (Eddy and Chamberlain, 2000), further suggesting that the quality of foster parenting is a mechanism that influences behavioral and social outcomes for children in foster care.

Other Parenting Programs A number of parenting interventions not developed specifically for foster care children have been adapted for use with this population. Many of the general principles of effective parenting, such as positive reinforcement and consistent use of non-harsh punishment, apply to foster caregiving. Thus, many of the parenting programs developed to treat child behavior problems have been extended to use in foster families, whether the child has a behavior problem or not. One such program is a modified version of Incredible Years (Webster-Stratton and Reid, 2012). Incredible Years was originally developed to treat child behavior problems by training parents in 386

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behavioral management strategies and child-directed interaction. The modified version of the Incredible Years includes a coparenting component that involves the foster parent and birth parent. The program promotes open communication and negotiation around common conflicts, such as visitation, discipline, and family routines. This important component aids in creating a smooth transition for the child between foster and birth homes. Research on the modified version of Incredible Years has demonstrated that foster parents show improvement in coparenting skills and positive discipline, but the program does not show effects for child externalizing problems (Linares, Montalto, Li, and Oza, 2006). Parent-Child Interaction Therapy (PCIT; Eyberg and Matarazzo, 1980; McNeil, Hembree-Kigin, and Anhalt, 2011) has also been implemented with parents and children in the foster care system.This program was developed for children between ages 2 and 7 and uses targeted coaching to improve parenting. The program has two phases. In the first phase, parents focus on using positive attention, in the form of behavioral descriptions, reflections, and praise, to build a warm interactional style with their children. In the second phase, parents are taught to set limits and use short-term discipline strategies (e.g., “time out”) to increase child compliance and reduce child behavior problems, such as oppositional behavior and aggression. PCIT reduces child behavior problems and caregiver distress in foster parent–child dyads (Timmer, Urquiza, and Zebell, 2006). In this study, there was no difference between foster caregivers and non-abusive biological caregivers in terms of treatment effectiveness. In addition, PCIT has been beneficial in reunification efforts. A study with parents who had previously been reported for physical abuse found that those who received PCIT were less likely than those with no treatment to engage in physical abuse again with their children (Chaffin et al., 2004). Thus, PCIT can be a helpful intervention for children in the foster care system, as well as those who reunite with their birth parents. Child-Parent Psychotherapy (CPP; Lieberman, Ghosh Ippen, and Van Horn, 2006; Toth, MichlPetzing, Guild, and Lieberman, 2018) has also shown promising results with foster caregivers and children. CPP is focused on reducing traumatic stress in infants and young children by supporting the development of a secure parent–child relationship. Sessions include psychodynamic therapy and education with the parent, and play therapy with the parent and child. A study of young foster children before and after treatment showed that children had a decrease in mental health symptoms and an increase in socioemotional functioning following the intervention (Weiner, Schneider, and Lyons, 2009). Future research is needed to understand how CPP compares to care as usual for children in foster care, but results from biologically intact dyads support its efficacy in enhancing secure attachment and normalizing cortisol regulation (Cicchetti, Rogosch, and Toth, 2006; Cicchetti, Rogosch, Toth, and Sturge-Apple, 2011).

Summary of Interventions for Foster Parents Parents and children involved in the foster care system face a variety of unique challenges. Several parenting interventions exist to help support foster caregivers in providing a safe, warm, and consistent environment for foster children of all ages. These interventions have shown a wide range of benefits, from improving children’s mental health symptoms to reducing placement disruptions. Even interventions that were not specifically developed for foster care have shown positive effects on foster parent functioning and child mental health. These interventions represent an opportunity to help improve the experience of foster caregivers and the children who are placed with them.

Controversies in Foster Parenting Foster care can be an effective intervention for many children, providing them with a safe and stable environment, which can have a regulating influence following experiences of maltreatment. However, sometimes foster care goes awry. We discuss two issues related to the foster care system that 387

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often draw the attention of the media, including the occurrence of abuse and neglect in foster care and possible discrimination in decision-making within the foster care system.

Abuse and Neglect in Foster Care Although foster care is designed to remove children from maltreating parents and unsafe environments, some children face further harm while in foster care. In 2016, 0.2% (2 in 1000) substantiated cases of maltreatment in the United States involved foster parents as the perpetrator of abuse or neglect (U.S. Department of Health and Human Services, 2016), which reflects a decline from previous years (i.e., 0.32% in 2014; U.S. Department of Health and Human Services, 2017). These rates are relatively small, but such cases of maltreatment while in out-of-home care gain substantial attention in the news, exacerbating public concerns that the foster care system not only fails to protect children, but also causes direct harm. Some studies have found that children in foster care are more likely to be the subjects of maltreatment allegations than children in the general population, but that maltreatment allegations against foster parents are less likely to be substantiated than those against birth parents (Benedict, Zuravin, Brandt, and Abbey, 1994). DePanfilis and Girvin (2005) explored barriers to effective decisionmaking in investigations of child maltreatment in foster care, which may result in underestimates of the prevalence of maltreatment in out-of-home placements. In this study, New Jersey Division of Youth and Family Services (DYFS) Institutional Abuse Investigation Unit (IAIU) files were examined to determine the extent to which investigations of abuse and neglect in out-of-home care followed professional standards and policies. Whereas 12.3% of out-of-home maltreatment reports were substantiated by the IAIU, objective coders estimated that 33% of the cases should have been substantiated based on state definitions of maltreatment. Specifically, coders disagreed with the IAIU decisions when the documented incidents met New Jersey’s definitions of child abuse or neglect, such as a foster mother hitting a child in the face with a belt, leaving in a 4-inch mark. DePanfilis and Girvin attributed faulty decisions about abuse and neglect in foster care to a number of factors, such as limited knowledge (e.g., lack of thorough investigations, limited resources/guides about assessing safety), inadequate information processing (e.g., failure to match facts of the case to legal definitions), and perceptual blocks (e.g., disregard of inconsistent perspectives on case). The most concerning factor, however, was what they called “task environment,” which included issues about the work environment that interfered with the quality of decision-making. For example, investigators had high caseloads, which may have led to inadequate time investigating and/or documenting incidents and risk. Related to this, substantiating a case led to additional burden on workers, as it required follow-up actions, such as removing a child from a foster home and revoking a foster caregiver’s license. Additionally, notes in the records indicated a shortage of foster homes and difficulty finding alternative placement resources. Together, these personal, professional, and systemic factors may lead to incidents of maltreatment in foster care remaining unaddressed. The occurrence of child abuse while in foster care, though relatively limited based on national statistics, raises serious concerns regarding the system’s ability to protect already vulnerable children and may lead to increased distrust in foster parents and foster care workers. Thus, ongoing attention is needed in order to ensure that practices (e.g., screening and training of foster parents, monitoring of the quality of care, and investigation of concerns) adequately protect the safety and well-being of children in out-of-home care.

Discrimination in Foster Care Placement Decisions A second issue that can increase distrust of the foster care system involves the apparent ethnic disparities in families who become involved with the child welfare system. In the United States, 388

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African American children are disproportionately likely to be subjects of child maltreatment reports and investigations (Fluke, Yuan, Hedderson, and Curtis, 2003; Harris and Hackett, 2008) and to be placed in foster care (Hines, Lemon, Wyatt, and Merdinger, 2004). Using a sample of approximately 72,000 investigations of substantiated maltreatment from the National Child Abuse and Neglect Data System between 2004 and 2005, Knott and Donovan (2010) examined the association between ethnic identity and foster care placement. Controlling for child characteristics (e.g., age, behavioral problems), caregiver characteristics (e.g., substance use, domestic violence), household factors (e.g., poverty, inadequate housing), and abuse characteristics (e.g., maltreatment type), ethnic identity significantly predicted the likelihood of placement into foster care. Specifically, African American children had 44% higher odds of out-of-home placement relative to White children. In another study, however, interactions between socioeconomic status and ethnic group suggested a more complex picture. After adjusting for socioeconomic and health factors that were correlated with CPS involvement, Black and Latino children with low socioeconomic status had a lower risk of substantiation and foster care placement than White children with low socioeconomic status (Putnam-Hornstein, Needell, King, and Johnson-Motoyama, 2013). The issue of overrepresentation of minority children in foster care has received much attention in the popular press (Clifford and Silver-Greenberg, 2017; MacFarquhar, 2017), with these stories often calling into question the ethical and fair decision-making of key professionals. Combined with the findings of research studies, it is clear that further attention to injustices occurring within the child welfare system is sorely needed.

Summary of Controversies in Foster Parenting Despite the purpose of the foster care system to offer protection of children and support well-being, these goals are not always achieved. The occurrence of maltreatment while in foster care, as well as discrimination in child welfare decision-making, are examples of clear failures of the foster care system.

Future Directions in Research, Policy, and Practice Related to Foster Parenting There is still much to learn about foster parenting, and much to be improved about the foster care system. Here, we offer some suggestions about future directions for research, policy, and practice related to foster parenting. Given the need for high-quality and stable foster care placements, one important area for research is evaluating procedures for the selection and retention of exceptional foster parents. The Quality Parenting Initiative, developed by Carol Schauffer and the Youth Law Center, is an example of a change in policy and practice that aims to strengthen foster care by ensuring high-quality parenting to children in foster care (Skene, 2011). QPI partners with child welfare systems and communities, as well as participants in those systems (i.e., foster parents and birth parents), to jointly define highquality parenting and implement practices and policies that are aligned to support that definition. By including these key stakeholders in decision-making and “re-branding” of the foster care system, QPI aims to change foster care in substantial ways, such as increasing retention of strong foster parents, improving the relationships between birth parents and foster parents, and reducing disruptions for children in care. Research about system- or policy-level changes, such as those implemented through QPI, can help demonstrate the effectiveness of such practices. In turn, such evidence of effectiveness may lead to increased funding and support for important policies and practices. Another important area for research is understanding how foster parenting shapes children after children leave care. For example, it may be useful to examine to what extent the quality of care 389

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provided in one foster placement influences children’s adjustment in future placements or the likelihood of successful reunifications with birth parents.Taking the example of attachment as an outcome, research suggests that young children form attachment relationships relatively quickly when placed in foster care and organize their expectations around the foster parent’s availability (Dozier et al., 2001); thus, some interventions aim to enhance foster parents’ availability and responsiveness, in order to increase the likelihood of children forming secure attachments while in care (Bick and Dozier, 2013). However, few research studies have followed foster children as they transition from placement to placement. Although we may speculate that forming secure attachments in one foster care placement may be associated with smoother transitions in future placements, reduced behavioral problems, or enhanced socioemotional adjustment, there is little evidence for these longitudinal effects. Research examining the extent to which initial placements matter for later adjustment would inform practice decisions for how to target services to support foster parents and the children in their care. Additionally, although the number of evidence-based programs that aim to support foster parents is growing, there is a need for ongoing research evaluating the efficacy and dissemination of such practices. Foster children are more likely to need mental health treatment than their peers (Burns et al., 2004) but less likely to receive it; furthermore, the services that foster children receive are only estimated to sufficiently meet their needs 25% of the time (Kolko, Herschell, Costello, and Kolko, 2009). As evidence-based interventions, which show strong efficacy in research settings, are disseminated into communities, their effectiveness often declines (Durlak and Dupre, 2008; Weisz, JensenDoss, and Hawley, 2006). Given evidence that foster children are underserved and evidence that interventions have reduced effectiveness when moved into communities, future research is needed to identify potential barriers to accessing treatment and challenges of their effective implementation.

Conclusions Foster parents have a challenging role in providing substitute care for vulnerable children. Foster children often have elevated emotional, behavioral, and developmental needs and may express attachment behaviors (e.g., avoidant behaviors, resistant behaviors) that fail to elicit nurturing care. Thus, foster parents are faced with the challenge of providing therapeutic caregiving that is sensitive and consistent. Providing such care may be challenging, as it may not come naturally to some foster parents, based on their own attachment representations, and because it may be difficult to commit to a foster child, given that the relationship is expected to be temporary. The quality of foster parenting (e.g., engagement in sensitive and consistent interactions) and foster parent commitment have been shown to matter for foster child outcomes, such as attachment quality, children’s behavior problems, and children’s socioemotional competence. Given the impact of foster parents on children’s well-being, it is critical that foster parents are supported in providing high-quality care. Indeed, a number of parenting interventions, such as ABC, MTFC, and KEEP, enhance parenting quality and reduce parenting stress among foster parents, with these changes, in turn, influencing foster children’s outcomes.

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Foster Parenting Smyke, A. T., Zeanah, C. H., Fox, N. A., Nelson, C. A., and Guthrie, D. (2010). Placement in foster care enhances quality of attachment among young institutionalized children. Child Development, 81, 212–223. doi: 10.1111/j.1467-8624.2009.01390.x. Stovall, K. C., and Dozier, M. (2000).The development of attachment in new relationships: Single subject analyses for 10 foster infants. Development and Psychopathology, 12, 133–156. doi: 10.1017/S0954579400002029. Stovall-McClough, K. C., and Dozier, M. (2004). Forming attachments in foster care: Infant attachment behaviors during the first 2 months of placement. Development and Psychopathology, 16, 253–271. doi: 10.1017/ S0954579404044505. Strathearn, L., Li, J., Fonagy, P., and Montague, P. R. (2008).What’s in a smile? Maternal brain responses to infant facial cues. Pediatrics, 122, 40–51. Retrieved from http://doi.org/10.1542/peds.2007-1566. Swain, J. E., Lorberbaum, J. P., Kose, S., and Strathearn, L. (2007). Brain basis of early parent?infant interactions: Psychology, physiology, and in vivo functional neuroimaging studies. Journal of Child Psychology and Psychiatry, 48, 262–287. Retrieved from http://doi.org/10.1111/j.1469-7610.2007.01731.x. Timmer, S., Urquiza, A., and Zebell, N. (2006). Challenging foster caregiver–maltreated child relationships: The effectiveness of parent–child interaction therapy. Children and Youth Services Review, 28, 1–19. Retrieved from http://doi.org/10.1016/J.CHILDYOUTH.2005.01.006. Toth, S. L., and Emde, R. N. (1996). Representations of self and other in the narratives of neglected, physically abused, and sexually abused preschoolers. Development and Psychopathology, 9, 781–796. Toth, S. L., Michl-Petzing, L. C., Guild, D., and Lieberman, A. F. (2018). Child-parent psychotherapy:Theoretical bases, clinical applications, and empirical support. In H. Steele and M. Steele (Eds.), Handbook of attachmentbased interventions (pp. 296–317). New York, NY: Guilford Press. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2016). The AFCARS Report no. 23: Preliminary FY 2015 estimates as of June, 2016. Washington, DC: U.S. Department of Health and Human Services. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children,Youth and Families, Children’s Bureau. (2017). Child welfare outcomes 2010–2014: Report to Congress. Washington, DC: U.S. Department of Health and Human Services. van den Dries, L., Juffer, F., van IJzendoorn, M. H., and Bakermans-Kranenburg, M. J. (2009). Fostering security? A meta-analysis of attachment in adopted children. Children and Youth Services Review, 31, 410–421. Retrieved from http://doi.org/10.1016/J.CHILDYOUTH.2008.09.008. van IJzendoorn, M. H. (1995). Adult attachment representations, parental responsiveness, and infant attachment: A meta-analysis on the predictive validity of the Adult Attachment Interview. Psychological Bulletin, 117, 387–403. doi: 10.1037/0033-2909.117.3.387. van IJzendoorn, M. H., Schuengel, C., and Bakermans-Kranenburg, M. J. (1999). Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11, 225–250. doi: 10.1017/S0954579499002035. Webster-Stratton, C., and Reid, M. J. (2012).The incredible years: Evidence-based parenting and child programs for families involved in the child welfare system. In A. Rubin (Ed.), Programs and intervention for maltreated children and families at risk (pp. 11–30). Hoboken, NJ: John Wiley & Sons, Inc. Weiner, D. A., Schneider, A., and Lyons, J. S. (2009). Evidence-based treatments for trauma among culturally diverse foster care youth: Treatment retention and outcomes. Children and Youth Services Review, 31, 1199– 1205. Retrieved from http://doi.org/10.1016/J.CHILDYOUTH.2009.08.013. Weisz, J. R., Jensen-Doss, A., and Hawley, K. M. (2006). Evidence-based youth psychotherapies versus usual clinical care: A meta-analysis of direct comparisons. American Psychologist, 61, 671–689. doi: 10.1037/0003-066X.61.7.671. Windham, A. M., Rosenberg, L., Fuddy, L., McFarlane, E., Sia, C., and Duggan, A. K. (2004). Risk of motherreported child abuse in the first 3 years of life. Child Abuse and Neglect, 28, 645–667. Retrieved from http:// doi.org/10.1016/j.chiabu.2004.01.003.

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12 PARENTING TALENTED CHILDREN David Henry Feldman and Mel Andrews

Introduction Most parents would attest that rearing a child is among the most rewarding—and challenging—of human enterprises. Is parenting talented children easier, more difficult, or the same sort of challenge as parenting other children? As we discuss, and as any parent in this distinct position will discover, it can be all three. This chapter summarizes the state of the relevant literature today for the benefit of parents everywhere struggling to provide their children with experiences appropriate to their extraordinary potential—in the home, in the classroom, and in the world at large. Although talented children differ critically from their peers, they are, nonetheless, still children and share the majority of qualities with their peers.We focus on those aspects of parenting distinctive to talented children, assuming that many of the basic tasks of parenting are similar for all children: provisioning for adequate nutrition, health, safety, and the attainment of developmental milestones. Only when the existence of a special talent such as writing, mathematics, or gymnastics ability affects one of the basic areas of caretaking—such as nutrition or safety—are the more general areas of parenting of interest here. This chapter, based in part on a chapter that appeared in the last version of the Handbook of Parenting (Feldman and Piirto, 2002), takes on a series of aspects, from a number of perspectives, on the matter of parenting talented youth. We first take up several definitional, conceptual, and empirical issues that make our task more challenging. As it happens, the field of child development has traditionally taken little interest in this subject, focusing instead on central tendencies, statistical averages, and developmental universals (Feldman, 1980). The field of gifted studies has had a similar tendency, focusing on systematized metrics of generic intelligence as the operational definition of talent.When the field of child development has ventured beyond the construct of the typical child, it has tended to do so in the direction of clinical, intellectual, or economic deficits to be overcome, rather than the special challenges and opportunities that appear when a child possesses unusually strong talents and abilities. Parenting with even the most commonly studied form of talent—academic talent, as usually indexed by high performance on an aptitude test—has rarely been studied by developmentalists. The field that does concern itself with gifts and talents, that of Gifted Education, tends to be nondevelopmental and finds itself preoccupied with traditional academic success as the favored criterion. The empirical literature in this field is thus lopsided, including vastly more studies of standard-fare academic ability than the numerous other forms of talent (Kaufman, 2013). The lack of empirical data on parenting and talent development can, in part, be attributed to difficulties encountered when trying to define gifts and talents both concretely and accurately (Feldman, 398

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2016; Ziegler and Heller, 2000). There are, after all, many ways to be talented, and many ways in which talent may be developed.There exists to date no consensus definition of talent among scholars (Al-Shabatat, 2013; Feldman, 2014; Gagné, 1985; Renzulli, 2005). According to the American College Dictionary (1955, p. 1235), talent is “a special natural ability or aptitude.” This is the definition of talent employed in the present chapter. We further define talents as relatively broad (e.g., the set of abilities that make up IQ, often referred to as “gifts”), or relatively narrow (e.g., the ability to run very fast in a straight line); also as relatively extreme (e.g., a child prodigy in music) or greater than an individual’s other abilities, but not necessarily exceptional on a comparative basis. We take it as a given that all talents, as we define them, are products of multifold biological processes (including genetic influence, but not limited to genetic influence) as well as some contextual processes (including training, but not limited to training). When we refer to a talent, we are referring to the current level of function that we assume to be the product of several contributing forces, some of which we may be able to identify or even quantify, many of which are indeterminable. Talent is understood to be complex in origin and development. When we review efforts to enhance the quality or strength of a talent, we recognize that we are limited in our knowledge of both the natural as well as the sociocultural influences on its development. Talented youth may be further distinguished on the basis that they are not well served by standard approaches in parenting and education, and it is this property of our concept of talent that motivates the need for scholarly study. This definition assumes that wide variations exist in children’s natural talents and abilities, and that these talents and abilities may be detected by both formal and informal means of assessment. In this chapter we do not deal with the technical aspects of talent assessment, a challenging area in itself (Howe, Davidson, and Sloboda, 1998; Ziegler and Heller, 2000), but rather focus on the ways that parents tend to respond to the actual or presumed presence of such elevated potentials in their children. Assessing the existence and strength of a talent is only made possible in the context of performance. Although certain tests, such as intelligence quotient or musical aptitude, are held to be metrics of pure talent, this misconstrues both the purpose of assessment and the nature of talent. Musical talent, for instance, can only be assessed in the context of established forms of music, with technologies and techniques that have cultural histories and that are evaluated using standards established by a given musical community. The sciences of development, of biology, and of the mind are still young. As these domains mature, it is likely that improved methodologies—techniques that further our understanding of how the physiology of the brain gives rise to the phenomena of mind and behavior or how the genetic and cellular information contained within a fertilized egg give rise to a fully-formed living organism—will bring us closer to an empirical science of human potential. These transforming methods, however, entail reciprocal transformations in the space of theory. We can therefore expect that technologies to come will force reformulation of our notions of talent and ability as much as they provide evidence to substantiate them. Today, our modes of talent assessment are based on human judgment and, as such, caught up in the constraints of subjectivity and cultural context. The construct of talent may be divided into several broad categories for the purposes of discussion: general intellectual ability, commonly understood in relation to intelligence tests or scholastic achievement; specific intellectual abilities, such as pronounced aptitude in mathematical or linguistic domains; creative ability, as may be expressed in the visual or performance arts; and talents that are less readily categorized but no less extraordinary, such as athletic or practical ability. These categories are not to be understood as mutually exclusive: Most real-world activities require more than one kind of talent or ability; when there is a virtual absence of all but the focal ability, we may be looking at a savant (Treffert, 1989; Morelock and Feldman, 1993). We may focus, however, on the presence of one or more distinct talents in a given child and their contributions to the development of expertise in various fields. 399

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There are at least as many diverse family structures and parenting styles as there are forms of talent. Perhaps most prominently in the Western world, tolerance for unconventional parenting systems is on the rise. Increasingly, parenting is a task no longer limited to married, heterosexual couples, but is taken on by single men and women and by couples and individuals across the queer spectrum (Patterson, 2004). The empirical literature on anything beyond the traditional mother-father pairing is sparse, but we can assume that more research will appear as these varied forms of parenting become more common.With that caveat about the generalizability of findings on parenting talented children in mind, we can look for patterns and consistencies in research findings about both challenges and successful responses of caregivers to their children’s talent. Constraints on the empirical base make our task especially challenging. Much of what we can draw from current literature on parenting talented children would not pass muster as good social science research. Individual case studies may be found, along with reports from science journalists (Clynes, 2015; Suskind, 2014), but there are few studies of groups of children with well-identified talents or of parents whose approaches to childrearing vary systematically. It is under this premise that we introduce the main impetus of our chapter: a reorientation toward the task of parenting talented children in light of contemporary conceptual shifts. For decades, the field concerned with the development of human potential has been transitioning from a focus on central tendencies and universals to the subjects of personal and contextual variability. The conceptual revolution we speak of is well recognized within child developmental scholarship, but it has yet to percolate to the domains concerned with gifts, talents, and exceptional human achievement. We see the purpose of our chapter as laying the preliminary groundwork for integrating this theoretical metamorphosis with the research initiative on parenting talent in all of its many forms. We begin with a brief review of some of the major concepts that have been part of the fields of gifted studies and education, because such notions as gifts, talents, intelligence, and genius are central to our task. In the minds of many—and to the consternation of some—terms such as brilliant, genius, gifted, and especially intelligent became synonymous with a high measure of g—general intelligence— as determined via the now standard battery of aptitude tests (Gagné, 1985; Gardner, 1982, 1983; Smutny and Eby, 1990; Sternberg, 1985; Tannenbaum, 1983, 1986). The final decades of the twentieth century brought about a transition in the study of intellectual talent, one which transported the field away from homogeneity and toward a more varied and malleable conception of intelligence (Feldman, 1992; Gardner, 1983; Treffinger, 1991). In this chapter, we speak of talent as a child’s natural ability to achieve high levels of mastery in culturally valued domains (Borland, 2003; Dai, 2010, 2017; Feldman, 2003; Gardner, 1983, 2006, in press; Lee, 2000; Renzulli, 2005). The nature-nurture distinction, once hotly debated in the developmental sciences, is now widely understood to have been falsely dichotomized (Gottlieb, Wahlsten, and Lickliter, 1998; Simonton, 2014). The existence of an ability, therefore, does not mean it will flourish under any and all circumstances, and it will invariably require sustained efforts on the part of the child and those who support and instruct her or him to bring a natural talent to its full expression (Dai, 2010, 2017).This is, of course, where the parenting challenges lie: recognizing a particular talent, supporting its development, procuring resources and services, negotiating with individuals, agencies, and institutions, balancing development of the talent with other values, and trying to maintain healthy and positive relationships with others in the family and in the community at large. Each of these challenges is formidable under any circumstances; when a child is very talented, the challenges can be intensified and made yet more complex (Feldman, with Goldsmith, 1986; McPherson, 2016). Kaufman and Sternberg (2008), along with Al-Shabatat (2013), delineate four distinct approaches to the study of the gifted, talented, and precocious: A domain-general perspective, represented by intelligence assessment metrics, which typically regard human ability as a unitary and static factor (e.g., Binet and Simon, 1916; Galton, 1869; Terman, 1925-1959); A domain-specific perspective, represented by studies of specific talents or aptitudes and prodigious achievement (Feldman, 1980; 400

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Gardner, 1983; Stanley, 1997; Thurstone, 1941); A systems perspective, in which the causes leading to the manifestation of talents or gifts are conceptualized of in terms of an integrated complex network of psychological factors (e.g., Renzulli, 2005; Sternberg, 2005); And lastly, a developmental perspective, in which contextual and environmental factors are made the emphasis of models and research (e.g., Feldhusen, 2005; Feldman, 1979; Gagné, 2004; Tannenbaum, 1986). Dai (2010, 2017) puts forth a hybrid developmental systems model of gifts and talents. In the present chapter, we operate under a conception of talent that encompasses the many modes and factors in which, and by way of which, talents come to be expressed. The contextual aspects of talent development are, of course, our primary focus, as befits both the subject of parenting and the many changes that the field has undergone in the last decades. It bears repeating that there exists no unanimously accepted concept of talent in the gifted studies literature or in the child developmental literature. Gifted studies and the field of psychology in general has oscillated between single and multiple theories of intelligence for more than a century (Dai, 2010; Gardner, 1983; Winner, 1996). Since the dawn of psychometric evaluation, intelligence has been reified as a unitary quality. Talent was not separately defined, because it was believed to be subsumed under the broader and more general framework of the intelligence quotient, or IQ. There were occasionally challenges to this view, arguing for specific abilities either in place of or as a complement to IQ, but these efforts had little transformative effect on the academic field, nor had they great impact on the public (Thurstone and Thurstone, 1941). Challenges raised through scholarship outside of the field of gifted education proper (Gardner, 1983; Sternberg, 2000) have achieved greater success in transforming public perceptions of intelligence away from the limited historical conception of a static and unitary quantity. Although most scholars would now acknowledge that intelligence should be seen as including more specific abilities in addition to IQ, in gifted education especially the tendency to adhere to the traditional IQoriented view persists (Borland, 2003; Dai, 2010, 2017). Scholars within the field of gifted education, such as Gagné, have proposed frameworks that try to integrate traditional perspectives with the more contemporary, arguing that gifts are innate, or genetically determined, whereas skills or talents result from training and practice, transforming natural gifts into highly refined mastery within a particular domain (Gagné, 2004; 2015; Gagné and McPherson, 2016). From the perspective of contemporary developmental and biological sciences, however, the very separation of traits into wholly innate and wholly acquired categories reifies a dichotomy long-defunct. Feldman (Feldman, with Goldsmith, 1986) proposed an alternative account, arguing that evolution of the human intellect took a distinctive twofold path; one path emphasizing a kind of general ability to adapt under widely varied circumstances (called a gift, in this framework), whereas the other keyed on a multitude of highly specific abilities to adapt in very specific circumstances (labeled a talent). Both forms of ability are natural and may occur in varying degrees and combinations in humans; some blessed with exceptional ability in the more general form (what had traditionally been labeled a gifted child), and others display unremarkable general ability but possess remarkable ability in one or more specific areas (a talented child). Prodigies, for example, are individuals with a very powerful specific talent in a recognized area, supported by at least a moderate degree of general ability, whereas savants are individuals with only a specific talent who largely lack general ability (Feldman and Morelock, 2012). Dai (2010, 2017) drew on elements of Gagné and of Feldman, among others, in constructing the most complete current framework for the development of gifts and talents. Dai distinguished between characteristic and maximal development of gifts and talents, with the former likely to occur within the usual range of environments available to human beings in most parts of the world, and the latter requiring specialized and less widely available circumstances and resources available only to those fortunate enough to have access. Following Horowitz (2000), Dai proposed a four-phase sequence that begins with the recognition of unusually powerful gifts and talents when children are 401

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very young and proceeds through the highly specialized and refined conditions that give rise to and sustain excellence in domains valued within a given culture. Undoubtedly, there exist diverse manifestations and expressions of profound intellectual ability in various domains. The first hurdle parents of high-potential children must face is identifying the individual nature of their child’s exceptional potential, her or his “gifts” and “talents,” to use the terms from Feldman (2016), the implications of which will inform their approach as caregivers (Morelock and Feldman, 1991, 1993). For several decades, regrettably, the field has preoccupied itself with the incarnation of a single form of talent, measured by a narrow set of aptitude and achievement tests. The study of individual cognitive difference has moved from a focus on static factors within the individual and relative to characteristics of the individual’s broader sociocultural context to a dynamical, procedural view.This is seen to be reflective of a wider trend across the sciences, in which the individual is no longer conceptualized as an unwitting subject of God-given fate or biological determination, a hapless victim of chance or circumstance, or a wholly self-determining agent. The individual of today is bound into a complex causal web of biological and historical circumstance, chance and fortuity, experiential mediation, and her or his own agential power (Lewis, 2000; Witherington, 2007). Although all parents must grapple with the responsibility of fostering a satisfying life for their offspring, the weightiness of this task is perhaps most profound in parents of exceptionally endowed children, because the very existence of talented youth challenges our various colloquial conceptions of the individual. Talented children pose a demand for a coordinated effort from all the systems with which they interface, ranging from the social and health sciences to educational systems and, most crucially, their parents. Feldman, with Goldsmith (1986), for example, used a metatheoretical framework, called “co-incidence,” in an attempt to provide a scientifically grounded theory of the complex interconnected dynamics determining the emergence of talent. Although developed for extreme cases, the co-incidence model can be used to understand the full range of talents and gifts found in children (Feldman, 1979). The framework looks at the interplay among at least six vectors of influence on developing talent, along with chance events that may prove consequential. A similar framework, called “syzygies,” was proposed to account for the development of musical prodigies that included physical characteristics, personality traits, general intelligence, domain-specific abilities, social, cultural, and other environmental factors, as well as chance (Faulkner and Davidson, 2016).The vectors of co-incidence include talents and gifts, personal qualities, domains where exceptional talent can be expressed, families, teachers, and broader cultural and historical contexts. When the vectors of influence are brought into productive coordination and sustained over a sufficient period (often 10 years or more), the potential of a natural talent may be fully expressed in domain mastery and exceptional achievement. The responsibility for coordinating the vectors of co-incidence falls mainly on the child’s parents during the critical early years of development. Because access to resources is the key to successful support of exceptional talent, we turn to some of the current realities that limit and constrain access to resources among many families.

Talent, Diversity, and Adversity Exploring Human Variation, Circumstance, and Resource Access The explanatory power of the co-incidence model (Feldman, 1979, 2016; Feldman, with Goldsmith, 1986), although directed in its original form at the extremes of talent—the prodigy—reaches beyond those rare cases and is emblematic of a deeper shift in the dominant conceptualization of human development and potential. These forces are evolutionary—both biological potentials and cultural practices; personal or emotional qualities; the guidance of mentors, teachers, and role models; the domain in which the talent emerges; the constraints of the broader sociocultural context; and the impact of parenting style and family dynamics. Random events also play a critical role. Den Hartigh, 402

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Van Dijk, Steenbeek, and Van Geert (2016) proposed a convergent theory of talent development, termed a “dynamic networks approach,” and substantiated it with computer simulations. This innovative model similarly proposes that the key to profound human achievement cannot be reduced to any single factor, but rests instead on the complex interactions among many contributing influences. In this section, we look to three components of the hexadic co-incidence framework that the scholarship thus far has largely failed to address. These are the influences of human variation, the influences of sociocultural context, and the influences of resource access.We deal with the difficulties that arise when the identities of children possessing powerful talents are at odds with the identities or expectations imposed on them by their environment. We deal also with the issues that arise when there is a conflict or disconnect between sociocultural contexts on a micro scale—the family, the neighborhood, the classroom, the social circle—and sociocultural contexts on a macro scale: the educational systems, the class system, the job market, the economy.We demonstrate that the co-incidence model can provide far more realism—and optimism—than mainstream explanations for the appearance of ethnic, cultural, economic, and gendered patterns of achievement and talent expression. We turn to existing research findings and reassess them in light of this changing paradigm. For example, Ambrose (2002) cited a need to import context sensitivity into the fields concerned with talent development and human potential and urged reconceptualization of the core notions of “merit and ability” operationalized in these domains. We end with a concrete appeal to build the empirical and theoretical base to support heterogeneous concepts of talent, achievement, and potential. Researchers such as Azuma and Kashiwagi (1987), as well as Ruzgis and Grigorenko (1994), have helped initiate this directive, documenting the diversity and nuance of notions of intelligence and success. British researchers Koshy, Brown, Jones, and Portman Smith (2012) launched an effort to uncover commonalities in the experiences of parents with talented children living in relative poverty. Counter to prevalent beliefs in the field, they found that these parents articulated a powerful drive in favor of their children’s achievement and cogent visions for their children’s success.What they lacked was neither vision nor motivation, but the means to further involve themselves in their children’s education and community support. Parents from a lower socioeconomic background found the task of rearing talented children to be an isolating experience, in which they felt alienated from their respective families and communities, from their children’s social reality and schooling, and from their children themselves in respect to their talent expression. Cross-cultural work in the field remains strikingly sparse, but efforts to expand the scope of talent research beyond North America lend an enriched view of talent development and relevant vectors of influence thereon. A study in Saudi Arabia by Hein, Tan, Aljughaiman, and Grigorenko (2014) explored in-depth the interactions of parenting style, family composition, home environment, and cultural context in the development of academically talented children. Hein, Tan, Aljughaiman, and Grigorenko (2014) noted that family size and number of siblings negatively correlate with academic achievement in studies conducted in Western industrialized nations. Yet within their sample of academically talented children in Saudi Arabia, the researchers found the effect of family size to be gender-specific and contingent on the gender composition ratio of relatives. Among the gifted Saudi children studied, the gender of siblings played a far more important role in determining the outcomes of cognitive assessments than did family density or socioeconomic status (Hein, Tan, Aljughaiman, and Grigorenko, 2014). In much the same way that critical analysis has found the diagnosis of mental pathologies to be highly gender-specific and relative to era and cultural context, positive cognitive abnormalities are also gender-profiled. Little empirical evidence substantiates the assumption that actual sex differences in cognitive capacity underlie this apparent inequity (Spelke, 2005). Parents of high-ability children ought to be especially diligent during the critical developmental years not to preclude youth from pursuing their interests and developing proficiency in such domains as may be “gender-atypical” relative to the sociocultural environment in which they find themselves. On the other hand, parents 403

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should also be mindful of pushing their talented children to excel in areas that may seem natural to them, but not to their children. Talented youth are apt to be more susceptible than other children to pressures placed on them by caregivers and mentors (Freeman, 2010). Expression of gender and sexuality that fails to align with a familial, educational, or cultural context may be punished or may intensify an existing sense of alienation (Kerr and Nicpon, 2003). Many scholars over the past century have sought to understand the complicated and contentious relation between ethnicity, poverty, ability, and success and have labored much in the gathering of empirical evidence thereon (Darling and Steinberg, 1993; Ford, Grantham, and Whiting, 2008; Frasier, 1991; Neihart, Reis, Robinson, and Moon, 2002; Rudasill, Adelson, Callahan, Houlihan, and Keizer, 2013; Steinberg, Dornbusch, and Brown, 1992). Other scholars have sought to uncover and to critically examine what they saw as implicit biases operating within psychological research and educational research. Guthrie’s (1976) Even the Rat Was White: A Historical View of Psychology critiques the demographic homogeneity of mainstream psychological research in the United States, draws attention to marginalized scholars and overlooked evidence, and envisions a future for the psychological scholarship free from the prejudice of its past. In his 1981 book The Mismeasure of Man, Gould scrutinizes the fallacies of reductionism, reification, and ranking in the history of intelligence assessments (Gould, 1981). In a monograph entitled “Epistemological Perspectives on Intelligence Assessment Among African American Children,” Schiele (1991) takes on the cultural and demographic biases characteristic of aptitude testing in the United States education system and offers a directive for a more holistic assessment regime unbiased toward and inclusive of African American experience. Hilliard (1987), in “The Ideology of Intelligence and I.Q. Magic in Education,” probes the concept of intelligence as it is operationalized in the fields of psychology, development, and education, ultimately casting doubt on its scientific and pedagogical legitimacy. In a similar vein, Richardson (2017), in his book Genes, Brains, and Human Potential: The Science and Ideology of Intelligence, argues that more than a century of wanton reductionism and definitional vagueness in the study of intelligence and human potential has perpetuated a stratified social order and obscured the true dynamic complexity and diversity of human cognitive development. Taken together, these works amount to an indictment of the notion of intelligence as it has been put to work within the field of gifted education and within educational research at large. These authors set out a clear case for more holistic, nuanced, and scientifically accurate measures of cognitive ability and human potential. Once such integral and inclusive notions of ability and achievement have been formulated and employed, we can anticipate the amalgamation of evidence of sufficient quality and quantity to construct a scholarship of parenting exceptionally endowed children amidst diverse contexts and relative to diverse identities. Another issue that may add further complication to the task of parenting a talented child is when talents are embedded within, or found alongside, other unusual cognitive or emotional characteristics, especially problematic ones. It is this issue that we discuss next.

Neurodiversity and Talent Within the scholarship on individual cognitive difference, there has been increasing focus on what is known as twice-exceptionality (Neihart, 2008). Though hardly a novel phenomenon, the learning profile and its associated terminology are new. The twice-exceptional child is considered to be a child with gifted-level intelligence, or prodigious talent, in one or more domains, with marked deficits in other areas. These deficits have classically been limited to autism spectrum disorders (ASD), attention deficit or attention deficit hyperactivity disorders (ADD, ADHD), and dyslexia, dyscalculia, and dyspraxia (Armstrong, 2010; Jaarsma and Welin, 2012). We may expand our understanding of neurodiversity, however, to encompass the co-incidence of various talents with a range of learning and developmental disorders, intellectual deficits in other domains, behavioral problems, attentional problems, executive functioning problems, obsessive-compulsive disorders, or anxiety and mood 404

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disorders. Occasionally, a child may experience several such challenges, prompting some authors to urge a rebranding of the profile as “multi-exceptional” (Knapp, 2006). Along with the diagnosis of a disorder, a child will also demonstrate superior academic potential, typically by performing well above average on a standardized IQ test. Children are both “gifted” as well as constrained by their diagnoses. It is this combination of high intellectual ability and impairment that marks the twiceexceptional child. Parenting the twice-exceptional child is complicated by the initial difficulties parents frequently encounter in identifying the specific combination of ability and disability characteristic of their children, for the possibilities are numerous and sometimes confounding (O’brien and GiovaccoJohnson, 2007). For example, a very bright child may not be recognized as such by caregivers and educators because the talents may be masked by the impairment. Conversely, a child with certain extreme deficits may not be identified for appropriate care, or may not meet diagnostic criteria, because the talent or intelligence allows the child to compensate for the impairment (Danielian and Nilles, 2015). Even when both profound abilities and co-occurring impairments or atypicalities are appropriately identified, there is still the difficulty of finding resources to work with the child’s particular combination of talents and challenges. Few professionals have the necessary joint training in both areas, and few families have the time or resources to recruit a team of specialists. There are also few educational or extracurricular programs catering to the complex needs of twice-exceptional children, again putting heavier burdens on parents to provide appropriate settings and experiences for their children. Since the notion of twice-exceptionality entered the parlance of learning and educational specialists in the 1980s, most effort has gone into research, identification, and support of twice-exceptional children characterized by intellectual “gifts” in tandem with a specific learning disability (SLD), whereas little attention has been paid to talented children with physical, behavioral, or emotional impairments (Neihart, 2008). Over the decades, however, the field has shifted toward a focus on talented youth with attentional or autism spectrum disorders (Neihart, 2008). Resource allocation toward diagnosis, intervention protocols, and creation of specialized settings for twice-exceptional children on the autism spectrum now far surpasses that of any other fusion of talent and deficit. This is hardly surprising, given the rapid and drastic increase in diagnoses and corresponding scholarly, political, and medical attention paid to the ASD phenomenon, which began in the early 1990s, increased monotonically, and began to plateau in the early 2000s (Lundström, Reichenberg, Anckarsäter, Lichtenstein, and Gillberg, 2015). For families of twice-exceptional children with ASD, the chances of finding help and support are greater now than ever. By contrast, for exceptionalities other than this combination of ASD and high IQ, there is less systematic research and even fewer resources available to meet the specific needs of these children. For a child whose pattern of disability and ability consists of eidetic memory and OCD, musical virtuosity and ADHD, or mathematical skill and dyslexia, parents may find the task of adequately supporting their children frustrating and lonely. Few existing programs are designed to work with these unique sets of challenges and opportunities. Each twice-exceptional condition presents its own idiosyncratic burdens and affordances, and the two conditions often interact in ways that make them yet more problematic. A child struggling with ADD, and its tendency to scatter attention across topics in rapid succession, may not be able to focus on an area of interest long enough to satisfy his or her curiosity, adding intellectual frustration to the attentional chaos of ADD. In cases such as this, where a child’s fleeting attention, emotional volatility, uncompromising perfectionism, or antisocial behavior inhibits engagement in their domain of excellence, good parenting may require prioritizing diagnosis and treatment of deficits, while not entirely ignoring the child’s need for creative outlets or intellectual stimulation. The first challenge for parents who believe that they may be dealing with a twice-exceptional child is to obtain a clear diagnosis of the set of issues that their child must cope with and the unique 405

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opportunities and challenges that may come along with a label of “gifted.” Testing a child can be made more complicated by the influence of emotional or intellectual difficulties as well as the child’s willingness or ability to adjust to the testing procedure. Once testing is complete, a detailed plan to help control, mitigate, refocus, or eliminate any negative effects of the disorder is needed, with the aim of enhancing the child’s ability to adapt to school and other life situations. If successful, the child’s exceptional ability may be supported, rather than hindered, by her or his disorder. Success—or lack thereof—in dealing with the complexities of a child’s idiosyncratic talents and struggles lies within the family, and it is to the qualities of the family context that we now turn.

The Family System and the Development of Talent There is a saying that talent seems to run in families. Actors breed actors (the Fondas, the Redgraves, the Sheens); professors breed professors (Margaret Mead, Arthur Schlesinger, Jr.); race car drivers breed race car drivers (the Unsers, the Pettys); athletes breed athletes (the Ripkens, the Roses); artists breed artists (the Wyeths, the Renoirs); writers breed writers (the Cheevers, the Updikes); musicians breed musicians (the Graffmans, the Bachs) (see Albert, 1980, 1990; Brophy and Goode, 1988; Goertzel and Goertzel, 1962; Goertzel, Goertzel, and Goertzel, 1978; Simonton, 1984, 1988, 1991, 1994, 1999). Family systems theory has been developed to help explain this phenomenon of “like father, like son” (Fine and Carlson, 1992). In family systems theory, a child’s talent is viewed as an adaptation of the child to the entire family’s interactions; these include parents, grandparents, and siblings and take into account birth order, labeling, and gender (Jenkins-Friedman, 1992; Olszewski-Kubilius, 2008). The notion that there is something in the family’s interactions that produces talented behaviors takes into account the environment within which a child is reared and that child’s responses to the environment (Sulloway, 1996). Simonton (1984) found that the age of the parents matters, and younger parents who are able to interest their children in their own passions seem to be better able to excite their children to follow in their footsteps. An example from novelist and essayist Cheever’s memoir, Home Before Dark (1984, p. 107), illustrates how interest was developed in the children of a writer: Every Sunday after dinner, we each recited a poem for the rest of the family. It began with sonnets and short narrative verse, Shakespeare and Tennyson, but soon we were spending whole weekends in competitive feats of memory. My father memorized Dylan Thomas’s “Fern Hill,” my mother countered with Keats’ “Ode to a Nightingale,” I did “Barbara Fritchie,” my father did “The Charge of the Light Brigade,” and so forth. Ben, who was eight, stayed with shorter poems. Age of parents also takes into account the high level of energy it takes to keep up with a talented child. A number of factors determine how parents react to the presence of great talents in their children. The birth position of the child is one factor (Sulloway, 1996). The last born tends to be more rebellious and perhaps more creative; the firstborn tends to be more conservative and seeks approval more. Simonton (1984, 1988) noted that firstborns tend to reach eminence or to be considered geniuses more often than their younger siblings, but there is some evidence that laterborn children whose births have been spaced several years apart have similar opportunities. Much seems to depend on parental will and energy to nurture that talent (Kulieke and Olszewski-Kubilius, 1989). Family values may place particular importance on certain talents, such as music or mathematics, and traditions that provide a context within which the response to talent takes place. For these reasons, children with the same set of talents, manifesting themselves in the same ways but reared 406

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in different families, may provoke a strikingly different response depending on one or more of the factors just listed (Benbow, 1992; Feldman, 1992; Feldman with Goldsmith, 1986; Morelock and Feldman, 1991; Olszewski-Kubilius, 2008). Responsive parents and a family that values achievement (particularly in the target domain) are critical catalysts in cases of extreme potential (Bloom, 1981, 1985; Feldman, with Goldsmith, 1986; Goertzel and Goertzel, 1962; Goertzel et al., 1978; Goldsmith, 1987, 1990; Kulieke and OlszewskiKubilius, 1989; Radford, 1990;VanTassel-Baska, 1989). This is not to say that children whose homes have been turbulent, fractionated, or even pathological have not sometimes attained eminence or remarkably high achievement, especially achievement in artistic domains (Albert, 1980; Piirto, 1998b). Many family systems operate on what may be termed a dysfunctional level, yet these interactions, too, sometimes have positive impacts on talent development.VanTassel-Baska and OlszewskiKubilius (1989, p. 8) noted that “some form of adversity or a seemingly inhibiting or detrimental factor which exists within the family structure or happens to the individual can and does somehow work in a beneficial, generative manner.” Such factors may include economic disadvantage, physical deformity, rejection by parents or peers, tension in the family, and parental loss. High achievement after childhood trauma is an area not yet fully explored. The psychoanalyst Miller (1981) postulated that adult achievement in creative domains takes place when there has been childhood trauma with warmth present, whereas childhood trauma without warmth can produce adult destructive behavior. Albert (1980) called this effect “wobble,” the presence of tension or dissent in families of creative people. The implications for parents of talented children are that, in light of a traumatic event, children may be beneficially encouraged to express themselves not only in traditionally therapeutic or cathartic activities, but through metaphoric modes of expression as well (Piirto, 1998a,b, 1999). The evidence is unambiguous, however, in this respect: The more valued a particular form of talent is within a family and the greater the amount of support this talent receives, the greater the likelihood and extent that this talent will present itself in significant later achievement. A family’s internal dynamics have a tremendous influence on a child’s or teenager’s talent development and scholastic achievement, and nontraditional lifestyles do not seem to affect achievement much. It is rather that the closeness of the family, and the robustness of the family identity, appears to be salient in determining child outcomes. A 12-year longitudinal study of nontraditional families by Weisner and Garnier (1992) showed that academic achievement is not negatively affected when a child is in a one-parent family, a low-income family, or a family with “frequent changes in mates or in household composition,” so long as one particular factor is present: The family chose the lifestyle because it had an intelligible and clear meaning for them—for instance, a religious choice leading to homeschooling (p. 608). If the unconventional family had the resources to provide for the children’s needs and emphasized achievement as important, the children did not experience a lowered achievement pattern. Although the parents in Weisner and Garnier’s (1992) longitudinal study might have been “highly experimental” in such arenas as diet or health care, they ensured that their children had adequate nutrition, inoculations, and routine medical and dental care, and they valued and provisioned for their children’s scholastic success. Indeed, Weisner and Garnier (1992, p. 625) found that “some nonconventional life-styles can protect children against possible difficulties in school,” whereas others can put children at risk. Across cases, the crucial variable was that the parents were committed to the lifestyle and placed emphasis on their child’s academic achievement. One thinks of the “aging hippies,” the “bohemian actors,” and the “poor struggling artists in garrets” as falling into this category of unconventional yet intentional living. Although these modes of living might involve less financial or residential stability, or else atypicality in some other respect, such a childhood often turns out high achievers who follow in their parents’ footsteps, just as children do from families with more conventional lifestyles. Not all children, however, resemble their families of origin with respect to the domain of talent expression, and children from the same family may end up following quite divergent paths. The 407

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writer Graham Greene was a middle child in a large and nurturing family, and his father was a headmaster. Greene viewed his world with such great sensitivity that he attempted suicide in boarding school during his teenage years; he had to go into psychoanalysis while his older brothers thrived and were school leaders, although none of them would go on to attain the eminence of the younger Greene (Sherry, 1989). Piechowski’s interpretation of Dabrowski’s “overexcitability” theory may be in operation here; that is, the intensity with which each child perceives events may differ, and what may send one child into extreme reactions may simply wash off another’s back (Piechowski, 1979, 1989, 1991). In fact, children’s temperament and personality may be of the utmost importance in the development of their talents, and even in the case of multi-talented children, in the family’s choice of which talent to develop. A passive, dreamy personality and temperament may lend itself to the quiet, endless reading that seems to have been evident in the childhoods of most adult writers; an aggressive personality and temperament may lend itself to the cutthroat world of childhood chess or athletics (Piirto, 1998a, 1999, 2001). In reacting to the realization that one’s child is endowed with remarkable ability, parenting tactics frequently gravitate toward extremes. One such extreme is the “stage mother” or “Little League father” situation, where the parent is fixated, even to the point of destructive narcissism, with the development of a child’s talent—whether or not she wants to have her talent developed.We may take Judy Garland’s childhood as an example—Garland’s mother was so obsessed with her acting career that she even permitted the use of amphetamines and tranquilizers to facilitate Garland working longer hours in the studio (Edwards, 1975). On the other end of the spectrum is the parent who cares little what the child achieves or how he expresses himself, so long as he is happy. This laissezfaire parenting style may be enacted by particularly busy or absent-minded parents. Both situations are capable of producing talented adults, but may have negative repercussions on the child’s social and emotional development.We may consider the case of the actor and comedian Steve Allen, whose mother permitted him to move, alone, from Chicago to the Southwest at the age of 16 in order to take a job as a radio announcer. Other parents move with their children in order that they might pursue their talents.The mother of the dancer Suzanne Farrell moved Farrell and her two sisters from Cincinnati to New York City at the offer of an audition with Balanchine; they all lived in one room while their mother worked as a private nurse (Farrell and Bentley, 1990). The parents of Albert Einstein moved to Italy when he was a teenager, leaving him to board with a local family and attend secondary school by himself. He soon quit and went to join his family, never to graduate (Clark, 1971). However, Einstein’s father, like Edward Teller’s (Blumberg and Panos, 1990), saw his son’s mathematical talent and provided him with a college student tutor. The concert pianist Gary Graffman’s father was a violinist, and he frequently sat with Gary while he practiced his lessons (Graffman, 1981). Graffman gave a concert at Carnegie Hall during his early teenage years.The strong influence of family interests is especially common in the pursuit of musical talent. According to Graffman (1981, p. 47): Even though my father was dead set against turning me into a child performer, daily practicing came first: I practiced every morning from 7:20 to 8:20 before school (in addition to two or three hours afterward). Whether or not I wanted to do this was never a consideration. My parents brought me up in a loving, but strict, European manner. I was not consulted in such matters. One went to school, one ate what was set before one; one practiced. It was as simple as that. Thus, the families of talented children cope with that talent in remarkably different ways; some focus on it and some ignore it. On balance, though, those that focus on their children’s talent development are more likely to see the child’s talent fulfilled. 408

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Baumrind (1971) indicated that parenting could be meaningfully organized relative to three modes: authoritarian, authoritative, and permissive. All three environments have produced talented adults, although it has been theorized that the authoritarian style produces resentment and stifling that forces talented students to sneak, hide, and sublimate the expression of their talent so that it takes place outside the home or surfaces later in life. For example, the social reformer Margaret Sanger was forced to leave home in order to gain the freedom to finish school; her mother died of cervical cancer at the age of 49, and her alcoholic father wanted her to act as his housekeeper. Gray (1979, p. 25) reported that “she let their run-down house deteriorate even more. Realizing she could never get enough money to return to Claverack to graduate, she decided to leave Corning for good.” The actor Marlon Brando was sent to military school by parents who did not know what to do with his rebelliousness. He was asked to leave the school and came to New York City to live with his sisters, who were studying the arts. He wanted to study acting, but his father disapproved. As Thomas (1973, p. 20) wrote, “Marlon would not be dissuaded by his father’s scorn.” Although he had considered many careers, including the ministry, acting appealed to him. He began to study with Stella Adler at the New School for Social Research. There is also evidence that genders of the child and the parent influence the development of various kinds of talent. Male writers, for example, seem to have had what Miller (1987, p. 114) called ineffectual fathers: “It would strike me years later how many male writers had fathers who had actually failed or whom the sons had perceived as failures.” She noted that this was the case for Faulkner, Fitzgerald, Hemingway, Wolfe, Poe, Steinbeck, Melville, Whitman, Chekhov, Hawthorne, Strindberg, and Dostoevsky. The same is true for women writers (Piirto, 1998a, 2001). Mothers’ attitudes toward mathematics have greatly influenced both their sons’ and their daughters’ achievement. If mothers say, “Well, I was not any good at math, either,” daughters especially might view mathematics as not being a gender-appropriate field to pursue (Eccles and Harold, 1992). Students with high academic talent who participated in the talent searches conducted among seventh graders also had differential influence by fathers and mothers (Benbow, 1992; Kulieke and Olszewski-Kubilius, 1989;VanTassel-Baska, 1989). Academically talented youth who participated in talent searches tended to have strong, highly educated fathers as well as mothers who were highly educated but who did not work full-time outside the home.These are tendencies, however, not rules, and they reveal as much about the relations of talent visibility to educational and financial resource access as they reveal of raw talent. We next discuss parenting at the extremes of talent—cases where the child stands as an outlier even amongst very talented children.

Parenting Children With Extreme Talents In this next section, we will explore the scenario of parenting extremely endowed children. We will discuss the following types of extreme talents: cases of extremely high IQ; cases of extreme talents in specific areas with or without concurrent high IQs; and genius or eminence, an outcome that has been extensively studied in relation to parenting. Research on cases of highly pronounced intellectual faculties, as denoted by IQ scores under the extreme upper tail of the distribution, spans the last century, beginning with Terman’s massive study of the gifted in the 1920s (Sears, 1979), and continuing into the present day (Deary, Johnson, and Houlihan, 2009; Plomin, DeFries, Knopik, and Neiderhiser, 2013). More contemporary gene sequencing studies aimed at disambiguating the phenomenon of extremely high IQ profiles indicate that, though heritable, IQ is not parsimoniously reducible to any particular genetic factor (Benyamin et al., 2014; Davies et al., 2011; Plomin, 2013). The heritability and developmental plasticity factors of IQ are also masked by familial dynamics, socioeconomic status, sociocultural context, and educational environment (Piccolo, Arteche, Fonseca, Grassi-Oliveira, and Salles, 2016; Schwartz, 2015; Tsethlikai, 2011). 409

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Studies of extreme talents in specific areas are more sporadic, falling into two categories: extreme talent in either mathematical or verbal abilities, such as shown by a very high score on a component of the Scholastic Aptitude Tests (Benbow, 1992; Benbow and Minor, 1990; Hunt, Frost, and Lunneborg, 1973) or on the American College Tests (Colangelo and Kerr, 1990). One difference found in these extremely high scorers is that high mathematics scorers have superior short-term memory and high verbal scorers have superior long-term memory (Benbow, 1992). High verbal scorers often use their verbal ability in fields that are less specific to their ability than do high mathematics scorers. For example, high verbal talent is necessary in academia, business, leadership, politics, law, and most high-level professions. A lack of high mathematical ability does not preclude a person from reaching eminence. High mathematical ability is much more specific to achievement in science, mathematics, and engineering. A second area in which extreme talent has been studied is in child prodigies in various specific fields (Deakin, 1972; Feldman, 1979; Feldman, with Goldsmith, 1986; Radford, 1990). Studies of genius and eminence go back at least to Sir Francis Galton (1869) and have been carried on by Albert (1983, 1980, 1990; Albert and Runco, 1986) and Simonton (1984, 1988, 1994, 1999, 2012), among others. Here, too, family variables have often been found to play a significant role in determining the degree of expression of talent. Biographical studies have produced substantial information with respect to the degree of family influence on the achievement of eminence (Goertzel and Goertzel, 1962; Goertzel et al., 1978). With the exception of Simonton’s work on historical movements (1984, 1988, 1991, 1994, 1999) and to some extent Bloom’s (1985) work on world-class performers, virtually all of the information available from observations of parenting, family structure, and the like is based on the study of individuals or relatively small groups of cases.This means that the database is quite small, but such studies often produce rich and extensive information about each situation. Only a few studies of extreme talent have examined relations among parenting variables and outcomes in children. Still fewer studies attempt to control or manipulate variables, thus limiting the generalizability of findings. Because the topic of study is so specific to individuals, that is how their talent was nurtured and developed, the present limitations of the research do not look to be easily remedied. Longitudinal studies such as those of Terman (1925–1959), Subotnik and Steiner (1993) of Westinghouse winners, Arnold (1993, 1995) of Illinois valedictorians (Arnold, 1995; 1993), the Study of Mathematically Precocious Youth (Benbow, 1992, 2000; Benbow and Lubinski, 1995, 1997), or snapshot studies, such as Harris (1990) of the students at the Hollingworth experimental schools in New York City and the follow-up studies of high-IQ students who attended the Hunter College Campus Schools in New York City (Subotnik, Karp, and Morgan, 1989; Subotnik, Kasson, Summers, and Wasser, 1993), are imperfect but valuable ways of looking at high-IQ and high-achieving students. Most of the students in the Hunter and Hollingworth studies had IQs about three standard deviations above the mean. Case studies are often the method of choice when an area of investigation is just beginning. This technique is better suited to exploring unknown psychological terrain; Freud’s work on the unconscious (1915), Piaget’s studies of babies (1926), or Darwin’s observations of his son Doddy (Kessen, 1965) were all based on case study research. This conspicuous lack of quantitative data should alert the reader to the fact that work in extreme giftedness is still in its early phases, and that whatever patterns of parent behavior have been observed should be taken as provisional. Those who have studied parenting in cases of extreme giftedness have found that there are many similarities between situations of parenting for extreme intellectual talent and the situation of parenting children with handicaps (Albert and Runco, 1986; Bloom, 1982, 1985; Borland, 1989; Clark, 1992; Feldman, with Goldsmith, 1986; Goldsmith, 2000; Hall and Skinner, 1980; Morelock, 1995; Robinson, Zigler, and Gallagher, 2001; Solomon, 2012;Tannenbaum, 1983;Treffert, 1989;Vail, 1987). One difference between the two kinds of extreme situations is that impediments to functioning are naturally seen as a higher priority for intervention, and consequently the allocation of public resources tends to be much more substantial, whereas in all but a few countries talents are typically 410

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seen as the responsibility of the individual child and her or his family. Placing the burden of supporting talent development entirely on the shoulders of parents makes the likelihood of successfully rearing talented children often as dependent on the parents’ abilities to generate adequate material resources as on their parenting skills. We consider three issues about parenting extremely talented children: recognizing extreme talents and gifts, responding to identified talents and gifts, and sustaining optimal conditions for the development of talents and gifts.

Recognizing Extreme Gifts and Talents The first task that faces parents who may think that they have a child of unusual potential is to try to identify what the nature and strength of the talent might be. For some talents this is a relatively straightforward matter, even during the first few years of life. For other talents and gifts, the signs may be more subtle or not evident until the child is older. For the 120 participants in Bloom’s (1985) study of world-class performers—mathematicians, research neurologists, concert pianists, sculptors, Olympic swimmers, and tennis champions—the talents that were to lead to such high levels of achievement before age 35 were evident before the age of 5 for some fields, but not others. For research neurologists, mathematicians, and to some extent sculptors, there were few early signs of the children’s extreme potential. However, the swimmers and tennis players as well as the pianists were identified as having a special inclination toward the particular field before the age of 5 (Bloom, 198l, 1985; Gustin, 1985; Sloan and Sosniak, 1985; Sosniak, 1985a, 1985b).The identified talent was not always exactly a match for the future field of excellence; for example, a child might have been intensely interested in all ball games before the age of 5 but focused on tennis during the succeeding 5 years. The research of Bloom, Sosniak, Gustin, and Sloan also revealed that few children across all fields were thought to be child prodigies, that is to have prodigious talents that leaped full blown into existence. Growth trajectories were more gradual and tended to follow a pattern of expression that depended on the presence of attentive and active parental support, direction, and encouragement. This pattern was also found by Feldman, with Goldsmith (1986) and Goldsmith (2000) in child prodigy cases. It was also true that in all fields there was an early need to involve other people who could offer specialized instruction. In explicit contradiction to the often believed view that extreme talent will somehow express itself, Bloom and his coworkers (1985) found that sustained efforts to identify and nurture talents in children was a distinguishing feature of families. Although the data are less plentiful, the more extreme the talents of children, the more extreme the qualities and characteristics of their parents often are (Deakin, 1972; Feldman, 2000; Feldman, with Goldsmith, 1986; Goertzel and Goertzel, 1962; Goertzel et al., 1978; Treffert, 1989). For example, in their study of child prodigies, Feldman, with Goldsmith found that in each of the six families, one or both of the parents essentially devoted their life to providing optimal support for a child’s emerging talent. The families also tended to see themselves as different from other families, to isolate themselves from the rest of their community, and to create a kind of cocoon-like structure to nurture their child’s early development (Feldman, 1992). These prospective findings tend to be confirmed by the retrospective data on those who have achieved eminence in their lives and careers (Goertzel and Goertzel, 1962; Goertzel et al., 1978). Parents who were highly opinionated, actively involved in causes or movements, and sometimes unstable were common in the families of those who were to become eminent. However, it appears that the families in Bloom’s (1985) sample of “world-class” performers provided more stable and tranquil contexts, albeit ones highly focused on the particular domain to be mastered.The cocoon-like quality that Feldman found in the prodigy families seems to be present as well in the Bloom sample, but with a somewhat different emotional tone. The families of the prodigies seem more fortress like, whereas those of the world-class performers seemed open but protective and focused on the task at hand. 411

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In their longitudinal study of six male child prodigies in fields ranging from chess to music to science to writing, Feldman (Feldman, with Goldsmith, 1986; Goldsmith, 2000; Radford, 1990) found that, even among these very extreme cases, it was not obvious before age 5 for three of the children in what field they would become a prodigy. For one musician and the two chess players in the sample, talents were strikingly obvious early on, whereas ability was far less immediately and readily apparent for the writer, the scientist, and for one child whose gifts were so diverse that it was impossible to guess in what direction he would go. In a follow-up to the six boy prodigies described by Feldman, with Goldsmith (1986), Goldsmith (2000) found that early adulthood experiences varied from case to case. In two cases, relatively steady progress from early prodigiousness to adult successful careers seemed well under way. A boy who chose violin performance at 10 was establishing himself as an internationally active solo performer, whereas another boy, whose writing interests began at age 3, found himself able to integrate music interests that emerged at about age 8 into a highly successful music journalism career. Another child became a successful adult, but not in the field of his prodigious activity. By age 10, this child had given up chess and turned his attention to law at a large New York firm, and seemed on his way to a successful career. A child who was multi-talented as well, but who gravitated toward music, became a more well-rounded person during his early 20s. Major differences between and among the family situations of the boys in this study may have accounted for at least some of the variation in how the boys managed the transition from prodigies to young adults. The families that seemed stable and connected to the wider world seemed to have fared better in preparing their talented boys for productive activities as young adults.The more isolated families were at greater risk for disintegration when their boys began to assert their independence, perhaps because so much of their closeness revolved around responding to the child’s great talents. The greater the continuity, both in terms of the fields chosen to pursue and in terms of the family’s ability to adapt to changing circumstances, the greater the likelihood that the outcome would be positive for the child, even if the outcome was different from what marked the child as talented earlier (Goldsmith, 2000). Bloom’s, Feldman’s, and Goldsmith’s research shows that early identification and valuing of talents tend to occur in homes where there is already a tradition of involvement in a relevant field. In other words, if a child with musical talent is born into a family that values and enjoys music and where music is an important part of family life, the chances are better that this talent will be recognized and developed than in a family with different values. There are few, if any, performers at the top of their fields in classical music or chess who began playing later than age 10, whereas beginning the process by age 3 or 4 confers a distinct advantage. Whether there is a critical period in the strict sense of the term (i.e., a period of time during which it is essential to be exposed to a particular kind of stimulation) is not known (Bornstein, 1989), but it is true that the later a talent for chess or music is discovered, the less likely it is to be fully expressed. If not discovered and responded to before age 10, the likelihood of full expression of potential is greatly reduced (Feldman, with Goldsmith, 1986). In other fields, such as writing, art, mathematics, dance, and most sports, identifying a strong talent and responding to it can occur several years later. Most writers, artists, and mathematicians, for example, do not begin serious preparation until after age 12, although the interests, predispositions, and behaviors predictive of the emerging talent are evident earlier (Piirto, 1999). For example, the mathematician and philosopher Bertrand Russell and the theoretical physicists Albert Einstein and Edward Teller all demonstrated their passion for mathematics and logical thought before they were about 10 or 11. Russell (1967, p. 38) wrote: At the age of eleven, I began Euclid, with my brother as my tutor.This was one of the great events of my life, as dazzling as first love. I had not imagined that there was anything so delicious in the world. After I had learned the fifth proposition, my brother told me that it 412

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was generally considered difficult, but I had found no difficulty whatever. This was the first time it had dawned upon me that I might have some intelligence. From that moment until Whitehead and I finished Principia Mathematica, when I was thirty-eight, mathematics was my chief interest, and my chief source of happiness. For the most part, however, students who pursue natural science and philosophical studies tend to begin later, often well into their teens (Feldman, with Goldsmith, 1986; Lehman, 1953). If a child is discouraged or prevented from pursuing interest in a particular field because doing so would break social conventions, or because the child is laterborn and only firstborn children tend to be seen as especially talented, the chances of noticing a talent are certainly reduced. Or, if a family’s history is focused on one domain, such as theater or medicine or music, but the child’s talent happens to be in a different domain, again the chances are diminished that an extraordinary talent will be recognized and nurtured (Feldman, with Goldsmith, 1986). As more is known about the relation between a child’s natural areas of talent and a family’s match or mismatch with those talents, it may be possible to equip parents to better recognize talent in areas other than those to which they are naturally predisposed. Once recognized and responded to, it then falls to parents to decide how to sustain the development of a talent that has emerged in their child. When we shift our focus to the more general academic abilities, there are many studies of early identification of high IQ in children. The literature shows that it is difficult to determine the degree of general intellectual giftedness before the child is 3 years old (Louis, Lewis, Subotnik, and Breland, 2000; Roedell, Jackson, and Robinson, 1980). Some studies have used experimental or neuroimaging procedures during early infancy to predict IQs at later ages, but these procedures are not available to parents, and are in any case still in the early phases of development (Bornstein, 1989; Rose, 1989). A study of the families of Head Start students who were high achievers showed that the parents had higher levels of educational attainment, greater income, fewer children, and were probably European American. Contrary to those who did not achieve, these parents rarely suffered from depression and were more attentive, tractable, and promoted the children’s autonomy (Robinson, Weinberg, Redden, Ramey, and Ramey, 1998).

Sustaining the Development of Exceptional Talents in Young Children It is now well established that a talent, however extreme it may be, requires sustained, coordinated, and effective support from parents and others for a period of at least 10 years to have a chance of fulfilling its promise (Bloom, 1985; Feldman, with Goldsmith, 1986; Hayes, 1988; Morelock and Feldman, 1991; Piirto, 1999). Having great talent does not guarantee great achievement, nor is talent capable of expressing itself without substantial resources external to the child. Therefore, the decision to try to develop even an extreme talent has profound implications for every member of the target child’s family. It is unlikely that a family will have the resources to sustain more than one process at the same time (Bloom, 1985; Feldman, with Goldsmith, 1986; VanTasselBaska and Olszewski-Kubilius, 1989). This means that siblings of the target child are likely to receive a great deal less, proportionally, of the family’s resources, a reality often difficult to accept and live with (Rolfe, 1978).The need to focus or refocus resources makes it somewhat unsurprising that there is rarely more than one prodigy in a family, and that families historically have tended to concentrate on the firstborn (and oftentimes male) child when it comes to talent development (Feldman, with Goldsmith, 1986; Goldsmith, 1990; Radford, 1990). Historically, support and assistance has been withheld from talented girls, because in much of the world and throughout much of history, the likelihood of a daughter being able to fulfill her talent was less than that afforded by a son, owing to an imbalance in culturally ingrained and institutionalized gender roles (Goldsmith, 1987, 1990; Greer, 1979; Piirto, 1991). 413

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How is a parent to know if the sacrifices necessary to develop a child’s talent are worth making? This question may seem to have an obvious answer, but in truth does not. Of course, most parents would say that they want to develop a child’s talents to their fullest, whatever the cost. But few families have the resources to develop every child’s talents to their fullest expression, and that often makes it necessary to focus on one child’s talents over another’s, or to insist that all children develop talents in the same domain—the domain valued by the parents, or one with greater chances of material reward. This was the case, for example, with the three Polgár sisters, all chess players (Polgár, 2005). Thus, we have the establishment of salons, dynasties, or teams. Going into the so-called “family business” is a common practice in the development of all talents, not just extreme talent. If a family with a child with great musical talent, for example, lives in a rural area far from the next level teacher, and lessons must be taken weekly or semiweekly, the family is faced with a difficult decision: Shall we move to be nearer the teacher? Moves such as this were documented by Feldman, with Goldsmith (1986) in the case of one prodigy studied, who moved from another city to the Boston area to find a suitable school, but moves to develop talent are more common in the cases of talented athletes (especially tennis, ice skating, and gymnastics) or musicians. The decision to develop a talent is one that requires reflection as to parents’ values, goals, and priorities as well as a realistic assessment of the strength and potential of the child’s talent and the effect that developing the talent will have on the family system, especially on siblings. To help with the decision of whether to pursue full talent development, it is often wise to consult with individuals who are knowledgeable about the domain in question and who have had experience in what it means to go through a rigorous, protracted training process. This is especially true for parents who find themselves trying to reckon the strength and potential of a child’s talent in a field with which they themselves are unfamiliar. Even when parents are experienced in the domain in question, there are reasons to seek advice from outside experts or consultants. First, it is difficult for parents to accurately assess the potential in their own children because of their close attachment to them. Second, coaches, master teachers, trainers, and high-level practitioners generally have much more experience than parents do in assessing and developing talent. Parents have themselves and their children to use as a primary basis for judgment. An active coach or teacher may have worked with hundreds of students (Bloom, 1985; Feldman, with Goldsmith, 1986). In most instances, the advice given by experienced people within a domain will not be definitive with respect to the course of the talent’s development. This is true for several reasons, the most important of which is that it is not possible to predict with confidence what will happen to a talent over time.There are too many uncertainties in the process to assert with confidence what the course of any given child’s progress will be. Indeed, parents would be wise to question too positive a prediction, particularly if the person giving that prediction is trying to recruit the child into a program, school, or mentorship relationship. The earlier the prediction about the strength and distinctiveness of a given talent, the less confidence can be placed in its accuracy. This is not so much because it is impossible to detect and assay talent early; in some fields such as chess, music, and certain athletic domains talent can be assessed at very early ages, in many cases younger than 5.The uncertainty in making predictions is that there are myriad factors, both genetic and environmental, involved in bringing even an extreme talent to full expression, and a generative confluence of all relevant factors can never be guaranteed. Even if such a fortuitous convergence should occur, the variables positively influencing talent development must be sustained over several years, and, when necessary, fluidly adapted to the changing needs of the child and the maturation of her or his ability. The kinds of supports that must be put into place and kept there include the right teachers teaching the right kinds of things for child performers; the right integration of the target activity with other priorities for the child and the family; the right level of challenge in terms of competition and

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public performance; and a context that encourages continued involvement in the activity in question. In summary, a number of factors beyond the control of the child and her or his respective family play roles in the development of talent, including the additional sufficiency of financial resources, proximity to appropriate facilities, and the availability of appropriate teachers. Another less well-documented, although no less essential component in talent development is freedom from cultural proscriptions against certain activities. Although a child might possess high natural potential, proscriptions may hamper the child’s aspirations and attainment of excellence based on such social or institutional constructs as race, gender, and class categorization. For example, in the United States, a young male might experience disapproval if he wants to put his psychomotor talent to use in dance such as classical ballet. Jacques D’Amboise, the former Balanchine dancer who now conducts school-based classes in New York City, is especially eloquent on the topic of attracting psychomotorically talented males to the art of dance and has even set up special classes for them during the school day, but the battle against cultural proscription is an uphill one. Even world-class dancers such as Rudolf Nureyev, have had to contend with a disapproving father in order to seriously pursue dance as a career. Percival (1975, p. 21) wrote that Nureyev’s father “was none too pleased to find that his only son had grown up to be interested only in something as ‘unmanly’ as dancing and told the boy to forget the whole thing.”   Young women, on the other hand, might experience disapproval if they want to employ their logical-mathematical talent, such as is used in the game of chess. Few female chess talents continue playing tournament chess beyond the elementary tournament years, in spite of a demonstrated ability to do so. The most prominent counterexample to this trend would be the case of the Polgár sisters. The three girls received regimented training throughout childhood with the explicit goal in mind of attaining prodigious achievement in the discipline of chess by their father—a committed chess enthusiast and educational psychologist who sought to dismantle the notion of innate genius (Polgár, 2005). Each of the sisters quickly attained eminence. The youngest of the sisters, Judit Pulgár, became a chess grandmaster at the age of 15, making her the youngest player ever to have earned this distinction. A fellow grandmaster, Kasparov, lauded as the greatest chess player in history, said of Polgár, “It’s inevitable that nature will work against her, and very soon. She has fantastic chess talent, but she is, after all, a woman. It all comes down to the imperfections of the feminine psyche. No woman can sustain a prolonged battle” (Lidz, 1990). Despite years of public antagonization, Polgár went on to beat Kasparov, and now serves as the head coach and captain of the Hungarian national men’s chess team (Verőci, 2015). In some fields where talent development begins early, a phenomenon (perhaps unfortunately) labeled the “midlife crisis” in musical performers has been observed with some frequency (Bamberger, 1982, 2016). Usually manifesting sometime between the ages of 12 and 18, this so-called midlife crisis refers to a breakdown in the child’s ability to perform and an accompanying emotional crisis in the child’s confidence in her or his level of performance. Many promising careers have come to an early end because of the debilitating effects of such a crisis in adolescence. The description of an adolescent crisis for performers has been documented in only one field—music—though informal observations have been made in the field of chess (Feldman, with Goldsmith, 1986) and in writing (Piirto, 1998b). It should also be stressed that this adolescent crisis phenomenon has only been observed amongst young performers in U.S. American culture; it may or may not occur in other cultural contexts. It could also be that this so-called midlife crisis is in part precipitated by the highly professionalized and competition-oriented schools of music where most of the students with extreme talent pursue their chosen field. How such schools are organized, how they respond to and develop talent, and what they see as furthering their interest in terms of public visibility all play a significant part in how conservatories or music training academies impact the process of talent development (Subotnik, 2000; van Lieshout and Heymans, 2000).

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Conclusions At the turn of the twenty-first century, a major shift was underway in both cultural attitudes on a global scale and the field that targets talented children. Some hailed these changes as a “paradigm shift” (Dai, 2017; Feldman, in press; Kaufman, 2013), in the sense that many fundamental assumptions about gifts, talents, and their development were being replaced with new assumptions. The field of gifted studies has not yet fully embraced the changes called for in this new “paradigm,” and no standard methodological approach has yet been adopted to replace the former research standards, yet there are strong indications that the development of novel methods and new frameworks is imminent. These changes already impact parenting talented children. Under the framework that guided the field of gifted studies for more than a century, talent was typically assumed to be well captured by a standard paper-and-pencil psychometric evaluation (almost always an IQ test), and parenting was studied in relation to its success in helping higher-IQ children do well in school, in college, and in their careers. Famous longitudinal studies documented the lives and careers of children considered talented—or gifted, as they were often labeled in the field—in this way (e.g.,Terman, 1925–1959).Talent was, in essence, equated with and reducible to a child’s forecasted earning potential. Later studies differentiated talent into verbal and mathematical components (following the SAT format), but the approach was similar in structure to earlier studies (e.g., Benbow and Minor, 1990; Stanley, 1997). The small step from a single talent to two or more talents in research helped to catalyze more changes to both colloquial and scholarly understandings of what constitutes talent, with contemporary studies extending to athletic, artistic, musical, and other more specific talent areas, as well as gender differences in talent development (Ericsson, 1996; Gardner, 2006; Kaufman, 2013; Kerr, 1985; Sternberg, 1996). There are even research studies that demonstrate that abilities other than talents in the usual sense (mindset, grit) may be as important, or more important, than canonically “cognitive” forms (Duckworth, 2007; Dweck, 2006). As the landscape on which talent studies are carried out has shifted, so has the landscape on what kinds of parenting abilities, if any can indeed be so generalized, are of most relevance across the spectrum of talent domains—the diversity and breadth of which appears to be ever expanding. We know more about extreme cases of specific talent development and parenting than we do about any other area, but this work is largely based on a few cases and uses predominantly qualitative, informal, or anecdotal research methods (Feldman, with Goldsmith, 1986). A few studies have added psychometric data to the case material, but the database remains relatively small and unsystematic (Ruthsatz and Detterman, 2003; Ruthsatz and Urbach, 2012). Parents of talented youth are widely presumed to have it easy.Yet the academic literature specific to gifted and talented children provides empirical evidence that these individuals require a far greater commitment of all variety of resources from their respective families (Albert, 1980, 1990; Bloom, 1981, 1985; Feldman, with Goldsmith, 1986; Howe, 1982; Radford, 1990; Sears, 1979).What is more, parents of talented children may find typical sources of support to be lacking, as they engender little sympathy from their communities. Lacking larger and more systematic studies, questions about parenting can at best be provisionally answered based on science journalism as found in books (Bazzana, 2007; Clynes, 2015; Ruthsatz and Stephens, 2016; Solomon, 2012; Suskind, 2014). The cases reported are sometimes complex and extreme, including Solomon (2012), who deals with children possessing a wide range intellectual faculties, emotional sensitivities, and identities, such as child prodigies, and explores the various challenges for parents presented with these differences. A comment on the back cover of Solomon’s Far From the Tree captures the impact of the material well: I have seldom read a book that made me feel moral quandaries as intensely as this one. . . . What undid me again and again, was the radical humanity of these parents, and their gratitude to and for children they would never have chosen.

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As Feldman, with Goldsmith (1986) found in their study of six child prodigies, the more extreme and unusual the talent—or talents—a child possessed, the more extreme and unusual the abilities required of the parents. When one explores the addition of further complicating factors in the mix, such as neurodevelopmental disorders or the interplay of gender, ethnic, and cultural identities, the ante for successful parenting rises again dramatically (Solomon, 2012). While Solomon’s book addresses developmental challenges outside the scope of this chapter—individuals with dwarfism, Down syndrome, or schizophrenia; children of sexual assault; transgender children—his thoughts about parenting under extreme circumstances are often highly applicable to cases of talented children. Although not the result of systematic scientific research, they are the product of careful observation and a thorough familiarity with the available research literature. Given the rapid pace of change in the fields that conduct quantitative research on talent and parenting, we can look forward to findings that support or else cause us to question the impressions reported in current science journalists’ accounts. For the time being, we are largely limited to anecdotal reports. Almost all of the cases described in the newer literature, including within science journalism, are stories of relative successes. That is, what we see are parents and children who are doing relatively well by one another. Were that not the case, the children would not even have been recognized as having exceptional talents, never mind afforded the opportunity to develop them. In all likelihood, there is a vastly greater number of children whose talents are unfulfilled than those whose talents are flourishing under exceptional parental care. When children succeed, they do so in large measure because they are given the support, care, and devotion of parents whose lives are committed to their welfare and achievement. There are exceptions, of course, of children who find ways to accomplish their goals in spite of, rather than because of, what their parents have done for them. Our goals, however, are to reduce the need for heroic resilience in the face of overwhelming barriers and to increase our ability to identify the kinds of parenting strategies that work best with the ever-growing diversity of talents, alongside corresponding difficulties and deficits, and situated within the growing variety of contexts in which parenting takes place.The tasks are formidable and complex, but the rewards of greater fulfillment and better parenting seem worthy of our most dedicated efforts.

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13 PARENTING CHILDREN BORN PRETERM Merideth Gattis

Introduction Parenting influences child health and development. Families, practitioners, and researchers are increasingly aware of how child health and development affects parenting. Research on parenting children born preterm has made important contributions to our understanding of both directions of influence. This chapter summarizes research on parenting of children born preterm and situates that research within the broader context of relations between child health and development and parental care. The chapter is divided into four sections. It begins by describing how preterm birth affects children, both immediately after birth and over the long term. The second section identifies how having a preterm child affects parents. The third section reviews ways in which interactions between parents and children, including parental care and interventions that shape and support parental care, influence developmental outcomes. The fourth section raises emerging questions and lays out future directions for research on parenting children born preterm.

Preterm Birth Influences Child Health and Development Preterm children are born before 37 weeks gestation and are therefore born at an immature stage of development. Preterm birth is common: Every year an estimated 13–15 million children around the world are born preterm (Beck et al., 2010; Blencowe et al., 2012). Due to variations in female literacy, malaria, maternal body mass index, and medical care during pregnancy, the rates of preterm birth are highest in Africa and North America, where more than 10% of children are born preterm, and lowest in Europe, where about 6% of children are born preterm (Blencowe et al., 2012). Gestational age influences immediate risks as well as long-term outcomes for children and affects parents and their interactions with children.To help identify risks and evaluate outcomes, the World Health Organization (WHO) distinguishes different groups of children born preterm based on gestational age, including children born extremely preterm (before 28 weeks gestation), very preterm (between 29 and 32 weeks gestation), and moderate or late preterm (between 32 and 37 weeks gestation).

Theoretical Accounts of How Preterm Birth Influences Child Health and Development Research investigating preterm birth is often empirically rather than theoretically led, evaluating multiple variables that may predict, exacerbate or alleviate, or result from preterm birth (Blencowe 424

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et al., 2013; McDonald, Kehler, Bayrampour, Fraser-Lee, and Tough, 2016; Saigal and Doyle, 2008). Even in an empirically focused research area, however, theories influence judgments about what specific research questions are worthwhile and which explanations of empirical findings are acceptable (Karmiloff-Smith and Inhelder, 1974–75; Kuhn, 1962). Theories also influence design and measurement in basic research as well as interventions (Glanz and Bishop, 2010). Two broad theoretical perspectives guide research investigating how preterm birth influences child health and development. The maturation perspective emphasizes the influence of biological maturation on children’s health and behavior (Bakewell-Sachs, Medoff-Cooper, Escobar, Silber, and Lorch, 2009; Baron, Litman, Ahronovich, and Baker, 2012; Forslund and Bjerre, 1983; Hunt and Rhodes, 1977; Longin, Gerstner, Schaible, Lenz and Konig, 2006; Parmelee and Shulte, 1970). When children are born preterm, their immaturity may prevent them from adapting to the extrauterine environment in the way that a full-term child can, and may also render them vulnerable to harm. Children born preterm may initially require specialized care, including maintenance of basic bodily processes, such as respiration and thermoregulation, as well as protection from infection, but as individuals mature over time, the consequences of preterm birth become less noticeable and less impactful (Luciana, 2003). According to the maturation perspective, negative outcomes associated with preterm birth are the consequences of complications of preterm birth, disruptions or harm to the developing child during a period of vulnerability, or deprivation of the additional time needed for maturation (BakewellSachs et al., 2009; Baron et al., 2012). In general, however, the same developmental processes are involved, and (unless there are complications or co-morbidities) the development of children born preterm should proceed at the same rate as children born full-term, with allowance for the difference in biological age. Differences in gestational age at birth between children born preterm and full-term may sometimes create the appearance of developmental differences or delays in children born preterm, but when studies use corrected age (adjusting for total age since conception so that comparison groups are similar in terms of developmental stage) rather than simply chronological age (age since birth, also called postpartum age), these differences diminish or even disappear. Several studies of children born preterm have compared the relative influence of maturation and experience on development. Studies comparing phonemic processing, for example, in children born preterm and full-term address questions about whether early language skills are determined by maturational timelines or language exposure (Gonzalez-Gomez, and Nazzi, 2012; Rago, Honbolygo, Rona, Beke, and Csepe, 2014). Many of these studies can be said to operate from a maturation perspective, insofar as the logic behind the comparison is grounded in an assumption that the same processes govern the development of children born preterm and full-term. From this perspective, the purpose of comparing children born preterm and full-term is not to identify differences in their underlying processes, but to use prematurity as a window onto the processes. Studies that compare the influences of maturation and experience on behavior sometimes match children born preterm and full-term across both chronological and corrected age (using either different groups or multiple testing times for the preterm group) to allow more accurate evaluations of the relative influences of maturation and experience on development. Interventions grounded in the maturation perspective focus on protecting, supporting, and stimulating preterm children and their parents during the initial period of vulnerability and hospitalization. A second theoretical perspective, not only on prematurity but on development more generally, emphasizes the complexity of developmental processes, and the sensitivity of those processes to environment and timing. According to this second perspective, the divergence perspective, differences in the timing of birth and related environmental inputs, may cause the developmental trajectories of preterm children to diverge from the developmental trajectories of full-term children, potentially involving different processes as well (Aylward, 2005; Guarini et al., 2009; Reichetzeder, Putra, Li, and Hocher, 2016; Sansavini, Guarini, and Caselli, 2011; Sesma and Georgieff, 2003; Sullivan, Hawes, Winchester, and Miller, 2008; Volpe, 2009; van de Weijer-Bergsma, Wijnroks, and Jongmans, 425

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2008). Preterm birth is thus likely to have a persistent influence on development, and the differences between children born preterm and full-term may amplify over the course of development, rather than attenuate.Two somewhat paradoxical empirical findings led to the divergence perspective: First, researchers documented differences between preterm and full-term children on physiological and behavioral measures, even when testing at corrected ages to allow for similar levels of maturation, and, second, rates of dysfunction in children born preterm increase with age, in particular after children begin school, and some dysfunctions appear to be lifelong (Aylward, 2005; Johnson and Marlow, 2011; Sesma and Georgieff, 2003; van de Weijer-Bergsma et al., 2008). Aylward (2005) argued that because of the nature of neurodevelopmental processes, multiple, subtle insults to the brain influence long-term developmental outcomes following preterm birth. Other researchers have focused on environmental risk factors, such as maternal age, education, and income, and how those factors interact with the immediate consequences of preterm birth (Blencowe et al., 2012). Both types of arguments, whether focused on physical risks, psychosocial risks, or some combination of the two, recognize the impact of multiple risk factors that interact and increase the probability of negative developmental outcomes for preterm children over the long term. The divergence perspective emphasizes the integral role of change in development, the intrinsic relation between plasticity and vulnerability, and the cascading nature of development (Anderson, Spencer-Smith, and Wood, 2011; Aylward, 2005; Bornstein et al., 2006; Sesma and Georgieff, 2003). The divergence perspective predicts that, in some cases as a result of earlier extrauterine experience, preterm birth may lead to earlier development of certain competences (van de Weijer-Bergsma et al., 2008). The conditions of preterm birth and the plastic nature of development may, however, lead to changes that are adaptive in the short-term but are also lasting and consequent, with the potential for negative long-term outcomes (Guarini et al., 2009; Reichetzeder et al., 2016; Sullivan et al., 2008; Volpe, 2009). Interventions grounded in the divergence perspective seek to mitigate maladaptive long-term outcomes by identifying and addressing earlier adaptations, including interactions with other factors, such as parental beliefs, knowledge, or support. The maturation and divergence perspectives are not antithetical. Humans are complex, and preterm birth influences multiple aspects of child health and development, from basic physiology to cognition to social interactions. It is possible, and indeed likely, that some developmental outcomes are primarily influenced by maturation and other outcomes are more consistent with divergence. Proponents of both perspectives also note that several factors associated with preterm birth, such as maternal age, education, and health, influence long-term developmental outcomes, either directly or indirectly, and see the need to evaluate or control for these factors in research. Nonetheless, the two perspectives are distinct, generating different research questions and predictions about how preterm birth influences child health and development; they also motivate different approaches to care.

Acute Biological Risks Preterm birth poses immediate biological risks, the most urgent of which is mortality. Preterm birth is the most frequent cause of death amongst neonates around the world (Blencowe et al., 2013). Gestational age influences mortality: infants born extremely preterm (before 28 weeks gestation) and very preterm (between 29 and 32 weeks gestation) have especially high mortality rates. Mortality poses a threat to infants born preterm across all gestational ages, even for infants born moderate or late preterm (between 32 and 37 weeks gestation). Available care influences mortality as well: Most infants born extremely or very preterm require special care to survive, including neonatal intensive care. In many countries, neonatal intensive care is either not available or not well established, leading to higher mortality rates (Blencowe et al., 2013). In addition to directly influencing mortality rates, preterm birth also contributes indirectly to mortality because it increases the risk of infection (Blencowe et al., 2013). Infection is the second-most frequent cause of death for neonates generally and 426

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interacts with preterm birth, increasing mortality rates in particular amongst infants born moderately or late preterm. The fundamental cause of immediate biological risks for children born preterm is immaturity of the organs (Lawn et al., 2010). The immaturity of the brain and lungs are especially important: Neonates born preterm have increased rates of brain injury, respiratory problems, and temperature instability (Saigal and Doyle, 2008). As a result, neonates born preterm have higher rates of hospitalization, longer durations of hospitalization, and higher rates of medical interventions. Medical care influences survival and developmental outcomes for children born preterm. Appropriate neonatal care environments are critical to improving the survival rates of infants born preterm. High-quality neonatal intensive care can, for example, help neonates maintain physiological stability of respiration and temperature and protect infants from infection. At the same time, however, neonatal intensive care is associated with higher levels of light and noise, both of which may disrupt internal regulation. In some cases, neonatal intensive care is also associated with higher rates of infection, which in turn increases the risk of mortality amongst infants born preterm. In the 1980s and 1990s, a new model of neonatal intensive care was introduced, the Neonatal Individualized Developmental Care Program (NIDCAP), or more simply, developmental care (Als et al., 1986). The motivation for developmental care is that the physical environment of neonatal intensive care units may be disruptive to newborns due to an excess of stimulation, including light, noise, and the presence of medical equipment. The aim of developmental care is to support optimal development of neonates, including those born preterm, by changing the physical environment, for example by reducing noise and introducing cyclical lighting systems that simulate day and night, thus reducing stress and supporting self-regulation. Randomized control trials demonstrated that developmental care in neonatal intensive care units led to improvements in long-term functioning of children born preterm, especially those born extremely and very preterm (Als et al., 1994; Als et al., 2004) and in some cases also those born moderately or late preterm (Buehler, Als, Duffy, McAnulty, and Liederman, 1995; but see also Ariagno et al., 1997).

Regulatory Problems Preterm birth increases the rate of regulatory problems during infancy, including the regulation of sleeping, feeding, and crying, three factors which are especially important to parents. Researchers have evaluated whether and when regulatory problems occur, as well as identifying and evaluating potential causes for those problems. Understanding the causes of regulatory problems is important because different causes have different implications for long-term outcomes as well as interventions. If, as would be predicted by the maturation perspective, immaturity is the primary cause of regulatory problems, interventions can be minimal and focus on sustenance and protection; if environmental factors, such as noisy, bright hospital environments, are the primary causes of regulatory problems, improved environments should resolve the problems; and if, as would be predicted by the divergence perspective, regulatory problems reflect functional changes, they may interact with aspects of the environment, such as noise, light, or other aspects of care, and lead to longer-term problems. One of the first studies to examine sleeping patterns in children born preterm utilized time-lapse recording in the homes of infants and their parents. The study compared sleeping patterns in infants born full-term and infants born preterm at seven different ages across the first year, from 2 to 52 weeks (Anders and Keener, 1985). Infants in the preterm group were somewhat heterogeneous: most were born very preterm, but some of the infants were born extremely preterm and some moderately preterm. Age was adjusted for infants in the preterm group, so that they were equivalent with infants in the full-term group in terms of developmental stage, but therefore chronologically older and more socially experienced. At the youngest ages observed, infants born preterm had slightly higher levels of active sleep and slightly lower levels of quiet sleep compared to infants born full term. Infants born 427

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preterm also showed less stability of sleep patterns compared to infants born full term. Overall, however, sleep-wake organization was similar across the two groups of infants, with a gradual decrease in active sleep and gradual increase in quiet sleep over the first year of life. Anders and Keener (1985) argued that prematurity in and of itself is not a risk factor for sleep regulation, and that problems with sleep regulation in preterm infants may largely reflect immaturity rather than a lasting impairment. In a longitudinal study of preterm infants while they were still in the hospital, Holditch-Davis (1990) reported further evidence that problems with sleep regulation are related to maturation. Because the duration of hospitalization varied across infants, the number of observations per infant varied. On average infants were observed over a period of 3 or 4 weeks when they were between 29 and 39 weeks gestational age, or in other words were not yet full term. Active sleep was the most common sleeping state, but decreased across the duration of the study. Quiet sleep increased across the duration of the study, much like the pattern observed by Anders and Keener (1985). HolditchDavis argued that, in addition to state changes, sleep organization increased across the study duration, before infants reached full-term age. Holditch-Davis also examined relations between sleep and other functional domains, such as respiration and crying, and reported evidence that regulation is linked across domains. Importantly, however, Holditch-Davis observed large individual differences between infants for both sleeping and respiration states. Many of the patterns observed at the group level, such as the increase in quiet sleep, were not observed at the level of individual infants. HolditchDavis argued that the influence of preterm birth on internal regulation is not uniform, and regulation varies considerably across individual infants. At least some evidence indicates that preterm birth does impact children’s sleep over the longer term. Caravale et al. (2017) compared sleeping patterns in a heterogeneous sample of 2-year-old children born preterm with those of healthy 2-year-olds born full term. Children born preterm had more sleep difficulties, including restlessness and difficulties with breathing. Further research is needed to evaluate the influence of preterm birth on long-term sleep outcomes. Infants born preterm have higher rates of feeding difficulties compared to infants born full term. Sucking and swallowing develop around the beginning of the second trimester of pregnancy, and preterm infants might therefore be expected to demonstrate normal feeding behavior. Nonetheless, several studies have documented differences in feeding behaviors between preterm and full-term infants, including immature patterns of sucking and swallowing. Hafström and Kjellmer (2000) used an automatic system built into infant pacifiers to observe non-nutritive sucking in a group of infants born preterm between 26 and 35 weeks gestation.The recordings were made on a weekly basis while infants were still in the hospital. As in Holditch-Davis’s (1990) study, the duration of hospitalization varied across infants, and as a result the number of observations per infant varied, but 26 infants had four recordings over a period of 4 weeks. Sucking was highly variable both within and between infants, but all infants in the study were capable of sucking. Across infants, the duration and amplitude of sucking was influenced by infant weight and gestational age. Hafström and Kjellmer’s (2000) results thus indicate a maturational influence on sucking and, by inference, on feeding. Lau, Alagugurusamy, Schanler, Smith, and Shulman (2000) identified five stages of sucking maturity in infants born preterm, characterized by degree of suction, rhythmicity, and amplitude. Infants who demonstrated more mature stages of sucking also demonstrated more mature feeding, as indicated by more feeds per day. In another study, sucking also predicted when preterm infants achieved independent oral feeding. Bingham, Ashikaga, and Abbasi (2010) conducted a prospective study of sucking and feeding in infants born between 25 and 34 weeks gestation. Infants who showed more organized and consistent sucking behavior responded to oral feeding at earlier ages. The severity of prematurity and the presence of co-morbidities both influence feeding. Infants born at earlier gestational ages are delayed in progressing to independent oral feeding (Jadcherla, Wang, Vijayapal, and Leuthner, 2010). Similarly, infants with low birth weight, who require respiratory support, and who have had gastrointestinal surgery have more feeding difficulties and are slower 428

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to begin independent oral feeding (Gianni et al., 2015). In such studies, however, it is difficult to distinguish among the effects of maturity, the effects of impairments or co-morbidities, such as infection, gastrointestinal problems, or respiratory problems, and indirect effects that result from medical interventions. In the study conducted by Jadcherla et al. (2010), infants were often fed by a tube that delivers milk directly to the stomach, and in addition had some form of ventilation, especially initially and amongst the youngest infants. The youngest infants (those born with a gestational age of less than 28 weeks) also were the slowest to achieve independent feeding. Parents and medical staff sometimes have concerns that assisted feeding and ventilation may increase reflux, a common feeding-related issue for preterm infants, either due to the presence of tubing or to the air pressure involved in ventilation. However, this is not the case. Newell, Morgan, Durbin, Booth, and McNeish (1989) conducted a study with infants receiving ventilation and found that infants had less reflux during ventilation. They proposed that ventilation could actually assist in reducing reflux due to the pressure involved. The regulatory problems of infants born preterm also include increased crying and/or fussiness. One of the first studies to investigate this possibility utilized diaries recorded by parents of 35 infants born between 27 and 34 weeks gestation (Barr, Chen, Hopkins, and Westra, 1996). None of the infants in the study had serious medical issues other than preterm birth and low birth weight. Parents recorded crying and seven other infant behaviors in diaries for a 24-hour period at six time points between 40 weeks gestational age and 24 weeks corrected age. Infant crying, assessed as duration and frequency, increased from term to 6 weeks corrected age, and decreased thereafter. Much like term infants, crying was initially distributed across the 24-hour period and gradually decreased at night, so that by 12 weeks corrected age nighttime crying was low and remained low. Barr and colleagues concluded that increases and decreases in crying are largely due to maturation, and pointed toward the peak observed in preterm infants at 6 weeks corrected age, which is similar to the peak observed in infants born full term. If crying is largely due to maturation, the period in which infants cry most—up until about 2 months—is likely to be extended for preterm infants, as they are born earlier and thus require longer to reach the same stage of maturation. As a result, preterm infants might be expected to cry more during the initial weeks of life, but to reach the same level of crying as infants born full term around 2 months corrected age. Korja et al. (2008) used the diary method developed by Barr and colleagues (Barr et al., 1996) to evaluate crying and other behaviors of preterm (N = 30) and full-term (N = 36) infants. Parents recorded crying and fussing for a 3-day period when their infants were 5 months old (corrected age). Crying and fussing were combined to create one variable, assessed as duration and frequency. Preterm and term infants fussed and cried for the same duration per day (M = 82.6 minutes and M = 64.9 minutes), but preterm infants fussed and cried more frequently per day (M = 9.0 versus M = 5.5 for full-term infants). Some factor other than maturation thus appears to influence fussing and crying in preterm infants. Infants born preterm are usually hospitalized for longer times than are infants born full term, however, and as a result spend those initial weeks in a different environment, one that differs from the home environment in terms of light and noise. One of the consequences of developmental care programs was reduced stimulation, including light and noise, in neonatal intensive care units (Als et al., 1986). Researchers have considered that consistently reducing light levels in neonatal intensive care units may, however, deprive infants of valuable environmental cues, such as the cyclical variations in light that occur each day in a typical home. Guyer et al. (2012) investigated whether cyclical lighting that simulates day and night reduces crying in preterm infants. Very preterm infants (born at or before 32 weeks gestational age) were randomly assigned to either cycled or standard lighting conditions in the hospital ward. In the cycled lighting condition, lights were turned on from 7 a.m. to 7 p.m. and off from 7 p.m. to 7 a.m. In the standard lighting condition, lights were generally dim and were turned off whenever possible, particularly when the infant was sleeping, but not in a structured 429

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pattern. Light levels were thus similar for infants in the two conditions at night, but were higher for infants in the cycled lighting condition during the daytime, because the lights were on continuously for a 12-hour period. Parents recorded infant crying and sleep patterns at 5 and 11 weeks corrected age, by which time all infants were at home. No difference was observed in sleeping patterns at either age across the two conditions. At 5 weeks corrected age, infants who had experienced cycled lighting in the hospital cried and fussed less than infants who had experienced standard lighting (1.25 versus 2.22 hours fussing and .64 versus 1.11 hours crying). Crying and fussing decreased at 11 weeks corrected age, but still differed between groups. Guyer and colleagues concluded that cycled lighting has the potential to reduce crying in preterm infants, even when infants are at home and cared for by parents.Thus, both maturation and environmental conditions influence regulation in preterm infants. The influence of cycled lighting was restricted to crying and fussing, however, and did not extend to sleeping, suggesting that the interrelations between structured environmental cues and specific domains of regulation are not uniform.

Developmental Outcomes in Infancy and Childhood Disability is a profound consequence of preterm birth. In a study of 6-year-old children in the United Kingdom and Ireland, only 20% of children born extremely preterm had no disability, whereas 22% had a severe disability, such as blindness, deafness, cerebral palsy that prevented the child from walking, and/or severe cognitive or communicative impairments.The remaining children had either moderate or mild disabilities, including cognitive and physical disabilities (Marlow et al., 2005). Specialized care following birth, such as assistance with respiration and thermoregulation, not only reduces mortality rates but also reduces the risks of disability (Howson, Kinney, and Lawn, 2012; Saigal and Doyle, 2008). (Other attempts to mitigate disability are discussed in the section on intervention studies of parental care that influence outcomes.) Preterm birth is one of the most important predictors of developmental delays in cognitive and communicative skills during infancy and childhood (McDonald et al., 2016). At the age of 2, very preterm children process linguistic information more slowly (Ramon-Casas, Bosch, Iriondo, and Krauel, 2013) and have smaller vocabularies than do their peers (Foster-Cohen, Edgin, Champion, and Woodward, 2007). At the age of 6, children born preterm (24–33 weeks gestation) make more vocabulary errors and have poorer grammatical and phonological skills (Guarini et al., 2009). Negative relations between gestational age and cognitive and communicative skills are not simply due to differences in maturity: Gestational age is negatively related to cognitive and communicative skills in studies that correct for gestational age as well as those that match on chronological age. Although some relations between gestational age and developmental skills attenuate with age, preterm birth remains negatively related to cognitive skills at 5 years, as indicated by school performance (Quiqley et al., 2012). Children born preterm are 3–4 times more likely to be diagnosed with a childhood psychiatric disorder compared to children born full term (Johnson and Marlow, 2011). Numerous studies have evaluated hypotheses about the causal pathways from preterm birth to psychiatric disorder, including the possibility that preterm birth biases children toward negative social relationships and/or behavior problems, which increases the risk of later psychiatric disorders. Infants who were born preterm are sometimes described as having more challenging or more difficult temperaments, and some researchers have pointed toward temperament as a potential risk factor for psychiatric disorder (Cassiano, Gaspardo, Faciroli, Martinez, and Linhares, 2017; Eisenberg et al., 2001; Rutter, Birch, Thomas, and Chess, 1964). Documented differences in temperament between preterm and full-term infants are not uniform, however, and instead vary considerably across ages and study methodology.Washington, Minde, and Goldberg (1986) asked parents of preterm infants to rate their infants’ temperament using the Revised Infant Temperament Questionnaire when their infants were 3 and 6 months old and the Toddler Temperament Scale when their infants were 12 months old. The percentage of preterm 430

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infants with difficult temperaments differed from a term comparison group at 6 months but not at 12 months. Hughes, Shults, McGrath, and Medoff-Cooper (2002) asked parents of moderately preterm infants (24–32 weeks gestation) to rate their infants’ temperament at 6 weeks using the Early Infancy Temperament Questionnaire, at 6 months using the Revised Infant Temperament Questionnaire, and at 12 months using the Toddler Temperament Scale. Ratings for infants with data at two of the three time points were compared against standardized norms. At six weeks, preterm infants were less rhythmic and more distractible compared to the standardized norms. At 6 months, preterm infants were less adaptable but did not differ from standardized norms in any other way. At 12 months, preterm infants were less persistent but did not differ from standardized norms in any other way. Perez-Pereira, Fernandez, Resches, and Gomez-Taibo (2016) asked parents of preterm and fullterm children to rate their infants’ temperament using the Infant Behavior Questionnaire-Revised when their infants were 10 months old. Preterm infants smiled more and showed less fear—or in other words, had more positive temperaments—compared to full-term infants, but did not differ in any other way. Cassiano et al. (2017) suggested that temperament may be related to gestational age in a more complex manner and/or be influenced by complications and co-morbidities, but in a study of 100 18- to 36-month-olds born preterm, temperament and behavioral problems were not related to gestational age or complications (bronchopulmonary dysplasia or retinopathy of prematurity). Overall, no consistent influence of preterm birth on temperament is apparent. The durability of belief that preterm infants have more difficult temperaments may reflect increased crying and related regulatory problems (as described in the section on regulatory problems above). Alternately, temperament may be influenced by other factors that are also related to preterm birth, but vary between individuals, such as NICU experience (Cosentino-Rocha, Klein, and Linhares, 2014). Caravale et al. (2017) reported that 2-year-old children born preterm were higher in negative emotionality and had more sleep difficulties, such as restlessness and difficulties with breathing, compared to a control group of healthy 2-year-olds born full-term. Furthermore, sleep difficulties were negatively correlated with positive emotionality, and bedtime difficulties were positively correlated with negative emotionality. Further research is needed to clarify the relations between regulatory problems and temperament following preterm birth. Preterm children are more likely to have impairments to attention, executive functioning, and socioemotional self-regulation compared to full-term children. Cohort studies and meta-analyses indicate that developmentally the constellation of attention, executive functioning, and self-regulation is the most significant area of impairment for children following preterm birth (Boyd et al., 2013; van de Weijer-Bergsma et al., 2008). In social interactions, preterm infants are less active and more passive compared to full-term infants (Boyd et al., 2013; Brachfeld, Goldberg, and Sloman, 1980). Clark, Woodward, Horwood, and Moor (2008) compared self-regulation in children born very preterm and extremely preterm with full-term children.They evaluated self-regulation in children at 2 and 4 years of age using three observational methods: structured parent–child interactions, cognitive testing, and parent interviews based on the Emotion Regulation Checklist. For the parent–child interactions, researchers rated children’s affect, persistence, and quality of transitions between tasks. For the cognitive testing, researchers rated children’s affect and motivation, attention, cooperation, persistence, and social orientation and engagement. During the interviews, parents rated the children’s ability to manage their emotions. Gestational age was positively related to self-regulation at both ages: Children with younger gestational ages at birth received lower self-regulation scores across multiple indicators. The relation between gestational age and self-regulation was primarily due to differences between the extremely preterm group and the full-term group, as indicated by effect sizes. Ford et al. (2011) demonstrated similar relations between gestational age and executive function skills in 7- to 9-yearold children. Gestational age at birth also influences language skills throughout infancy and childhood. Children born extremely preterm have poorer language outcomes compared to children born full-term, 431

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and children born moderately preterm perform at a level that is intermediate between the two groups (Putnick, Bornstein, Eryigit-Madzwamuse, and Wolke, 2017). Furthermore, the level of language skills of children in these three groups are stable from 5 months to 8 years, indicating that the influence of preterm birth on language outcomes is lasting (Putnick et al., 2017). Longitudinal analyses comparing attention and language skills in children born preterm indicate that impairments to attention precede and predict impairments to language (Ribeiro et al., 2011). One of the most promising hypotheses about causal relations between preterm birth and developmental outcomes focuses on attention, self-regulation, and the timing of behavior in social interactions. Infants born preterm show delays in early social interactions, particularly in terms of the ability to initiate interactions and to respond to the initiations of others compared to full-term infants (Garner and Landry, 1994; Garner, Landry, and Richardson, 1991; Landry, Smith, Miller-Loncar, and Swank, 1997; Ulvund and Smith, 1996). Over the past two decades, numerous studies have considered and evaluated how impairments to the timing of social behavior might influence infants’ interactions with social partners and create a developmental cascade with long-term consequences. The proposal that problems with attention and self-regulation could change the timing of behavior in social interactions and subsequently impact developmental outcomes is thus rooted in the divergence perspective.The next section considers how preterm birth influences parents, and then returns to the question of how attention, self-regulation, and the timing of social behavior might influence parents’ interactions with preterm children.

Preterm Birth Influences Parents and the Care They Provide Preterm birth not only influences children, it also influences parents. Some of the ways in which preterm birth influences parents are part of a constellation of changes that happen during the transition to parenthood, regardless of whether a child is born preterm or full-term. Other ways in which preterm birth influences parents and the care they provide are specific to preterm birth and related risk factors. This section begins by identifying four general principles of parenting that provide a foundation for considering how preterm birth influences parents, then identifies the psychological risks for parents associated with preterm birth, and finally discusses theoretical accounts of how preterm birth influences parental care for children.

Four Foundational Principles of Parenting Four broad principles about parents and the tasks of parenting provide a helpful foundation for identifying and understanding how preterm birth influences parents and the care they provide. First, parents influence children, not only through reproduction and increasing a child’s chances of survival, but also through the relationships that they build with children, which form a social, emotional, and cognitive environment for development. Second, the social and emotional context of parenting matters, both to parents and to children (Packer and Cole, 2015; Sameroff, 1998). Social and emotional contexts determine a number of factors that predict the quality of parent–child relationships, including caregiving expectations, stress, confidence, and social support. Third, parental beliefs and knowledge matter (Sameroff and Siefer, 1983; Sigel, McGillicuddy-DeLisi, and Goodnow, 1992). Beliefs and knowledge influence how parents engage with the task of parenting (Bornstein, Putnick, and Suwalsky, 2018a). Beliefs and knowledge shape important aspects of parents’ relationships with children, including bonding, sensitivity, and stimulation. Relevant beliefs and knowledge include the attitudes and expectations that parents have about pregnancy, the roles of parents and children, and knowledge of child development. Fourth, children influence parents (Fiese and Sameroff, 1989; Lamb and Lewis, 2015; Lerner et al., 2019). Children are not simply the passive recipients of parenting; they are social partners who influence those around them. Children’s temperaments, interaction 432

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styles, and other specific behaviors influence parents’ behaviors and emotions in a continuous and dynamic manner.

Psychological Risks for Parents The birth of a child inevitably involves change, risk, and at least some stress for all parents, even when they already have children. For parents whose children are born early and have accompanying biological risks and regulatory problems, the stress may be sufficiently burdensome to lead to distress, anxiety, and/or depression.

Psychological Symptoms Following Childbirth Both mothers and fathers of children born preterm report higher levels of stress and negative feelings compared to children born full term (Ionio et al., 2016; Tooten et al., 2013). The stress associated with preterm birth begins even before parents see or hold their child for the first time. Arnold and colleagues interviewed parents of very preterm infants about their first moments together (Arnold et al., 2013). They asked parents to describe their feelings when they saw and/or touched their baby for the first time. One 20-year-old mother described her feelings: “You’re so on edge, and you want to care for them and touch them if you can, or whatever, but also you just feel terrible if you think you’ve done something wrong.” Another 24-year-old mother recalled, “I thought I’ll go onto the ward and, thoughts running through my mind of what I was, what I was gonna find, how many tubes was he gonna have, was he gonna be OK.” Both statements capture the uncertainty and stress that many parents report after the preterm birth of a child. Kaplan and Mason (1960) described the stress and negative emotions that mothers experience during and after a preterm birth as an acute emotional disorder. They interviewed 60 families after the preterm birth of an infant, both in the hospital and after the infant had been discharged and living at home for 2 months. Immediately following the preterm birth of an infant, women reported feelings of shock, helplessness, failure, and grief.When mothers were discharged but infants remained in the hospital, mothers reported feeling distant and in some cases did not visit their infants. Once infants were discharged and taken home, mothers reported feeling increased anxiety. Kaplan and Mason argued that these negative emotions were the acute effects of preterm delivery and associated factors, rather than caused by some pre-existing, chronic condition. They predicted that the emotional experiences of mothers in this situation would return to a more typical pattern once they had processed these emotions and engaged in daily care for their infants. Importantly, however, for some mothers, the negative emotions associated with preterm delivery led to further difficulties, including clinically significant levels of anxiety, fear, and depression. In a quantitative study of maternal mood two decades later, Blumberg (1980) documented a dramatic relation between neonatal risk and maternal mood. One hundred mothers who had recently given birth and whose infants were hospitalized at the time of the study completed measures of maternal mood, including depression and anxiety, as well as the Neonatal Perception Inventory. Researchers categorized each infant into one of five risk categories, based on medical records. The risk categories ranged from no risk, when birth had involved no complications, feeding had commenced, and the infant was discharged from hospital together with the mother, to the highest risk when an infant was born at a gestational age of less than 33 weeks, weighed less than 1,600 grams, and/or had a severe congenital disorder. Neonatal risk, including preterm birth as well as a range of other factors, accounted for 61% of the variance in maternal depression and 55% of the variance in maternal anxiety between the first and fifth days after delivery. Neonatal risk was also associated with more negative maternal perceptions of infants. Like Kaplan and Mason, Blumberg argued that highrisk births lead to acute emotional crises for mothers. 433

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To better understand the influence of preterm birth on the emotional experiences of parents, longitudinal studies have examined the time course of parental stress and distress beyond hospital discharge and extending into early childhood. For example, Singer et al. (1999) compared mothers of high- and low-risk children from 1 month until their children were 3 years old. All of the children in the two risk groups were very low birth weight (VLBW), with an average gestational age at birth of 27 weeks for the high-risk group and 30 weeks for the low-risk group, while children in a control group were born at term with a weight above 2,500 g. When children were 1 month old, maternal psychological distress was proportionate to risk: mothers of high-risk infants had the highest levels of distress, measured with the Brief Symptom Inventory, a clinically valid assessment tool designed to evaluate mental health symptoms. Mothers of term infants reported the lowest levels of distress, and mothers of low-risk infants reported distress levels in between the other two groups. The relation between maternal distress and risk changed as children grew older. Distress initially decreased for mothers of children in both risk groups in the months following birth, and continued to decrease for mothers of low-risk children across the following 3 years. For mothers of high-risk children, however, distress increased again when their children were 2 and 3 years old and remained significantly higher compared to the other two groups. Maternal stress, measured with the Parenting Stress Index (Abidin, 1983), showed a different pattern. Although mothers of high-risk children had somewhat higher levels of stress at birth, maternal stress was elevated for all three groups at birth, and generally recovered over the following months and years. As children grew older, however, differences in maternal stress emerged across the three groups. When children were 1, 2, and 3 years old, maternal stress was highest for mothers of high-risk children, lowest for mothers of term children, and in between those two points for mothers of low-risk children. Singer and colleagues attributed the increase in stress to poorer child outcomes:The degree of risk predicted developmental problems, which became more evident as children developed, and led to increased maternal stress. The time courses of parental stress and distress from birth to early childhood thus differ, but both stress and distress interact with risk. Longitudinal patterns of stress and distress, as well as their interactions with children’s risk levels, highlight the importance of children’s long-term developmental outcomes on psychological risks for parents. The observation that preterm birth leads to increasing maternal stress across development has been confirmed by other studies. Gray and colleagues compared self-reports of stress for women whose children were born between 24 and 30 weeks gestational age and women whose children were born full term.When children were 4 months old (corrected for gestational age at birth), women’s stress levels did not differ by the birth status of their children (Gray, Edwards, O’Callaghan, and Cuskelly, 2012). When children were 12 months old (corrected for gestational age at birth), women whose children had been born preterm reported higher stress levels than those whose children had been born full term (Gray, Edwards, O’Callaghan, Cuskelly, and Gibbons, 2013). When the same children were 2 years old (corrected for gestational age at birth), women whose children had been born preterm again reported higher stress levels than those whose children had been born full term (Gray, Edwards, and Gibbons, 2017). A longitudinal analysis across the three time points confirmed that for women whose children had been born preterm, stress increased as their child grew older. Polic et al. (2016) asked mothers to complete the Parenting Stress Index when their children were 6–12 years old, and again observed an influence of preterm birth on stress. They compared parental stress across three groups of women: those whose children had been born between 34 and 36 weeks gestation and admitted to the intensive care unit, those whose children had been born between 34 and 36 weeks gestation and were not admitted to the intensive care unit, and those whose children had been born full term and had been admitted to the intensive care unit. Both groups of mothers whose children had been born preterm reported elevated levels of stress in comparison to those whose children had been born full term.

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Evaluating Causes of Psychological Risks Some researchers have argued that psychological risks for parents, such as stress and distress, are not a consequence of preterm birth per se or poor developmental outcomes, but are instead due to parental difficulties in coping with related factors such as hospitalization, medical procedures, and separation from their child (Schappin,Wijnroks,Venema, and Jongmans, 2013). Several studies have documented parental difficulties in coping with hospitalization. For example, Arockiasamy, Holsti, and Albersheim (2008) interviewed fathers whose infants were hospitalized in a NICU for at least 30 days due to preterm birth and/or illness. The dominant theme that emerged from qualitative analyses of the interviews was fathers’ sense of a lack of control over the situation. For some fathers, that lack of control was not inherently negative if, for example, it was complemented by trust in the medical care staff. For other fathers, their sense of a lack of control caused stress and led them to withdraw from the parental role. One father described the situation as: “out of my control . . . it was like so frustrating for me, so I stopped coming to the hospital for a while.” In another study, mothers of preschool-aged children who were born preterm recalled the judgments and admonishments of hospital staff about family interactions with infants during their hospital stay (Adkins and Doheny, 2017). To evaluate whether psychological risks for parents are a consequence of preterm birth per se, of hospitalization, or of developmental outcomes, researchers have compared parental mood across groups that vary according to birth status and developmental outcomes. For example, Mehler et al. (2014) examined the impact of children’s medical and developmental status on psychological risk amongst parents of moderate and late preterm and full-term infants. Shortly after birth, parents of preterm infants had higher scores on the Edinburgh Postnatal Depression Scale (EPDS) (Cox, Holden, and Sagovsky, 1987) than did parents of term infants. As in the study from Singer and colleagues described above, parental mood improved with infant age:The EPDS scores of parents whose infants were born preterm were significantly lower when infants were 3 months old compared to when infants were born, indicating a decrease in depression, and no longer differed from the EPDS scores of parents whose infants were born full term. To examine whether infants’ medical and developmental status accounted for parental depression, Mehler and colleagues compared parents’ EPDS scores with infants’ motor capabilities, illness severity, and neurological assessments. In their data, parental mood was not associated with preterm infants’ medical and developmental status, and they concluded that parents’ psychological risk was associated with preterm birth but independent of child outcomes, thus supporting the hypothesis that psychological risks for parents are a consequence of hospitalization rather than preterm birth per se. Importantly, however, the preterm infants in their sample had a low rate of impairment: Preterm infants did not differ from term infants on assessments of motor and neurological function, and a relatively small percentage of the preterm infants had required mechanical ventilation following birth (which is frequently considered a proxy measure for risk). Because the preterm children’s risks and rates of impairment were low, it would have been unlikely for the researchers to observe an effect of impairment on psychological risks for parents. At least some conditions of hospitalization influence psychological risks for parents.Trombini, Surcinelli, Piccioni, Alessandroni, and Faldella (2008) asked parents whose infants were born at less than 31 weeks gestation in one of two hospitals in Bologna, Italy, to complete the Symptom Questionnaire and the Rapid Stress Assessment three times over a period of 2 weeks in a repeated-measures design. In one hospital, parents were allowed free access to the unit where their infants were hospitalized and had contact with specialized support staff, including physiologists who taught infant massage and clinical psychologists who provided regular support, as well as other health professionals. In the other hospital, parental access to the neonatal wards was restricted by fixed time schedules. As a result, parents had limited opportunities to interact with their infants and with health professionals. In addition, the second hospital did not provide any specialized support for parents. Ten days after children were born, mothers of children in the hospital with unrestricted access and specialized support reported

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lower levels of anxiety, depression, and hostility compared to mothers of children in the hospital with restricted access and no specialized support (Trombini et al., 2008). The difference between the two groups of mothers increased over the 2-week study period. Psychological symptoms of stress either remained stable or decreased for mothers of children in the hospital with unrestricted access and specialized support. In contrast, anxiety, depression, and hostility increased for mothers of children in the hospital with restricted access and no specialized support. Some hospitals have responded to evidence that the conditions of hospitalization influence psychological risks for parents by designing environments that enhance access and support for parents. For example, integrated care models encourage parents to care for their infants during hospitalization, to participate in education and training, and in some cases even to participate in medical rounds of the hospital ward (Jiang, Warre, Qui, O’Brien, and Lee, 2014). Some hospitals provide specialized training for professional medical staff on how to facilitate the integration of parents in medical care, and psychologists and/or peer groups may provide further support for parents. Qualitative evidence indicates that in integrated care contexts, both parents and professional medical staff are aware of feelings of separation that parents may experience when their preterm infant is hospitalized and are able to identify actions that promote feelings of closeness for parents (Feeley et al., 2016).

Looking Beyond the Immediate Circumstances of Birth and Hospitalization Psychological distress and related difficulties in coping differ between individuals as well as according to circumstances of birth and hospitalization. Holditch-Davis et al. (2015) identified five patterns of psychological distress in mothers whose infants were born preterm (the average gestational age across the sample was 27 weeks) and weighing less than 1,750 grams at four hospitals in the United States. Mothers completed measures of depressive symptoms, anxiety, worry, posttraumatic stress, and parental stress while their infants were in the hospital but no longer required ventilation. The researchers used latent class analysis to assign mothers to one of five categories according to their pattern of responses: low, moderate, or extreme distress, high NICU stress, or high depression and anxiety. Mothers completed the measures of psychological distress again when their infants were discharged and when their infants were 2, 6, and 12 months. The measures of psychological distress included parental stress, posttraumatic stress symptoms, and perception of the infant.The longitudinal patterns of psychological distress differed across the five groups, demonstrating not only that patterns of distress vary across individuals, but also that distress at birth predicts later distress. Mothers in extreme distress and mothers with high anxiety and depressive symptoms during their infants’ hospitalization showed elevated levels of distress throughout the study compared to the other three groups. These two groups were distinct from one another, however, both in terms of the longitudinal patterns of psychological distress and in terms of their infants. Mothers in extreme distress were considerably more likely to have infants who were very ill after birth, as indicated by the percentage requiring mechanical ventilation.This pattern is consistent with the argument that maternal psychological distress results from infant risk and associated developmental outcomes. Mothers with high anxiety and depressive symptoms, in contrast, were only slightly more likely to have infants requiring mechanical ventilation compared to mothers with low or moderate distress, indicating some other cause or causes beyond infant risk and associated developmental outcomes. Psychological risk is thus not only influenced by infant risk, but by other individual factors that precede and endure after childbirth. Education and income are closely related and important influences on preterm birth, but surprisingly few studies have investigated how education and income influence psychological risks for parents of children born preterm. Education and income are negatively related to stress during pregnancy: Women with less education and low incomes have higher levels of stress during pregnancy (Larson, 2007).Voegtline, Stifter, and The Family Life Project Investigators (2010) focused on mothers living in an economically deprived area in the United States and over-sampled for low-income families. 436

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In their sample, mothers of late preterm infants were three times more likely to have symptoms of depression or anxiety compared to those of full-term infants. Education and income are positively related to gestational age at birth: Women with more education and higher incomes give birth at older gestational ages (Blumenshine, Egerter, Barclay, Cubbin, and Braveman, 2010; Goldenberg, Culhane, Iams, and Romero, 2008; Larson, 2007; Rini, Dunkel-Schetter, Wadhwa, and Sandman, 1999; Ruiz et al., 2015; but see also Bushnik, Yang, Kaufman, Kramer, and Wilkins, 2017). At the country level, income also predicts mortality following preterm birth: In low-income countries, an estimated 90% of children born preterm do not survive beyond the neonatal period (Blencowe et al., 2012). Montirosso, Provenzi, Calciolari, Borgatti, and the NEO-ACQUA Study Group (2012) conducted one of the few analyses examining the influence of socioeconomic status on maternal stress following preterm birth and other complications leading to infant hospitalization in a NICU. Their measure of socioeconomic status did not directly evaluate education or income, but occupation. Mothers with lower socioeconomic status reported higher levels of stress while their infants were hospitalized. The psychosocial context also influences rates of postpartum depression amongst women who give birth preterm. Women who report lower levels of social support following a preterm birth are more likely to be diagnosed with postpartum depression (Hawes, McGowan, O’Donnell, Tucker, Vohr, 2016;Vigod,Villegas, Dennis, and Ross, 2010). Other psychosocial factors that influence stress, distress, anxiety, and postpartum depression include a negative childrearing history, stressful life events, general maternal well-being, maternal mental health problems prior to giving birth, and negative maternal perceptions of infants (Assel et al., 2002; Hawes et al., 2016; Voegtline et al., 2010; Woodward et al., 2014). Baia et al. (2016) argued that socioeconomic resources and social support may be important factors in differentiating long-term outcomes for parents following preterm birth, but few studies have addressed this question yet.

Theoretical Accounts of How Preterm Birth Influences Parental Care Theoretical accounts of how preterm birth influences parental care draw on three traditions in research on parenting more broadly. The first tradition emphasizes the importance of parental bonding. The second tradition emphasizes the importance of sensitive and responsive behavior from parents. The third tradition emphasizes the timing of social interactions and the bidirectional or transactional nature of development: Children influence parents as well as parents influence children. Each of these traditions is thus concerned with interactions between parents and children but brings different assumptions and insights to that focus.

Parental Bonding and Attachment One of the most influential theories of human development is attachment theory, which states that close emotional relationships between children and their caregivers form the basis for subsequent exploration and relationships (Bretherton, 1992; Cummings and Warmuth, 2019; Lamb and Lewis, 2015). In 1983, Martin Richards proposed that preterm birth jeopardizes parents’ feelings of emotional closeness to their children, including bonding and attachment. Richards hypothesized that the biological and psychological risks associated with preterm birth, as well as physical separation, may make it difficult for parents to fully engage with their children and as a result may negatively influence the emotional relationship between parents and children born preterm, including the extent to which parents feel bonded with their infant following preterm birth. For many parents, practitioners, and researchers, this hypothesis has an intuitive logic (Evans, Whittingham, and Boyd, 2012; Gonzalez-Serrano, et al., 2012; Kommers, Oei, Chen, Feijs, and Oetomo, 2016). Empirical evidence as to whether this is indeed the case is mixed, however, and the results of some studies suggest that preterm birth may even lead to higher levels of parental bonding and attachment. 437

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Feldman, Weller, Leckman, Kuint, and Eidelman (1999) compared maternal bonding to infants across three groups: mothers who had given birth to full-term infants, mothers who had given birth to late preterm infants, and mothers who had given birth to very preterm or extremely preterm infants. Mothers of full-term infants were discharged from the hospital together with their infants. Mothers of late preterm infants were all discharged before their infants but were able to hold their infants within 2 days after birth. Mothers of very and extremely preterm infants were discharged before their infants and were not able to hold their infants until 12–48 days after birth. All infants in the last group required intensive care. Feldman et al. (1999) interviewed mothers using the Yale Inventory of Parental Thoughts and Actions (Leckman et al., 1999) to evaluate maternal bonding to infants. Bonding was negatively related to gestational age across the three groups: mothers of fullterm infants had the highest bonding scores, and mothers of very and extremely preterm infants had the lowest bonding scores. Feldman et al. (1999) argued that proximity, separation, and potential loss all mediated the relation between preterm birth and bonding. Borghini, Pierrehumbert, Miljkovitch, Muller-Nix, Forcada-Guex, and Ansermet (2006) investigated how preterm birth influences parental bonding using the Working Model of the Child Interview (Vreeswijk, Maas, and van Bakel, 2012; Zeanah and Benoit, 1995), a researcher-administered semi-structured interview that was designed to measure parents’ perceptions of their children, and more specifically to evaluate parental bonding and attachment to children. Responses were coded from recordings, and parents were assigned to one of three attachment categories: balanced, disengaged, or distorted. Mothers completed the interviews when their children were 6 and 18 months old using corrected age. Fifty of the mothers in the study had given birth to a preterm infant (from 25 to 33 weeks gestation) and 30 mothers had given birth at term. Mothers of children who had a severe physical, chromosomal, or neurodevelopmental abnormality were excluded, as were mothers with a history of drug abuse or psychiatric illness. At both 6 and 18 months, balanced attachments were more frequent amongst mothers of full-term infants compared to mothers of preterm infants. To further explore this relation, Borghini and colleagues used the Perinatal Risk Inventory to divide preterm infants into one of two risk groups and then evaluated whether and how risk influenced maternal attachment to preterm infants. They reported that risk did not impact maternal attachment to preterm infants at 6 months, but that at 18 months, mothers of high-risk infants (a relative label as it was based on the range of scores within the study sample) more frequently demonstrated balanced attachments compared to mothers of low-risk infants (42% versus 17% respectively).The sample size was relatively small, however, and very high-risk infants were not included as a consequence of the exclusion criteria.Together, both factors limit the conclusions that can be drawn about the influence of infant risk on maternal attachment from the study. Korja, Savonlahti, Haataja, Lapinleimu, Manninen, Piha, Lehtonen, and the PIPARI Study Group (2009) also used the Working Model of the Child Interview to investigate the influence of preterm birth on maternal attachment. In their study, mothers completed the Working Model of the Child Interview just once, when their infants were 12 months corrected age. Birth status did not affect maternal bonding and attachment to infants: Balanced attachments were similarly frequent amongst mothers of full-term infants and mothers of preterm infants. To further examine the influence of infant and maternal risks on maternal attachment, Korja, Savonlahti, Haataja, Lapinleimu, Manninen, Piha, Lehtonen, and the PIPARI Study Group (2009) also evaluated relations between maternal attachment category and several risk factors, including infants’ gestational age at birth, birth weight, whether infants required ventilation, duration of hospitalization, a standardized measure of infant development, and maternal mental health. No relations were found. This absence of relations between risk and maternal bonding and attachment is noteworthy because, in contrast to the fairly restrictive exclusion criteria used by Borghini et al. (2006), the only exclusion criteria used by Korja and colleagues (2009) were the native language of the mother, whether the mother had previous children, multiple births, and known drug or alcohol exposure to the fetus. 438

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Studies using parent-report measures to investigate the relations between preterm birth and parental bonding provide additional evidence that preterm birth does not negatively affect parental bonding. Hoffenkamp et al. (2012) asked mothers and fathers of very preterm infants, moderately to late preterm infants, and full-term infants to complete the Pictorial Representation of Attachment Measure (van Bakel, Maas,Vreeswijk, and Vingerhoets, 2013) when infants were 1 day, 1 week, and 1 month old (chronological, or uncorrected, age) and the Postpartum Bonding Questionnaire (Brockington, Fraser, and Wilson, 2006; Brockington et al., 2001) when infants were 1 month old (chronological, or uncorrected, age). Mothers and fathers reported similar feelings of closeness to their 1-day-old infants regardless of whether their infants were born very preterm, moderate to late preterm, or full term. When infants were 1 week and 1 month old, mothers of very preterm and moderate to late preterm infants reported increased closeness compared to when their infants were 1 day old, whereas mothers of full-term infants reported similar feelings of closeness across all three ages. A parallel pattern was observed amongst fathers, though somewhat attenuated: Fathers generally reported feeling greater distance from infants compared to mothers, and fathers of preterm infants reported increasing levels of closeness across the study, but fathers of full-term infants did not. Reports of bonding problems on the Postpartum Bonding Questionnaire at 1 and 6 months were congruent with feelings of closeness: Mothers reported fewer bonding problems than fathers across all three groups, and parents of the most premature infants reported the fewest bonding problems (Hall et al., 2015a; Hoffenkamp et al., 2012). Researchers interviewed the same parents when infants were 6 months old, using the Working Model of the Child Interview (Tooten et al., 2014). Tooten, Hall, Hoffenkamp, Braeken, Vingerhoets, and van Bakel (2014) noted increased parental fear and anxiety for preterm infants, but birth status did not affect parental bonding. Balanced attachments were similarly frequent amongst mothers and fathers of full-term infants and preterm infants. Studies examining parental bonding during the first year after preterm birth thus have produced disparate results, even when using the same measures. In some studies the relation between gestational age and parental bonding is negative (see also Provenzi et al., 2017), in some there is no relation between gestational age and parental bonding, and in others the relation is positive. Differences in observed relations may arise from differences in sampling or some other unknown cause.

Sensitive and Responsive Parenting A related but distinct tradition of research on human development emphasizes the importance of sensitive and responsive behavior from parents. Sensitive and responsive parenting is attentive, and supports the child’s interests and skills (Landry et al. 1997). Sensitive and responsive parenting is engaged and involves touching, talking, or playing with children (Bell and Ainsworth, 1972; Blackwell, 2000). Sensitive and responsive parenting is contingent and acknowledges the needs, signals, and state of the child promptly (Bornstein, Tamis-LeMonda, Hahn, and Haynes, 2008; Goldberg, Lojkasek, Gartner, and Corter, 1989; Leerkes and Qu, 2017). Several studies indicate that parents are more attentive and engaged with preterm infants compared to full-term infants (Bakeman and Brown, 1980; Field, 1977; Minde, Perrotta, and Marton, 1985; but see Brachfeld et al., 1980). Field (1977) compared the activity levels of mothers playing with their 3.5-month-old infants (corrected age), who were born preterm (born on average at 32 weeks gestation), full term, or postterm. Infants in the two risk groups had both been hospitalized following birth, but preterm infants had been hospitalized considerably longer (on average one month, versus two weeks for postterm infants). Mothers of infants born preterm were more active with their infants, both when their infant was looking at them and when their infant was looking elsewhere, compared to mothers of infants born full term. Maternal activity was predicted by infant risk, as indicated by scores on the Neonatal Behavioral Assessment Scale, and did not differ across the two risk groups (preterm and postterm). Bakeman and Brown (1980) observed mothers and their 439

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infants who were either born preterm or full term during the first few months of life, and compared four interactive states: when the mother was active but the infant was not, when the infant was active but the mother was not, when both were active, and when neither was active. For preterm infants and their mothers, more of the interaction involved the mother being active when the infant was not, and less of the interaction involved the infant being active when the mother was not. Minde, Perrotta, and Marton (1985) found that mothers not only looked at but also talked to infants more at 4 and 8 weeks if their infants were born preterm compared to full term. Other researchers have reported that parental attention and engagement are proportional to risk: Parents are more attentive and engaged with infants who have a higher degree of medical risk. Brachfeld et al. (1980) observed three groups of parents playing with their infants when their infants were 8 and 12 months old. One group of parents had infants who had been born full term and healthy, another group of parents had infants who had been born at 31–37 weeks gestation but were otherwise healthy and were therefore considered low-risk, and a third group of parents had infants who had generally been born more preterm (26–33 weeks gestation), at a lower gestational weight, had respiratory distress, and were hospitalized longer. For all of these reasons, infants in the third group were considered high-risk. In order to ensure that all parent–infant dyads had equivalent social experience with one another, they observed all groups at the same chronological age. When children were 8 months old, parents were more physically close to high-risk preterm infants compared to low-risk preterm and healthy infants, and touched and showed toys to high-risk preterm infants more often compared to the other two groups. Child development researchers and practitioners generally consider parental engagement a positive indicator of sensitive and responsive parenting that should be promoted, in part because engagement supports optimal cognitive and communicative outcomes for children and protects children against negative socioemotional outcomes (Bell and Ainsworth, 1972; Blackwell, 2000; Bornstein and Tamis-LeMonda, 1997; Kotila, Schoppe-Sullivan, and Dush, 2014; Stefana and Lavelli, 2017;VernonFeagans et al., 2008; Weisleder and Fernald, 2013; Woodward et al., 2014). Bell and Ainsworth (1972) reported that mothers who were more engaged and responsive to their infants’ cries had children who cried less throughout the first year of life. Kotila, Schoppe-Sullivan, and Dush (2014) also reported that parents who engaged in more activities with their children such as talking, singing, and playing had children who expressed less negative affect, and to a lesser extent, more effortful control. Parents who are more engaged with children during interactions also provide children with richer language environments, which in turn leads to better language outcomes for children (VernonFeagans et al., 2008; Weisleder and Fernald, 2013). Although a number of studies thus indicate that parents are more attentive and engaged with preterm children compared to full-term children, some researchers have argued that parenting following preterm birth is actually less sensitive and responsive and is instead intrusive or controlling (Flacking et al., 2012; Forcada-Guex, Borghini, Pierrehumbert, Ansermet, and Muller-Nix, 2011; Loi et al., 2017; Muller-Nix et al., 2004). To support their argument, they point to evidence that parents of preterm children initiate interactions more frequently, respond to children less frequently, and exert more control compared to parents of full-term children (Loi et al., 2017; Macey, Harmon, and Easterbrooks, 1987). As a result, parental behavior is sometimes described as being less contingent on the interests and actions of preterm children compared to full-term children. Contingent responding is defined as appropriate as well as timely responding and is considered a critical aspect of sensitive and responsive parenting (Bornstein et al., 2008; Goldberg, Lojkasek, Gartner, and Corter, 1989; Leerkes and Qu, 2017). Contingent responding is usually evaluated through researcher observation and coding of interactions between social partners, and in the case of parenting studies, between a parent and child. Researchers who take a macro approach to the measurement of contingent responding either assign a rating to the quality of parental behavior across an entire observation or assign multiple ratings to fixed periods or tasks within an observation and 440

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then create an average (Clark et al., 2008; Landry, Smith, Miller-Loncar, and Swank, 1997; Treyvaud et al., 2009). For example, Clark et al. (2008) observed parents and their 2-year-old children while the child completed three problem-solving tasks, and for each task assigned parents a score on a 5-point Likert scale for parental sensitivity, which included timely responding to the child, and parental intrusiveness, which included directing or controlling the child. To evaluate parental interactions with their children at 6 and 12 months, Landry, Smith, Miller-Loncar, and Swank (1997) combined a macro approach in which researchers rated three dimensions of parental responsiveness (positive affect, warm sensitivity, and contingent responsiveness) with a micro approach in which researchers counted the frequency of episodes when the parent stimulated the child’s attention in some way, and then categorized those episodes as either maintaining, directing, or restricting the infant’s focus of attention. Different approaches to measurement may lead to contrasting results: Clark et al. (2008) reported that parents of extremely preterm and very preterm children were less sensitive and more intrusive compared to parents of full-term children, whereas Landry, Smith, Miller-Loncar, and Swank (1997) reported that parents of high-risk and low-risk preterm infants did not differ from parents of full-term infants in responsiveness or the frequency of stimulation (see also Landry, Chapieski, and Smith, 1986). Researchers sometimes point toward the psychological risks for parents associated with preterm birth, such as stress, anxiety, and separation from infants, or to confounding factors such as education and income, to explain why parenting might be less sensitive and responsive following preterm birth. Wijnroks (1999) argued that increased maternal anxiety leads to decreased sensitivity. They visited the homes of children born preterm three times over a 10-day period when the child had turned 6 months. They observed mothers playing with their children twice, for five minutes during each visit, and later coded maternal behavior during the observations in terms of activity, sensitivity, intrusiveness, and a number of other factors. They also interviewed mothers during the second visit to evaluate stress and anxiety around the time their children were born. Mothers of preterm children who reported higher levels of anxiety were more active, more intrusive, and less sensitive during their observed interactions with children compared to mothers who reported little or no anxiety (Wijnroks, 1999). Muller-Nix et al. (2004) argued that the trauma experienced by mothers when their children are born preterm might lead to a decrease in sensitive and responsive parenting. They observed mothers interacting with their children at 6 and 18 months, and evaluated maternal and child behavior using the Care Index (Crittenden and Bonvillian, 1984). When children were 18 months, mothers also completed the Posttraumatic Stress Disorder Questionnaire (Quinnell and Hynan, 1999). Mothers who retrospectively reported higher levels of stress surrounding the preterm birth of their child were less sensitive and more controlling compared to mothers of full-term children. Mothers who reported lower levels of stress surrounding the preterm birth of their child showed intermediate levels of sensitive and controlling behavior with their children. When their children were 18 months old, the three groups of mothers no longer differed in their levels of sensitive and responsive parenting. Muller-Nix et al. (2004) also argued that infant risk might lead to a decrease in sensitive and responsive parenting. They used the same Care Index data to compare infants born preterm with infants born full term, but this time divided the infants born preterm into two groups based on infant risk factors. They assessed infant risk using the Perinatal Risk Inventory (PERI), which considers factors such as gestational age, ventilation, and Apgar scores and correlates with standardized developmental measures of cognitive outcomes (Scheiner and Sexton, 1991). Mothers of high-risk infants had slightly lower scores for sensitivity and slightly higher scores for controlling behavior compared to mothers of full-term infants at 6 months (p = .05), but the comparison was not significant across the three risk groups, and no differences were observed at 18 months. Overall, consistent evidence indicates that parents are more attentive and engaged with preterm infants compared to full-term infants. Preterm infants may nonetheless be at risk for less sensitive 441

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parenting, or more specifically, for less contingent responding from parents. The higher levels of stimulation that are characteristic of parents interacting with preterm infants may at times be intrusive or controlling. Importantly, however, the existing evidence does not consistently support the claim that intrusive or insensitive parenting is characteristic of parents of children born preterm. Evidence of the influence of stress and anxiety on parenting is more consistent: Parents who report higher levels of stress and anxiety appear to be more likely to interact with children in a manner that is controlling or insensitive. The next section considers the importance of expanding the question to include the child in definitions as well as evaluations of social interactions between parents and children born preterm.

Timing and the Bidirectional Nature of Social Interactions A third theoretical tradition in human development emphasizes the dynamic, bidirectional influences between social partners in all relationships and in parent–child relationships in particular (Fiese and Sameroff, 1989; Lerner et al., 2019). According to this tradition, because children influence parents as well as parents influence children, the contributions that children make to social interactions influence how parents interact with children. Children thus influence their own development, in part through their contributions to social interactions with their parents and other people. Most human interactions are characterized by remarkable temporal coordination from the earliest months of life onward, whether in the turn-taking of vocal exchanges or the shifts of attention to follow a social partner (Bornstein, Putnick, Cote, Haynes, and Suwalsky, 2015; Hilbrink, Gattis, and Levinson, 2015; Jaffe, Beebe, Feldstein, Crown, and Jasnow, 2001; Perra and Gattis, 2010, 2012). Bornstein Putnick, Cote, et al. (2015) examined the frequency and timing of vocalizations from mothers and their 5-month-olds in their homes in 11 countries. The frequency of vocalizations for both mothers and infants differed dramatically across countries, with infants in some countries vocalizing more than twice as much as infants in other countries, and mothers in some countries vocalizing more than four times as much as mothers in other countries. Despite these differences in the frequency of vocalizations across countries, the coordination of timing between mothers and infants was relatively similar across countries.To evaluate the coordination of timing between maternal and infant behaviors, Bornstein, Putnick, Cote, et al. (2015) calculated the extent to which the vocalizations of one social partner were contingent on the vocalizations of the other social partner. In 9 of the 11 countries, mothers were more likely to vocalize within 2 seconds of the end of their infants’ vocalizations compared to the rest of the 50-minute observation. In other words, mothers’ vocalizations were contingent responses to their infants’ vocalizations. In half of the countries, infants were more likely to vocalize within 2 seconds of the end of their mothers’ vocalizations compared to the rest of the observation. Mothers’ responses to infants’ vocalizations were thus more consistently contingent, but many infants’ responses to their mothers’ vocalizations were also contingent, and in both cases across diverse cultural settings. One hypothesis about how timing influences parents and the care they provide for children following preterm birth is that because children born preterm are less active and are slower to respond to the initiations of others (as described above in the section on developmental outcomes in infancy and childhood), their parents and other social partners may become more active, in particular in terms of attempts to solicit or direct attention (Garner, Landry, and Richardson, 1991; Landry, 1986; Landry, Chapieski, and Schmidt, 1986). The increased activity levels of parents in turn influence their children, not only in the immediate social context but also in terms of subsequent cognitive and communicative outcomes. Landry and colleagues conducted a longitudinal study of attention development and maternal attention-directing strategies at 6, 12, and 24 months across three groups of children: low-risk preterm, high-risk preterm, and full term (Garner, Landry, and Richardson, 1991; Landry, 1986; Landry, Chapieski, and Schmidt, 1986). Researchers used a micro-coding approach that 442

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considered the frequency, timing, and type of parental stimulation, as well as child attention, exploration, and communication. Preterm birth influenced child attention from the earliest observations onward. At all three ages, children in the high-risk group showed more passive looking than low-risk and full-term children (Garner, Landry, and Richardson, 1991). At 12 and 24 months, children in the high-risk group also showed less active attention, as indicated by functional play, compared to lowrisk and full-term children (Garner, Landry, and Richardson, 1991). Preterm birth also influenced interactive behaviors for both partners, but the onset of those differences was later than the onset of differences in child attention. When children were 6 months, they and their mothers spent equal amounts of time—nearly half of the 2-minute observation—sharing attention to the same object regardless of gestational age and risk status (Landry, 1986). At 12 months, risk status influenced the frequency of mothers’ attention-directing: mothers of high-risk children directed their children’s attention more frequently than did mothers of low-risk and full-term children (Landry, Chapieski, and Schmidt, 1986). Garner, Landry, and Richardson (1991) argued that the observed differences in mothers’ attention-directing strategies across risk groups reflected an adaptive and effective response to children’s attentional capacities. Low-risk preterm, high-risk preterm, and full-term children were equally likely to respond to their mothers’ attention-directing strategies at 12 months, further supporting the argument that mothers’ attention-directing strategies were adaptive and effective (Landry, Chapieski, and Schmidt, 1986). A second hypothesis about how timing influences parents and the care they provide following preterm birth is that because children born preterm have problems with internal regulation (as described above in the section on developmental outcomes in infancy and childhood), their affective states and behavior are less temporally regular and predictable compared to children born full term. As a result, the social interactions between parents and children born preterm are less coordinated, which in turn negatively influences children’s outcomes (Feldman, 2006, 2007, 2009; Lester, Hoffman, and Brazelton, 1985). Lester, Hoffman, and Brazelton (1985) developed a multi-step analytic procedure for characterizing the fluctuations between behavioral states for parents and children, and then comparing those fluctuations or periodicities to evaluate the similarity of state changes across social partners. In the first step, mothers of 3-month-old infants (20 term, 20 preterm tested at corrected age) sat directly facing their infants and played with them for 3 minutes. Mothers and infants repeated the same procedure again when infants were 5 months. Researchers then rated the states of mothers and infants separately by assigning a state score between 1 and 13 to each second of the 3-minute interaction. The scores referred to a range of behaviors such as avoid, avert, elicit, play, and talk. The scoring system thus treated qualitatively different behavioral states as quantitative values along a scale representing negative versus positive affect. The researchers used spectral analysis to identify oscillations, or temporal patterns of behavioral state changes within an individual. Finally, the researchers used cross-spectral analyses, a cross-correlation technique, to compare the temporal patterns of behavioral state changes across mothers and infants and to evaluate the extent to which state changes cohered across the interaction partners, or in their words, were synchronized. Lester, Hoffman, and Brazelton (1985) argued that the behaviors of mothers and infants differed from chance at both 3 and 5 months, or in other words that the behavior of both partners followed a temporal organization of periodic shifts between states. Although the patterns of behavioral states for term and preterm infants did not differ significantly, Lester, Hoffman, and Brazelton (1985) also argued that the behaviors of preterm infants were more variable, and that developmental shifts as well as dyadic synchrony differed for preterm versus term infants.The temporal organization of term infants’ behaviors increased from 3 to 5 months, but the temporal organization of preterm infants’ behaviors did not. In addition, the similarity of behavioral changes, or synchrony, between mothers and infants increased for dyads with a term infant from 3 to 5 months, but did not increase for dyads with a preterm infant. Lester, Hoffman, and Brazelton (1985) argued that temporal coordination of behavior between social partners relies on the predictability of the behavior of each individual, and 443

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that preterm infants were more variable in their individual behavior, as well as less coordinated or synchronous with social partners. Cohn and Tronick (1988) argued that the associations between infant and maternal behaviors observed by Lester, Hoffman, and Brazelton (1985), and observed in their own data as well, reflected bidirectional influences between mother and infant that were driven by dependencies, or what they called stochastic organization, rather than periodicities. In a study with full-term infants at 3, 6, and 9 months of age, they used the same state coding system as did Lester, Hoffman, and Brazelton (1985). Rather than coding each second of their 2-minute interactions independently, as Lester, Hoffman, and Brazelton (1985) had done, they coded changes in state and then generated scores for each second based on the continuous state data. They evaluated the subsequent time series for every mother and infant, and found little evidence of periodic cycles in the behaviors of infants at 3, 6, or 9 months or in the behaviors of their mothers. They did, however, find evidence of dependencies between the behaviors of infants and mothers at all three ages. The behaviors of mothers accounted for about one-third of the variance in the behaviors of infants at all three ages. The behaviors of infants accounted for over one-half of the variance in the behaviors of mothers at all three ages. The methods and ideas developed by Lester, Hoffman, and Brazelton (1985) and Cohn and Tronick (1988) have influenced numerous studies of how preterm birth affects parents and the care that they provide. Feldman (2006) described synchrony as social rhythms, and proposed that the rhythms of social interactions are influenced by the biological rhythms of individuals, including biological processes such as heart rate and sleep cycles. Feldman (2006) compared the temporal organization of behaviors for three groups of mother-child dyads: mothers with high-risk preterm infants (born before 30 weeks gestation), mothers with low-risk preterm infants (born between 34 and 36 weeks gestation), and mothers with full-term infants. When all infants were 3 months corrected age, researchers filmed mothers and infants playing together for 5 minutes in their homes and later applied the coding and analysis procedures developed by Lester, Hoffman, and Brazelton (1985) and Cohn and Tronick (1988). Cross-correlations, an indicator of the similarity of the timing and valence of behavioral state changes across social partners, ranged from .13 for the dyads with highrisk preterm infants to .18 for dyads with full-term infants, with dyads with low-risk preterm infants in the middle. The cross-correlations for the two groups of dyads with preterm infants differed significantly from the cross-correlations for dyads with full-term infants, but did not differ from each other. Importantly, biological variables collected from the preterm infants during the neonatal period predicted the degree to which mother-infant behaviors were coordinated: a hierarchical regression revealed that both sleep cycles and vagal tone were significant predictors of cross-correlations in the interactions at 3 months. Feldman (2006) concluded that basic biological processes such as heart rate and sleeping influence the quality of social interactions through the temporal organization of behavior. Other researchers using different methods to evaluate temporal relations in social interactions have reported that full-term infants have more symmetric and sequential interactions with their mothers compared to very preterm and extremely preterm infants (Doiron and Stack, 2017; Sansavini et al., 2015). However, Poehlmann et al. (2011) reported a negative rather than positive relation between early biological variables and the quality of mother-infant interactions, indicating that further research is needed to evaluate the causal relations between individual and dyadic states. Evidence from a range of studies supports the broad argument that children born preterm influence their parents and the care they provide, in particular in terms of the temporal coordination of social interactions. Current evidence does not clearly establish whether the contributions that children born preterm make to social interactions are simply slower, and thus lead to increased but effective parental attempts to solicit and guide attention, or are disorganized or perturbed, and may thus make it difficult for parents and children to have temporally coordinated interactions. Existing evidence also does not clearly distinguish between accounts of synchronicity that emphasize periodicities in behavior within as well as across social partners and accounts that emphasize contingencies 444

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across social partners. The wide variety of methods and contrasting analytic approaches used in different studies make it difficult to compare and evaluate different accounts of how timing influences interactions between children born preterm and their parents. Future research should utilize methods that make it possible to compare the relative and temporal contributions that parents and children make to social interactions, as well as their antecedents.

Parental Care Influences Outcomes for Children Born Preterm Parents influence children’s developmental outcomes through their care, their relationships, and the environments for development that parents and children build together. This section considers two types of evidence about when and how parents influence the developmental outcomes of children born preterm: observations and interventions. Observational studies allow researchers to examine the relations between complex, real-life factors that vary between individuals and in many cases are difficult to manipulate. As a result, observation studies have stimulated theory formation and guided the design of interventions addressing parental care and developmental outcomes following preterm birth. Interventions allow researchers to simultaneously test causal hypotheses and, in the ideal circumstances, also improve outcomes for children born preterm.

Observational Studies of Parental Care and Developmental Outcomes Observational studies of parental care following preterm birth have yielded numerous insights about how parental care varies between individuals and because of psychosocial factors. Observational studies have also improved understanding of how parental care influences children’s developmental outcomes following preterm birth. Some observational studies have examined the effects of parental care following preterm birth, following the model parental care → child outcomes. Other observational studies have investigated hypotheses about more complex causal chains, for example birth status → psychological risks for parents → parental care → child outcomes. The most complex observational studies have sought to identify both parent and child factors that result from preterm birth, how those factors interact, and how those interactions influence children’s outcomes. Such studies have considered multiple and potentially simultaneous causal relations, including bidirectional relations, following models such as birth status → biological risks/regulatory problems for children ←→ parental care ←→ child outcomes. Prospective longitudinal studies have made especially valuable contributions to scientific knowledge about parenting following preterm birth. The most beneficial studies have used both children’s and parents’ behavior to evaluate specific, clearly defined hypotheses about the causal pathways from preterm birth to developmental outcomes.

Relations Among Preterm Birth, Parental Bonding and Attachment, and Developmental Outcomes Numerous researchers have proposed that preterm birth may disrupt parental bonding, either due to the unexpected nature of a preterm birth, higher levels of stress, or longer periods of hospitalization, and as a consequence, influences children’s developmental outcomes indirectly through parental care, either in terms of socioemotional functioning or cognitive or communicative development (Borghini et al., 2006; Evans et al. 2012; Feldman,Weller, Leckman, Kuint, and Eidelman, 1999; Forcada-Guex, Borghini, Pierrehumbert, Ansermet, and Muller-Nix, 2011; Gonzalez-Serrano et al., 2012; Kommers et al., 2016). Although evidence regarding the relations between preterm birth and parental bonding is inconsistent (as described in the section on parental bonding and attachment above), several observational studies have included developmental outcomes for children in their examinations of relations between preterm birth and parental bonding and thus allow researchers to examine these hypotheses further. 445

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Korja and colleagues evaluated parent and infant behaviors at home, mother-infant interactions during a clinic visit, and maternal attachment for families with preterm (N = 38) and term (N = 45) infants. When infants were 5 months old (corrected age), parents recorded infant crying, fussing, sleeping, waking, and feeding, and their own soothing behaviors, defined as holding, caretaking, and moving around with the infant (Korja et al., 2008). When infants were 6 and 12 months old, mothers and infants played together in a standardized play setting, and researchers coded both maternal and infant behaviors, thus providing an indicator of both parental care and child outcomes (Korja et al., 2010; Korja et al., 2008). When infants were 12 months old, researchers interviewed mothers to evaluate maternal attachment (Korja et al., 2010; Korja et al., 2009). All assessments for preterm infants occurred at corrected ages. At 5 months preterm, infants cried more frequently compared to full-term infants (described in the section on regulatory problems above). At 5 months, parents also held preterm infants more compared to full-term infants (M = 198.3 and M = 140.2 minutes per day, respectively), which Korja and colleagues interpreted as an adaptive response to more frequent infant crying. At 6 months, preterm and full-term infants did not differ from each other in interaction behavior, but at 12 months, preterm infants were more sober and withdrawn and had lower-quality play and attention skills compared to full-term infants. Neither birth status nor infant biological risk influenced maternal attachment. In addition, the relations between maternal attachment and developmental outcomes did not differ according to birth status: Maternal attachment related positively to both mother and infant interaction behavior, such that mothers with balanced attachments had more positive involvement and communication with infants, and their infants had less sober and withdrawn mood and better play and attention skills, regardless of whether infants were born preterm or full term. Forcada-Guex et al. (2011) compared maternal stress and maternal bonding and attachment with interaction patterns for mothers and their preterm (N = 47) or term (N = 25) infants. When infants were 6 months old (corrected age for preterm infants), the researchers evaluated maternal bonding and attachment using the Working Model of the Child Interview, and evaluated dyadic interaction patterns from a 10-minute mother-infant play session. As in the studies from Korja and colleagues, interaction coding considered both maternal and infant behaviors, thus providing an indicator of both parental care and child outcomes. When infants were 18 months old, the researchers evaluated maternal stress during the neonatal period retrospectively using the Perinatal Posttraumatic Stress Disorder Questionnaire (Quinnell and Hynan, 1999). Balanced attachments were more common amongst mothers of full-term infants than mothers of preterm infants (also reported in an earlier paper by Borghini et al., 2006, as described above in the section on theoretical accounts of how preterm birth affects parental care). Interactions with a sensitive mother and cooperative infant were more common amongst dyads with a full-term infant than a preterm infant. Interactions with a controlling mother and compliant infant were more common amongst dyads with a preterm infant in which the mother had experienced higher levels of stress during the neonatal period. Forcada-Guex et al. (2011) concluded that preterm birth influences maternal attachment, and that both preterm birth and maternal stress influence the quality of interactions for both mothers and children. Their conclusions are supported by a study that compared maternal bonding and attachment with interaction quality in early infancy using very different methods. Provenzi et al. (2017) examined maternal bonding using a self-report scale (the Maternal Post-Natal Attachment Scale, Condon and Corkindale, 1998) and their 3-month-old infants’ regulatory abilities using the Face-to-Face Still-Face procedure (Tronick, Als, Adamson,Wise, and Brazelton, 1978).Very preterm (N = 33) infant-mother dyads had poorer bonding compared to full-term (N = 28) infant-mother dyads. Birth status interacted with bonding quality in terms of influence on infants’ regulatory abilities. Full-term infants whose mothers had higher-quality bonding demonstrated regulatory behaviors that very preterm infants did not. The results of Forcada-Guex et al. (2011) and Provenzi et al. (2017) are thus inconsistent with the results of Korja and colleagues. In a retrospective study with a diverse group of children born preterm (N = 96) or full term (N = 90) and their mothers, Gonzalez-Serrano et al. (2012) evaluated the relations between preterm 446

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birth, maternal stress, maternal attachment, and children’s outcomes at 2 years using the Bayley Scales of Infant Development (Bayley, 2006). Mothers of preterm children reported higher levels of stress than did mothers of full-term children, but did not differ in attachment and bonding. Although children born preterm scored lower on the mental scale of the Bayley Scales of Infant Development, indicating poorer cognitive outcomes at 2 years, and poorer maternal attachment was associated with poorer cognitive outcomes overall, the results did not support the causal model of preterm birth → parental distress → parental attachment → child outcomes. Researchers in the Netherlands conducted a prospective longitudinal study as part of a randomized control trial for a parenting intervention, but were able to evaluate the relations between birth status, parental bonding and attachment, and developmental outcomes from the observational data collected as part of their overall design (Tooten et al., 2012). Their pre-registered hypothesis can be summarized as preterm birth → parental stress/distress → parental bonding → parent–child interaction → child outcomes. The overall design involved both mothers and fathers from 231 families whose children were born very preterm, moderately preterm, or term. When their infants were 1 and 6 months old (all assessments refer to chronological postpartum age), mothers completed the Perinatal Posttraumatic Stress Disorder Questionnaire, the Edinburgh Postnatal Depression Scale, and the State-Trait Anxiety Inventory (Spielberger, Gorsuch, Lushene,Vagg, and Jacobs, 1983) to allow the researchers to evaluate maternal distress (Hall et al., 2017). When infants were 6 months old, mothers completed the Working Model of the Child Interview to allow the researchers to evaluate maternal bonding (Hall et al., 2017; Tooten et al., 2014).When the children were 1 day, 1 month, 6 months, and 24 months old, researchers recorded parent–child interactions to evaluate maternal sensitivity, intrusiveness, and withdrawal (Hall et al., 2015a, 2015b). When children were 24 months old, researchers evaluated child attachment using a standardized observational measure. Mothers of preterm children reported higher levels of distress compared to mothers of full-term children, but did not differ from mothers of full-term children in maternal bonding or in maternal sensitivity, intrusiveness, and withdrawal (Hall, et al., 2017; Hall et al., 2015b). Children born preterm did not differ from children born full term in attachment quality. Although the results did not support the hypothesized model of preterm birth → parental stress/distress → parental bonding → parent–child interaction → child outcomes, maternal bonding was associated with parenting quality, and parenting quality was associated with child attachment, all in a predictable and positive manner, irrespective of birth status (Hall et al., 2015b). Hall et al. (2017) proposed that psychological distress following preterm birth could at least in some circumstances play an adaptive rather than disruptive role in the relations between preterm birth, distress, attachment, and child outcomes.To support their argument, they pointed to the results of a latent class analysis, which revealed five distinct groupings of maternal distress and parenting quality. Mothers who reported high maternal distress and were rated as having either high- or medium-quality parenting were more likely to have a preterm than full-term infant. Hall and colleagues argued that although preterm birth often leads to higher levels of distress, that distress can lead to increased commitment to infant care and thus to better parenting. In sum, studies investigating the influence of preterm birth on parental bonding and child outcomes have yielded mixed results. The overall pattern of results does not support the claim that the psychological risks for parents that are associated with preterm birth have a negative impact on bonding and child outcomes. Instead, the results of multiple studies indicate that the influence of parental bonding and caregiving behavior on child outcomes is similar for children born term and preterm: high-quality parental bonding and care lead to positive child outcomes.

Relations Among Preterm Birth and Biomedical Risks, Sensitive and Responsive Parenting, and Developmental Outcomes Researchers have articulated two hypotheses about the relations between preterm birth, sensitive and responsive parenting, and developmental outcomes. Some researchers have argued that preterm birth 447

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is associated with less sensitive and less responsive parenting, which in turn negatively impacts developmental outcomes (described above in the section on sensitive and responsive parenting), while other researchers have argued that sensitive and responsive parenting is an important protective factor that mitigates the risks associated with preterm birth (Flacking et al., 2012; Forcada-Guex et al., 2011; Garner, Landry, and Richardson, 1991; Landry, 1986; Landry, Chapieski, and Schmidt, 1986; Loi et al., 2017; Muller-Nix et al., 2004). For the most part, researchers investigating both proposals have taken a transactional perspective and have thus considered sensitive and responsive parenting as a potential mediator or moderator of the relation between birth status and developmental outcomes. Many researchers have also considered how sensitive and responsive parenting might also be influenced by other variables, such as sociodemographic factors or child behaviors. Several observational studies indicate that sensitive, responsive parenting influences developmental outcomes. Landry, Smith, Miller-Loncar, and Swank (1997) conducted an observational study of parenting at 6 and 12 months and its influence on children’s cognitive, communicative, and social skills from 12 to 36 months. Children in the study were either born preterm and with one or more severe complications (high risk), preterm and with less severe complications (low risk), or full term. Notably, parents of infants in the three risk groups did not differ in the key behaviors that were considered potential predictors of children’s outcomes: warm responsiveness, maintaining attention, directing attention, and restricting attention. Individual parents did differ in these behaviors, allowing Landry, Smith, Miller-Loncar, and Swank to examine the predictive role of those behaviors. Parental maintaining-attention behaviors had a positive influence on children’s cognitive and communicative development, whereas parental restrictiveness had a negative influence on children’s cognitive and communicative development. The positive influence of parental maintaining-attention behaviors was particularly strong for the development of social initiating amongst high-risk infants. Parental directing of attention, by comparison, had both positive and negative influences on children’s development. In particular, high-risk children whose mothers were more directive were more capable in social responding, but their social skills developed more slowly across the duration of the study. Based on their findings, Landry et al. (1997) argued that moderate levels of directiveness provide the best support for the development of high-risk children following preterm birth. Sensitive and responsive parenting also influences longer-term developmental outcomes following preterm birth.Treyvaud et al. (2016) observed children who had been born at less than 30 weeks gestation and their primary caregiver, and then evaluated a range of indices of children’s cognitive and communicative outcomes at 7 years. Caregiver sensitivity at 2 years predicted fewer behavior difficulties and better cognitive skills at 7 years. Caregiver intrusiveness at 2 years predicted more behavior difficulties, poorer executive function, and poorer cognitive skills at 7 years. Poehlmann and Fiese (2001) examined the relations between risk, responsive parenting, and children’s cognitive outcomes. They observed three groups of infants with their mothers at 6 months (corrected age): full-term infants (gestational age 37–42 weeks, N = 44), low birthweight preterm infants (gestational age less than 27 weeks, N = 20), and very low birthweight infants (gestational age less than 27 weeks, N = 20). Researchers used a macro-coding approach that considered reciprocity and positive affect from both mothers and infants during the interaction, and produced a summed score that reflected the overall quality of the interaction. When infants were 12 months (corrected age), the research team assessed developmental abilities using the Bayley Scales of Infant Development. Risk scales for the mother and infant assessed sociodemographic risk factors for the mother and biomedical risk factors for the infant during the neonatal period. Infant risk was considerably higher for the two preterm groups, compared to the full-term group, and proportional to birth weight. Poehlmann and Fiese (2001) did not report whether birth status influenced interaction quality or cognitive outcomes, but interaction scores for full-term and low birthweight preterm infants were similar, while the scores for very low birthweight preterm infants were slightly higher (indicating poorer interaction quality). Cognitive outcomes for low birthweight and very low birthweight 448

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preterm infants were similar, while the scores for full-term infants were slightly higher (indicating better cognitive outcomes). Infant biomedical risk during the neonatal period predicted interaction quality at 6 months, and interaction quality at 6 months predicted children’s cognitive outcomes at 12 months. Interaction quality fully mediated the association between infant biomedical risk and children’s cognitive outcomes. Maternal risk did not predict outcomes. Poehlmann and Fiese (2001) argued that interactions shape developmental outcomes, and that sensitive and responsive parenting can protect infants against birth status and associated risks and lead to positive developmental outcomes. In a later longitudinal study of children born preterm, Poehlmann et al. (2011) observed the opposite relation between infant risk and interaction quality. Poehlmann et al. (2011) observed maternal interactions with children born preterm from 4 to 24 months and used a macro-coding scheme that distinguished between maternal and infant contributions to interaction quality.The coding evaluated factors such as infant attention, maternal sensitivity, and both infant and maternal affect.When infants were 4 months, infant risk was negatively related to maternal interaction quality: Mothers of higherrisk infants had higher scores for affect and engagement, greater sensitivity, and less intrusiveness, and this relation persisted over the duration of the study. Infant risk was also negatively related to infant interaction quality at 4 months: Higher-risk infants had higher scores for affect and social and communicative competence, but this relation did not persist over time. Maternal and child interaction qualities covaried over time, supporting the hypothesis that the relations between parental care and child outcomes are bidirectional and mutually reinforcing. Clark et al. (2008) investigated the influences of both biomedical risk and quality of parenting on self-regulation skills in children at 2 and 4 years following preterm birth. They used magnetic resonance imaging to evaluate biomedical risk in terms of white matter abnormalities and parent–child interactions to evaluate sensitivity and intrusiveness. Children’s self-regulation was positively related to gestational age: Children born at later gestational ages had fewer problems with self-regulation. Biomedical risk and quality of parenting also predicted self-regulation: Children with higher biomedical risk and lower quality of parenting had more self-regulation problems. Many studies investigating outcomes following preterm birth exclude infants with serious medical complications in order to have a more uniform sample. Wade, Madigan, Akbari, and Jenkins (2015) took an alternate approach, including all mothers who gave birth to an infant of greater than 1,500 grams birth weight, had at least two children under the age of 4 years, and could speak English. They created a cumulative index of biomedical risk that involved one point for each of 10 potential risk factors, including preterm birth. Researchers filmed mother-infant interactions in the home when infants were 18 months old, and later rated maternal sensitivity, mutuality, and positive control. Researchers also evaluated children’s developmental outcomes at 18 months, including joint attention, empathy, cooperation, and self-recognition. Both biomedical risk and responsive parenting influenced developmental outcomes. Furthermore, responsive parenting moderated the relation between biomedical risk and social cognition skills in 18-month-old infants (see also Poehlmann et al., 2012, where parental care led to different outcomes for children who were prone to distress). Observational studies thus consistently indicate that sensitive and responsive parenting influences children’s outcomes positively in preterm as well as full-term children. Some evidence indicates that preterm birth is associated with less responsive parenting, but in other studies preterm birth and associated infant risks are associated with more sensitive and responsive parenting, rather than less. Overall, consistent evidence supports the claim that sensitive and responsive parenting is a protective factor that can mitigate the risks associated with preterm birth and promote positive outcomes for children. Many observational studies have been motivated by transactional models of development and have demonstrated evidence of bidirectional influences of parent and child behaviors through extensive longitudinal data. The macro-coding approach adopted by most of these studies allows inferences about influences of parent and child behaviors across different measurement periods, but 449

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does not provide insight into the interplay of parent and child behaviors in a single observation. Micro-coding approaches that evaluate the dependencies between behaviors, such as contingencies, are a promising direction for future research investigating the relations between sensitive and responsive parenting and child outcomes.

Intervention Studies of Parental Care That Influence Outcomes Interventions seeking to improve parental care and developmental outcomes for children born preterm have been influenced by different theoretical perspectives on preterm birth, as well as by different traditions of research on parenting. The earliest interventions were influenced by the maturation perspective on preterm development, and as a result focused on providing stimulation to infants during hospitalization. Later interventions were influenced by the divergence perspective, and as a result have generally been applied during early infancy in an effort to address risk factors that may change children’s developmental trajectories. More recent interventions have also increasingly focused on the transactional nature of development, and as a result have considered how children born preterm influence their parents as well as how parents influence children born preterm.

Stimulation Interventions The earliest interventions targeting developmental outcomes for children following preterm birth emphasized stimulation for infants, in most cases delivered by hospital staff rather than parents (Leib, Benfield, and Guidubaldi, 1980; Oehler, Eckerman, and Wilson, 1988; Scarr-Salapatek and Williams, 1973; Solkoff,Yaffe,Weintraub, and Blase, 1969). Interventions emphasizing stimulation are grounded in the maturation perspective: Stimulating infants during hospitalization mitigates the effects of the hospital environment and supports normal maturational processes, such as physical growth and mental development. One stimulation intervention included visual and tactile stimulation, in the initial period following preterm birth, including a mobile above the incubator and gentle touch to the extremities during feedings (Leib et al., 1980). As infants’ health status improved, the intervention additionally included kinesthetic and auditory stimulation, such as rocking, talking, and singing. When they were discharged from the hospital, infants who had received the intervention had higher scores on the Neonatal Behavioral Assessment (Als, Tronick, Lester, and Brazelton, 1977) but showed no difference in weight gain compared to infants who had received standard care. At 6 months, the treatment group again had a developmental advantage, indicated by scores on the Bayley Scales of Infant Development, but did not differ in physical growth. The effects of stimulation interventions are equivocal, with some studies demonstrating benefits for physical growth, and other studies demonstrating benefits for developmental skills, but inconsistent results overall. An evaluation of one stimulation intervention revealed an interesting negative consequence, which provided a valuable insight into the unforeseen consequences of stimulation to preterm infants. Oehler et al. (1988) stimulated preterm infants in the hospital in three ways: talking in a soothing voice, stroking the infant’s extremities, chest, back, or head, and a combination of talking and stroking simultaneously. The immediate effects of stimulation included increases in visual attentiveness and other positive behavioral changes, but also included agitation and avoidance cues. The negative effects of stimulation were most notable when infants were stimulated with talking and stroking simultaneously and amongst high-risk infants. Stimulation thus appeared to have both positive and negative consequences, and in some cases to be overstimulation. This observation contradicted one of the primary assumptions motivating stimulation interventions, that because hospital care deprives infants of sensory stimulation, hospitalized preterm infants need more stimulation. Stimulation models and theories remain influential, in specific interventions, such as those that focus on massage and feeding (Dieter and Emory, 1997; Fucile, Gisel, McFarland, and Lau, 2011; 450

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Hernandez-Reif, Diego, and Field, 2007; Scafidi et al., 1990), as well as informing components of broader interventions.

Skin-to-Skin Contact In 1988, Whitelaw, Heisterkamp, Sleath, Acolet, and Richards conducted a randomized control trial in London of a low-cost intervention that had been developed in Colombia to address high mortality rates following preterm birth. They called the intervention skin-to-skin contact, or kangaroo care, and it has become the best-known intervention for infants following preterm birth. Mothers of hospitalized very low birthweight, preterm infants were encouraged to hold their infants against their skin on their chests (in the study from Whitelaw and colleagues, the average amount of skin-to-skin contact was 36 minutes per day, but subsequent studies have involved near-constant contact). Infants in the study had a cardiac or respiration monitor but did not require oxygen.When they were 6 months old, infants in the intervention condition cried less and had breastfed for longer. Whitelaw et al. (1988) proposed that skin-to-skin contact facilitates bonding between mothers and their preterm infants and thereby improves regulatory functions such as crying and breastfeeding. However, mothers in the skin-to-skin contact condition did not differ from mothers of comparable infants receiving standard care in terms of stress, distress, and psychological symptoms at hospital discharge or when their infants were 6 months old. Ample evidence indicates that skin-to-skin contact increases breastfeeding rates and decreases the time to begin exclusive breastfeeding amongst children born preterm (Boundy, et al., 2016; Oras et al., 2016; Whitelaw et al., 1988). Skin-to-skin contact also decreases infant mortality rates and several other risk factors including hypothermia, hyperthermia, sepsis, hypoglycemia, and the chance of hospital readmission following discharge (Boundy et al., 2016). The claim that skin-to-skin contact facilitates bonding or otherwise supports the emotional experiences of parents when children are born preterm has a strong appeal for researchers, practitioners, and parents alike, but the existing evidence does not clearly support the claim (Holditch-Davis, White-Traut, Levy, O’Shea, Geraldo, and David, 2014; Morelius, Ortenstrand, Theodorsson, and Frostell, 2015; Tessier et al., 1998; Whitelaw et al., 1988). Similarly, and perhaps relatedly, the claim that preterm birth jeopardizes parents’ feelings of emotional closeness to their children has motivated numerous interventions, including those that focus on skin-to-skin contact (Tessier et al., 1998) and longer-term interventions that provide detailed feedback and guidance to parents on their interactions with children (Evans,Whittingham, Sanders, Colditz, and Boyd, 2014). Although preterm birth increases parental stress and distress, it does not appear to jeopardize bonding and attachment (as described in the section on how preterm birth influences parents). Feldman, Weller, Sirota, and Eidelman (2002) proposed that skin-to-skin contact not only improves breastfeeding and physiological factors, but also improves long-term developmental outcomes for children born preterm by influencing internal regulation.They used a longitudinal design to compare multiple outcome variables for two groups of children born preterm: One group received skin-to-skin contact, and the other group did not. Infants in the skin-to-skin contact condition showed more organized sleepwake cycles in the period from 32 weeks gestation to term, increased levels of attention at 3 months, and more time sharing attention with their mothers at 6 months compared to the control group. Infants in the two groups did not differ on measures of emotion regulation at 3 months. Feldman et al. (2002) argued that skin-to-skin contact improves state regulation in infants born preterm, which in turn leads to improvements in attention and self-regulation in more demanding situations as the infant matures. Feldman, Rosenthal, and Eidelman (2014) again evaluated multiple outcome variables when the children in their intervention study were 10 years old. Skin-to-skin contact during the neonatal period was no longer related to sleep organization when children were 10, but it was related to executive function and the reciprocity of interactions between children and their mothers. Feldman et al. (2014) argued that self-regulation was the causal link between skin-to-skin contact and positive developmental outcomes. 451

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Parent Training Programs A number of interventions seek to improve developmental outcomes in infancy and childhood by helping mothers adjust to caring for their preterm child, increasing sensitive and responsive parenting, and improving the quality of bidirectional processes involved in social interactions. In these interventions, researchers or practitioners guide parents through a reflective process during the neonatal period and onward. The programs provide information about infant capabilities, infant cues, and a range of appropriate responses.The facilitators do not simply convey knowledge, they also provide opportunities for parents to reflect on and evaluate their infants’ behaviors as well as their own. The Mother-Infant Transaction Program was one of the first parent training programs for parents of children born preterm (Achenbach et al., 1990; Achenbach, Howell, Aoki, and Rauh, 1993; Rauh, Achenbach, Nurcombe, Howell, and Teti, 1988). The intervention began while infants were still hospitalized and aimed to improve maternal knowledge of and sensitivity to infant cues as well as to increase sensitive and responsive parenting. The evaluation of the intervention included the target group of low birthweight infants with an average gestational age at birth of 32 weeks, a control group of low birthweight infants with an average gestational age at birth of 32 weeks, and a comparison group of normal birthweight infants with an average gestational age at birth of 40 weeks. Rauh, Achenbach et al. (1988) reported that the intervention improved mothers’ adjustment to their infant rapidly, increasing their self-confidence and decreasing their judgments of infant difficulty.The children were assessed at 6, 12, 24, 36, and 48 months, but no cognitive and communicative benefits for children were observed until children were 3 years old. The benefits, however, were lasting. At 4 years, the children in the intervention group had dramatically better scores on the McCarthy Scales of Children’s Abilities than children in the preterm control group and were comparable to the normal birthweight, full-term children. At 7 and 9 years, the children in the intervention group had higher scores on the Mental Processing Composite of the Kaufman Assessment Battery for Children than did children in the preterm control group and were again indistinguishable from the normal birthweight, full-term children (Achenbach et al. 1993; Achenbach et al., 1990). Nordhov et al. (2010) reported a similarly positive influence of the Mother-Infant Transaction Program on the cognitive outcomes of preterm children in a larger study when children in the treatment group were 5 years old but not 3 years old. The collective evidence thus indicates that the Mother-Infant Transaction Program has a positive influence on developmental outcomes during childhood, but that the benefits are not immediate (but see Landsem et al., 2015). The Playing and Learning Strategies intervention (PALS) built on previous observational research indicating that responsive, contingent parenting supports the social and cognitive development of children, both in immediate outcomes, such as sharing attention with parents, and in long-term outcomes (Garner et al., 1991; Landry, 1986; Landry et al., 1986; Landry, Smith, and Swank, 2006; Landry, Smith, Swank, Assel, and Vellet, 2001). A facilitator/researcher visited 264 mothers in their homes on a weekly basis starting when their infant was 6 months old (Landry, Smith, and Swank, 2006). Infants were either preterm and very low birthweight or full term, and half from each group were assigned to either an intervention or control condition. In the intervention condition, the facilitator introduced four types of responsive behavior, asked mothers to reflect on their previous behavior with their children, encouraged mothers to review and evaluate their video-recorded behavior, and assisted them in planning future behavior. In the control condition, the facilitator primarily asked mothers about their children’s development, including evaluation of day-to-day issues as well as developmental milestones, but did not give advice on how to facilitate children’s development. Researchers evaluated infant outcomes at 12 months based on interactions with their mothers as well as interactions with an unfamiliar researcher. The intervention improved maternal responsiveness as well as related infant outcomes, including early communication skills, cooperation, and affect. Other studies have also demonstrated positive effects of parent training programs during 452

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infancy, as long as training for parents is structured, encouraging, and specific (Steinhardt et al., 2015; White-Traut et al., 2013). Recent interventions incorporate elements from multiple approaches. For example, the Family Nurture Intervention combines skin-to-skin contact with interaction guidance about how to speak to and interact with babies following preterm birth (Welch et al., 2015). The Family Nurture Intervention has been tested in a randomized control trial with families of 150 preterm infants, half of whom received the intervention and half of whom received standard care. At 18 months, children in the intervention condition performed better on measures of attention, cognition, communication, and social skills. Welch and colleagues (2015) argued that the intervention targeted regulatory problems by improving homeostatic mechanisms that are influenced by contact with caregivers, while at the same time improving caregiver awareness and behavior. In 1988, Rauh, Achenbach, Nurcombe, Howell, and Teti argued that interventions seeking to mitigate the negative effects of preterm birth and low birth weight had suffered from three important limitations. First, many interventions were designed without detailed understanding of the developmental needs and trajectories of children born preterm. Second, interventions motivated by concerns about bonding and attachment not only supported mother-infant relationships, but also increased infant stimulation more broadly, thus making it difficult to draw strong causal inferences about the validity of claims about bonding and attachment in development following preterm birth. Third, many interventions sought to address the active role that infants play in social interactions, influencing their parents and other social partners as well as their own development, but began too late in development. In the intervening years, researchers have developed and evaluated developmentally informed, causally informative, and temporally sensitive interventions. Overall, parent training programs are the interventions most clearly based on these three factors and with the strongest empirical evidence. Nonetheless, it is still unclear why the positive effects of some parent training programs on children’s outcomes are delayed for several years, and evaluations of parent training programs have sometimes yielded contradictory results. In addition, researchers still do not have a clear understanding of the causal processes and pathways linking the risks associated with preterm birth to positive or negative developmental outcomes for children. Further evidence from longitudinal studies that consider the effects of interventions on parents as well as children is needed. As Benzies et al. (2013) argued, interventions designed to influence outcomes for children born preterm need to identify and measure the influence on parents to understand more fully how the intervention works.

Emerging Questions and Future Directions in Research on Parenting Children Born Preterm Research on parenting children born preterm has made important contributions to our understanding of how parenting influences child health and development as well as how child health and development affects parenting. Careful consideration of theoretical frameworks and assumptions has been especially beneficial in helping researchers generate specific hypotheses about causal influences and design interventions to test hypotheses and mitigate the negative impact of preterm birth. New themes are emerging that will guide future theorizing as well as empirical tests of those theories.

How Does Preterm Birth Influence Fathers and How Do Fathers Influence Developmental Outcomes? Developmental scientists and medical practitioners are giving increasing attention to the impacts of preterm birth on fathers as well as mothers, and of paternal care on children’s outcomes following preterm birth. Few studies of parenting following preterm birth have included sufficient numbers of fathers to allow comparisons between mothers and fathers. Some evidence indicates that fathers 453

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report less stress than mothers do following preterm birth, but also more distance from infants during hospitalization and early care (Baia et al., 2016). Other studies have identified unique concerns of fathers following preterm birth, such as feelings of loss of control or higher levels of hostility and anger (Arockiasamy et al., 2008; Ionio et al., 2016).The ways in which preterm birth impacts parental feelings of closeness and bonding may differ for fathers and mothers, although the evidence is still very limited, and in at least some cases, fathers and mothers respond similarly to preterm birth (Hall et al., 2015a; Hoffenkamp et al., 2012; Tooten et al., 2014; Tooten et al., 2013). Future studies should also investigate triadic interactions in two-parent families following preterm birth, including not only the social exchanges that take place when multiple family members are present together, but also the ways in which psychological risks and support interact across parents and children following the birth of a preterm child.

How Do Parental Attitudes, Beliefs, and Knowledge Influence Developmental Outcomes Following Preterm Birth? Despite decades of research on psychological risks for parents following preterm birth, surprisingly little research has investigated the influence of parental attitudes and beliefs about the parental role on their adjustment following preterm birth. Parenting cognitions influence how parents interact with their child and the care they provide, including caregiving practices such as breastfeeding and cognitive stimulation (Bornstein, Putnick, and Suwalsky, 2018a; Winstanley and Gattis, 2013). Some research indicates that the experience of caring for a child following preterm birth influences parenting cognitions. Winstanley et al. (2014) examined maternal attitudes and beliefs shortly after giving birth preterm (N = 41) or term (N = 64) and again when their infants were 5 months old (chronological age) using the Concepts of Development Questionnaire (Sameroff and Feil, 1985) and the Baby Care Questionnaire (Winstanley and Gattis, 2013). In the neonatal period, mothers who had given birth preterm and mothers who had given birth full term reported similar attitudes and beliefs, but the beliefs of mothers who had given birth preterm changed over the ensuing months, indicating that the experience of caring for a child born preterm can influence parental beliefs. Beliefs and knowledge are important because they shape parents’ relationships with children. Some evidence indicates that knowledge of development is associated with higher-quality parent– child interactions and better outcomes for children following preterm birth (Dichtelmiller et al., 1992; Veddovi, Gibson, Kenny, Bowen, and Starte, 2004). Knowledge of development influences the quality of parent–child interactions (Bornstein et al., 2017; Veddovi et al., 2004) and plays an important role in the identification of early developmental delays (Smith, Akai, Klerman, and Keltner, 2010). Further research is needed to better understand how the experience of caring for a child born preterm influences parents’ beliefs and knowledge and how their beliefs and knowledge influence their care for children.

Are Physiological Regulatory Problems Related to Cognitive and Emotional Forms of Self-Regulation? Several lines of evidence point toward regulatory problems as an important and durable consequence of preterm birth that interacts with other environmental factors, including factors as diverse as hospital lighting, parenting quality, and early sociocognitive skills. Although some evidence indicates that early regulatory problems with sleeping, feeding, and crying are a consequence of maturation and should therefore resolve with age, other evidence indicates that early regulatory problems with sleeping, feeding, and crying may persist or even increase across development (Bilgin and Wolke, 2016). Early regulatory problems may lead to divergent trajectories of development and as a result influence diverse outcomes for children born preterm. Several research groups are beginning to examine 454

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relations between regulatory functions that are more obviously physiological, such as respiration, heart rate, feeding, and sleep, and regulatory behaviors that are more cognitive, such as affect regulation, attention to social partners, social reciprocity, and executive function. Future studies will benefit from a more detailed consideration of how early regulatory functions influence parenting behavior and may thereby indirectly influence developmental outcomes, as well as considering potential direct relations between both types of regulation.

Measurement and Design Issues Close attention to measurement and design can improve the quality and consistency of inferences about parenting children born preterm. One consequence of the maturation perspective on development following preterm birth is that most studies have evaluated families with children born preterm at corrected ages in order to ensure that preterm and full-term children are at the same stage of maturation. Such designs introduce an additional difference, however, in terms of social experience. When children born preterm are tested at corrected ages, they and their parents have more social experience together. Future studies need to consider the importance of social experience in choosing testing ages, and where possible consider alternative control groups. The dyadic context of parent–child interactions is a key feature of the majority of research investigating parenting following preterm birth. Moore et al. (2013) argued that there is still no consensus on how to empirically evaluate the individual and dyadic components of behavior within interactions. A critical issue is how to evaluate the relations between the behaviors of each individual in a way that accurately captures the contextual nature of behavior as well as the independent contributions of each social partner. Moore et al. (2013) argued that considerations of timing and the bidirectional nature of social interactions should consider other interactive concepts in addition to synchrony and pointed to the importance of behavioral flexibility in particular. Another alternative is for researchers to adopt a micro-coding approach that focuses on specific behaviors from each social partner independently, and to later combine those codes to evaluate contingencies between behaviors across social partners (Bornstein, Putnick, Cote, 2015). Contingencies based on micro-coding allow researchers to more carefully evaluate the timing of behavior in social interactions and related hypotheses about the influence of preterm birth on temporal coordination.

Risk and Resilience Stronger evidence from studies of children with varying levels of risk is needed to evaluate when and how risks associated with preterm birth interact with psychological functioning in parents as well as developmental outcomes (Aylward, 1992). Conclusions about how risk influences both parents and outcomes for children born preterm are often limited by sampling issues, in particular by using lowrisk samples and small samples. Risk is also influenced by parental histories. Studies using latent class analysis point to the importance of detailed and accurate identification of parental histories, including parental mental health (Holditch-Davis et al., 2015; Poehlmann and Fiese, 2001). The number of potential causal variables involved in developmental outcomes following preterm birth means that studies of parenting and development following preterm birth require larger samples that include a wider range of gestational ages and risk factors. Differences in sampling and exclusion criteria across studies also limit conclusions about risk and parenting children born preterm. Many studies compare a narrow range of gestational ages, contrasting for example children born extremely preterm with children born full term or contrasting children born moderately preterm with children born full term. Studies that consider a range of developmental outcomes and compare families across a wide range of child gestational ages are needed to accurately identify the relations between gestational age at birth, psychological risks for parents, and children’s outcomes. Fully identifying the causal 455

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pathways from the risks associated with preterm birth to developmental outcomes will consider not only regulatory problems, but also the ways in which children born preterm and their families are resilient (Beeghly and Tronick, 2011; Poehlmann et al., 2011).

Contexts of Development The majority of studies investigating parenting preterm children have been conducted in a small number of countries and cultures, limiting scientific knowledge of how sociocultural contexts influence parenting following preterm birth. Sociocultural contexts influence attitudes and beliefs about the parental role, birth and risk, developmental expectations, and specific caregiving behaviors (Bornstein, Putnick, Lansford, Deater-Deckard, and Bradley, 2015; Harkness et al., 2011; Obradovic, Yousafzai, Finch, and Rasheed, 2016). Future research needs to consider the influence of sociocultural context on the attitudes and beliefs of parents toward preterm birth and how those interact with parental behaviors and developmental expectations for children. Several prominent hypotheses may depend on socioeconomic factors, such as local mortality rates and the availability of medical care and social support. For example, discrepant findings with respect to hypotheses about how preterm birth impacts parental bonding and attachment may depend on the medical care and social support available to parents (Borghini et al., 2006; Korja et al., 2009). Research investigating parenting and child development following preterm birth in low-income settings has yielded important evidence about mortality rates, risk factors, and basic improvements to care (Blencowe et al., 2012). Future studies should address the need for research on how preterm birth influences parents in low-income settings, and how parental care can mitigate the potentially negative consequences of preterm birth with specific sociocultural contexts. The contexts of preterm birth also influence the feasibility and applicability of interventions. Although skin-to-skin contact was developed as an intervention specifically for low-income contexts where medical provision was limited, the majority of research investigating the efficacy of skin-to-skin contact as an intervention and the long-term effects of its application have been conducted in higher-income countries, where medical provision is sometimes extensive and may involve long-term hospitalization of infants following preterm birth (Boundy et al., 2016; Oras et al., 2016; Whitelaw et al., 1988). Future research should facilitate and evaluate the development of low-cost interventions that are feasible in low-income settings, where medical provision and parent education may be limited.

Conclusions Preterm birth affects children, both immediately after birth and over the long term. Having a preterm child affects parents by increasing psychological risks and by influencing interactions between parents and children. Parental care influences developmental outcomes in part because of bidirectional influences between parents and children. Interventions targeting increased knowledge and awareness of development following preterm birth lead to better long-term developmental outcomes for children.

Acknowledgments This chapter is dedicated to Shoba Cherian, in memory of her competence and compassion as a clinician and researcher. I thank Marc H. Bornstein for stimulating discussions about preterm children and their parents and for his many helpful suggestions.

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(1973). The effects of early stimulation on low-birth-weight infants. Child Development, 44, 94–101. www.jstor.org/stable/1127684. Schappin, R.,Wijnroks, L., Uniken Venema, M. M. A.T., and Jongmans, M. J. (2013). Rethinking stress in parents of preterm infants: A meta-analysis. PLoS ONE, 8, e54992. doi:10.1371/journal.pone.0054992. Scheiner, A. P., and Sexton, M. E. (1991). Prediction of developmental outcome using a perinatal risk inventory. Pediatrics, 88, 1135–1143. Sesma, H. W., and Georgieff, M. K. (2003). The effect of adverse intrauterine and newborn environments on cognitive development: The experiences of premature delivery and diabetes during pregnancy. Development and Psychopathology, 15, 991–1015. doi: 10.1017.S0954579403000488. Sigel, I. E., McGillicuddy-DeLisi, A. V., and Goodnow, J. J. (1992). Parental belief systems: The psychological consequences for children. New York, NY: Psychology Press. Singer, L. T., Salvator, A., Guo, S., Collin, M., Lilien, L., and Baley, J. (1999). Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. Journal of the American Medical Association, 281, 799–805. Smith, L. E., Akai, C. E., Klerman, L.V., and Keltner, B. R. (2010). What mothers don’t know and doctors don’t say: Detecting early developmental delays. Infant Mental Health Journal, 31, 455–466. Solkoff, N.,Yaffe, S., Weintraub, D., and Blase, B. (1969). Effects of handling on the subsequent developments of premature infants. Developmental Psychology, 1, 765–768. Spielberger, C. D., Gorsuch, R. L., Lushene, R.,Vagg, P. R., and Jacobs, G. A. (1983). Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press. Stefana, A., and Lavelli, M. (2017). Parental engagement and early interactions with preterm infants during the stay in the neonatal intensive care unit: Protocol of a mixed-method and longitudinal study. BMJ Open, 7, e013824. doi:10.1136/bmjopen-2016-013824. 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14 PARENTING BEHAVIORALLY INHIBITED AND SOCIALLY WITHDRAWN CHILDREN Paul D. Hastings, Kenneth H. Rubin, Kelly A. Smith, and Nicholas J. Wagner Introduction All children are essentially criminal. —(Diderot, 1713–1784) A child is a curly, dimpled lunatic. —(Emerson, 1803–1882) Having children is like having a bowling ball installed in your brain. —(Mull, 1978)

A glance at the quotations offered above would lead one to assume that parenting is not a simple matter. For hundreds of years, writers of philosophy, fiction, and comedy have portrayed the child as a significantly stressful addition to the family unit. Nevertheless, it is also the case that the arrival of an infant usually brings a great deal of joy and enthusiastic anticipation. Or to offer yet another observation: “My mother had a great deal of trouble with me, but I think she enjoyed it” (Mark Twain, in Byrne, 1988, p. 301). Most people would agree that children challenge their parents.Yet, parents often meet that challenge with acceptance, warmth, responsiveness, and sensitivity. At times, however, parents meet the challenge of childrearing in unaccepting, unresponsive, insensitive, neglectful, and/or hostile ways. It may be that ecologically based stressors produce such negative childrearing behaviors (e.g., lack of financial resources, parental separation and divorce, lack of social support), or perhaps child characteristics evoke negative parenting beliefs, affects, and behaviors. Also, perhaps parents themselves have experienced particularly negative childrearing histories and model the behaviors of their own parents and family culture or norms in rearing their own children (Covell, Grusec, and King, 1995). It is our belief that when parents think about childrearing and child developmental trends in ways that deviate from cultural norms, and/or when they interact with and respond to their children in psychologically inappropriate ways, they will develop negative relationships with their children. We also believe that when parent–child relationships and parent–child interactions within the family are negative, it does not augur well for normal child development. Thus, our chapter is focused on the parent–child relationships and interactions of one group of children who are known to deviate from their age-mates vis-à-vis their social, emotional, and 467

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behavioral profiles. Typically, this particular group of children has been referred to as behaviorally inhibited, socially withdrawn, socially anxious, or shy. Our focus is on childhood behavioral inhibition and social withdrawal because these early-emerging behaviors often precede and portend one of the most common classes of serious mental health difficulties in childhood—internalizing problems (Zahn-Waxler, Klimes-Dougan, and Slattery, 2000). It is our intention to examine the extant literature concerning the parents of children who can be identified as behaviorally inhibited during the toddler period and as socially withdrawn from early childhood through early adolescence. After a brief note on research design and measurement in this field, we then proceed to defining and contrasting the constructs of social and emotional competence and incompetence; as one might expect, behavioral inhibition and especially social withdrawal are viewed as manifestations of social and emotional incompetence. Then, we briefly describe a number of theories that have drawn parents into the developmental equation in which pathways to children’s behavioral overcontrol are predicted. Thereafter, we describe research in which (1) the quality of the parent–child relationship, (2) parental beliefs or ideas about the development of social competence and withdrawal, and (3) parenting practices are associated with the expression of childhood behavioral inhibition and social withdrawal. In doing so, we examine factors that may influence the types of parent–child relationships, parental beliefs, and parenting behaviors that are associated with the development of behavioral inhibition and social withdrawal.

Defining Behavioral Inhibition and Social Withdrawal The early study of social withdrawal was hampered by the lack of both conceptual and definitional frameworks (Rubin and Asendorpf, 1993). The lack of conceptual clarity was contributed to by the frequent and interchangeable use of a variety of (not well-differentiated) terms (e.g., shyness, withdrawal, reticence, behavioral inhibition, isolation). However, there has since been a more concerted effort to delineate a consistent typology of terms (Rubin, Coplan, and Bowker, 2009). Behavioral inhibition has been defined variously as (1) an inborn bias to respond to unfamiliar events by showing anxiety, (2) a specific vulnerability to the uncertainty all children feel when encountering unfamiliar events that cannot be assimilated easily, and (3) one end of a continuum of possible initial behavioral reactions to unfamiliar objects or challenging social situations (Kagan, Reznick, and Snidman, 1987; Stevenson-Hinde, 1989). These definitions highlight some common elements: Behavioral inhibition is (1) a pattern of responding or behaving, (2) possibly biologically determined, such that (3) when unfamiliar and/or challenging situations are encountered, (4) the child shows signs of anxiety, distress, or disorganization. Inhibition in infancy and toddlerhood is often a precursor of social withdrawal in early and middle childhood. Social withdrawal is a behavioral phenomenon that involves the child isolating himself/ herself from the peer group. In this regard, social withdrawal is viewed as emanating from such internal factors as social anxiety and wariness in the company of familiar peers, such as classmates (Rubin et al., 2009).

Behavioral Inhibition and Social Withdrawal as Risk Factors To casual observers, inhibited or withdrawn children may not seem to warrant much concern. Their quiet, controlled demeanors could be seen as veritable models of childhood compliance and proper school decorum.They are not disruptive, and thus their potential social or emotional difficulties may go undetected or ignored by the typical harried caregiver or educator (Coplan and Rudasill, 2016). Nevertheless, it is the case that professionals have persisted in regarding psychological overcontrol and its behavioral manifestations in childhood as comprising a major category of disorder (Zahn-Waxler et al., 2000) and as warranting intervention (Chronis-Tuscano et al., 2015). Moreover, the primary 468

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behavioral manifestations of overcontrol—behavioral inhibition and social withdrawal—become increasingly salient to caregivers and peers with increasing child age (Rubin et al., 2009). As such, the display of behavioral inhibition during the toddler period and socially withdrawn and reticent behavior during childhood and adolescence makes interaction effortful for others and contributes to the development of distant and sometimes difficult relationships (Gazelle and Druhen, 2009; Rubin et al., 2006). Furthermore, from a developmental perspective, it has been proposed that peer interaction represents a social context within which children learn to consider the perspectives of others and coordinate others’ perspectives with their own (Rubin, Bukowski, and Bowker, 2015). Thus, children who consistently avoid or withdraw from such interactions and learning experiences may be at major risk for failing to develop those social and social-cognitive skills and emotion regulation competencies. Not only is there evidence that behaviorally inhibited and socially withdrawn children are lacking in social and social-cognitive competence (Rubin et al., 2015), but with increasing age they come to recognize their shortcomings and express strong feelings of loneliness and negative self-regard (Salmivalli, Ojanen, Haanpää, and Peets, 2005; see Rubin et al., 2009, for an extensive review). Consequently, researchers have asked whether the quality of parent–child relationships and the experience of particular parenting styles contribute to the development of behavioral inhibition and social withdrawal in childhood.

Measurement and Design in Studies of Behaviorally Inhibited and Socially Withdrawn Children In studies of the socialization of behavioral inhibition and social withdrawal, parenting has most often been assessed using parent self-report measures; less frequent but still widely used are observational procedures of parent–child interactions. Alternative procedures, such as youth-report or spouse-report measures of parenting are less common, as are the kinds of multi-method measurement of parenting (e.g., questionnaires and observations) that are often recommended by experts in the field (Zeman, Klimes-Dougan, Cassano, and Adrian, 2007). To the extent that multi-method studies have been pursued, the correspondence between independent sources of information on parenting behavior has tended to be modest (Hastings, Kahle, and Nuselovici, 2014; McShane and Hastings, 2009). This level of agreement may be attributable to many factors, including parents’ introspective accuracy, their reactions to being observed, and the effectiveness of observational procedures for eliciting subtle or infrequent but potentially influential aspects of parenting. As well, a wide variety of questionnaires, interviews, observational contexts or tasks, and coding systems have been used to quantify parenting beliefs and behaviors in these studies. Echoing Bornstein’s (2016) observations about measurement of parenting more broadly, there has not been much consensus or consistency regarding the optimal measurement of parenting as it pertains to the development of wary and reticent children. Each may be seen as an important implement in the toolkit of parenting researchers, with greater confidence in research emerging when findings are replicated across studies with varying methods and measures. Identifying such replication can be challenging, though, when the equivalence or comparability of the measures has yet to be determined. Again paralleling other aspects of socialization research (Hastings, Utendale, and Sullivan, 2007), most studies of the parents of inhibited and socially withdrawn children have utilized single-timepoint, non-experimental designs. These have been useful for identifying which aspects of parenting are, or are not, associated with children’s inhibited and withdrawn characteristics and other aspects of their psychosocial adjustment, but of course they cannot provide any evidence of causality or directionality in the relations between parenting and children’s functioning (Bornstein, 2016). Fortunately, increasing numbers of developmental scientists are pursuing longitudinal studies and including repeated assessments of parent and child measures across time, and we draw heavily on these studies in our review. There have been markedly fewer studies with designs that can provide the 469

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strongest confidence in causal effects of parenting on the development of inhibited and withdrawn children, such as interventions and adoption studies, and we examine these separately from the nonexperimental studies that comprise the bulk of the literature.

Definitions and Theories of Social and Emotional Competence There may be as many definitions of social competence as there are students of it; as such, the definitions offered must be taken as reflecting the personal biases of the present authors. We begin by making three assumptions. First, it seems reasonable to assume that social competence is both desirable and adaptive. Second, an equally reasonable assumption is that socially wary or withdrawn children are lacking in social skills. Third, drawing on the first two assumptions, we believe that the demonstration of childhood behavioral inhibition and social withdrawal is maladaptive and not conducive to normal social and emotional growth and well-being. At least two themes can be recognized in approaches to the study of social competence. One theme is focused on social effectiveness. This functional approach emphasizes the child’s ability to meet her or his needs during social interaction. A second theme emphasizes the extent to which the child’s interactions with adults and peers are positive and appropriately supportive and responsive. Taken together, these themes have led us to define social competence as the ability to achieve personal goals in social interaction while simultaneously maintaining positive relationships with others over time and across settings (Rubin and Rose-Krasnor, 1992). Socially competent behaviors would be organized around the demonstration of sustained positive engagement with peers, marked by positive, regulated emotions. Thus, the consistent demonstration of friendly, cooperative, altruistic, successful, and socially acceptable behavior over time and across settings is likely to lead one to judge the actor as socially competent. Furthermore, the display of socially competent behavior in childhood results in the formation and maintenance of high-quality friendships, acceptance and likeability in the peer group, and successful adolescent and adult outcomes (Rubin et al., 2015). By contrast, the reasonably consistent demonstration of social withdrawal in the company of peers, of unassertive or inappropriate social strategies to meet social goals, and of relatively high rates of unsuccessful social outcomes have been judged as social incompetence (Stewart and Rubin, 1995). Furthermore, socially wary and withdrawn children’s friendships are of lesser quality than those of their more sociable and socially skilled age-mates (Rubin,Wojslawowicz, et al., 2006), and their reputation in the peer group elicits more rejection and victimization (Oh et al., 2008). If one believes that the attainment of social competence is adaptive, then socially withdrawn children display behaviors, emotions, and social cognitions that could be considered maladaptive, thereby placing these children at risk for the development of psychological difficulties. It is now well established that childhood behavioral inhibition and social withdrawal increase the likelihood of manifesting subsequent problems of an internalizing nature (Rubin et al., 2009). Having reached these conclusions, one may ask, “How do children acquire social competence, or in the case of behavioral inhibition and withdrawal, social incompetence?”

Parents and Social Competence: Developmental Theory According to Hartup (1985), parents serve at least three functions in the child’s development of social competence. First, the parent–child relationship is a context within which many competencies necessary for social interaction develop. It furnishes the child with many of the skills required to initiate and maintain positive relationships with others, such as language skills, the ability to control impulses, and so forth. Second, the parent–child relationship constitutes and confers emotional and cognitive resources that allow the child to explore the social and non-social environments. It is a safety net permitting the child the freedom to examine features of the social universe, thereby enhancing the 470

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development of problem-solving skills. Third, the early parent–child relationship is a forerunner of all subsequently formed extrafamilial relationships. It is within the parent–child relationship that the child begins to develop expectations and assumptions about interactions with other people and to develop strategies for attaining personal and social goals (Bowlby, 1969; Cassidy and Shaver, 2016). In keeping with these functions, both classical theorists and contemporary researchers have implicated parents and the quality of parent–child relationships in the development of adaptive and maladaptive social behaviors. Ethological adaptations of early psychoanalytic models (Ainsworth, 1973) have provided a rationale for the production of overcontrolled behaviors arising through the construct of “internal working models.” Bowlby (1973) proposed that the early mother-child relationship lays the groundwork for the development of internalized models of familial and extrafamilial relationships. These internal working models were thought to be the product of parental behavior, specifically, parental sensitivity and responsivity (Groh, Fearon, et al., 2014). Given an internal working model that the parent is available and responsive, it was proposed that the young child would feel confident, secure, and self-assured when introduced to novel settings. Thus, felt security has been viewed as a highly significant developmental phenomenon that provides the child with sufficient emotional and cognitive sustenance to allow the active exploration of the social environment. Exploration purportedly results in play (Cheyne and Rubin, 1983), which, in turn, leads to the development of problem-solving skills and competence in both the impersonal and interpersonal realms (Rubin and Rose-Krasnor, 1992). From this perspective, then, the association between security of attachment in infancy and the quality of children’s social skills is attributed, indirectly, to parental sources (Thompson and Goodvin, 2016). Alternatively, the development of an insecure infant-parent attachment relationship has been posited to result in the child developing an internal working model that interpersonal relationships are rejecting, neglectful, or unreliable. In turn, the social world is perceived as a battleground that must either be attacked or escaped from (Bowlby, 1973). Thus, for the insecure and wary/anxious child, opportunities for peer play and interaction are nullified by the child. When the socially wary child defies peer group norms of sociability and social competence, she or he becomes salient to the peer group at large. Oftentimes, this increased negative salience results in the child’s exclusion and isolation, thereby resulting in the child’s forced (by the peer group) lack of opportunities to benefit from the communication, negotiation, and perspective-taking experiences that will typically lead to the development of a normal and adaptive childhood. Consequently, social and emotional fearfulness prevail to the point at which the benefits of peer interaction are practically impossible to obtain. Finally, behaviorists suggested that parents shape children’s social behaviors and emotional reactions through processes of conditioning and modeling (Maccoby, 2007). Children’s tendencies to directly imitate adult communicative, prosocial, aggressive, and even socially anxious and withdrawn behaviors have been reported consistently in the literature (Aktar, Majdandžić, de Vente, and Bögels, 2013; Williamson, Donohue, and Tully, 2013), and social behaviors have been described as responsive to reinforcement principles (Baer and Sherman, 1964; Csapo, 1983). A strong link between parental socialization techniques and the display of child behavior in non-familial settings has been central to proponents of social learning theory.

Summary Almost all major psychological theories that address the development of children’s social and emotional development in general, and more specifically the development of competent and adaptive behaviors versus incompetent and maladaptive behaviors (e.g., social withdrawal), place a primary responsibility on parental attributes and behaviors, as well as on the quality of the parent–child relationship. Historically, these theories have provided the undercarriage for a quickly growing corpus of data concerning the nexus of parent–child relationships,“parenting” behaviors, and child “outcomes.” 471

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Attachment Relationships, Social and Emotional Competence, and Behavioral Inhibition and Social Withdrawal One of the most important contributions of parents to children’s early social development is the formation of a parent–child attachment relationship based on the quality of the caregiving that they provide to their infants. According to Bowlby’s (1969, 1973) theory of attachment, infants who receive consistently warm, responsive care from their parents form secure attachment relationships with their parents (type ‘B’ attachment), coming to view themselves as valuable and deserving of care, and expecting their social partners to be trustworthy and supportive. By contrast, children who receive inconsistent or harsh caregiving believe themselves to be undesirable and unworthy of care, and they expect others to be untrustworthy and rejecting. As a result, insecure children may be more likely to be socially wary, and their lack of social self-efficacy and anticipation of rejection may prevent them from approaching others frequently or investing significant effort into building relationships with peers. Children with insecure avoidant attachments (type ‘A’ attachment) stemming from harsh and rejecting parenting may perceive the social world as hostile and choose to either act aggressively or avoid social interaction (Cassidy, 1994). Meanwhile, children with insecure ambivalent attachments (type ‘C’ attachment) due to inconsistent, unpredictable caregiving may not be able to rely on caregivers to support self-regulation processes and may become emotionally dysregulated in social situations, leading to anxiety-driven social withdrawal (Spangler and Schieche, 1998).Thus, Bowlby’s theory predicts that secure attachment in infancy generates positive internal working models of relationships that lead to social competence and high-quality peer relationships, whereas insecure attachment styles may predispose children to demonstrate socially incompetent, withdrawn behaviors. There is considerable empirical support for linkages between secure attachment of parent–child relationships and the demonstration of competent social behaviors and peer relationships throughout childhood. For example, a meta-analysis demonstrated that securely attached children display better social skills with and are more accepted by peers than insecurely attached children (Groh et al., 2014). Thus, secure attachment is strongly associated with the ability to effectively engage in positive social interactions with peers. Initial support for the hypothesized relations between insecure attachment status and the display of wary-fearful behavioral inhibition and/or socially withdrawn behavior derived from several sources. To begin with, infants with ambivalent-insecure attachments (or ‘C’ babies) had been described as more whiney, easily frustrated, and socially inhibited at 2 years than their secure age-mates (Fox and Calkins, 1993). Children classified at 1 year as ‘C’ babies have been described at 4 years as lacking in confidence and assertiveness (Erickson, Sroufe, and Egeland, 1985) and at 7 years as passively withdrawn (Renken, Egeland, Marvinney, Sroufe, and Mangelsdorf, 1989). Spangler and Schieche (1998) reported that of the 16 ‘C’ babies they identified in their research, 15 were rated by their mothers as behaviorally inhibited. When the behaviorally inhibited toddlers were faced with novelty or social unfamiliarity, they became emotionally dysregulated and retreated from unfamiliar adults and peers. Furthermore, confrontation with unfamiliarity brought with it increases in hypothalamic-pituitary-adrenocortical (HPA) activity, a physiological cue of distress (Spangler and Schieche, 1998).This observation was paralleled by a report that behaviorally inhibited toddlers with insecure attachments have stronger HPA reactivity in the Strange Situation and in the Risk Room (a set of novel social events designed to assess inhibition) than do securely attached toddlers or insecurely attached but not inhibited toddlers (Nachmias, Gunnar, Mangelsdorf, Parritz, and Buss, 1996).Thus, it appears that both insecure attachment status and behavioral inhibition may serve as early impetuses for the development of distressed responses that could contribute to socially fearful and withdrawn behaviors in childhood. The specific relation between ‘C’ status and behavioral inhibition or social withdrawal has not been entirely consistent. Rather, findings support either negative relations between security of attachment 472

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and social withdrawal, or positive associations between insecurity (both avoidant (A) and ambivalent (C) status) and social withdrawal. For example, children who demonstrate secure attachment with their mothers in infancy display less observed social withdrawal with peers in middle childhood than do insecurely attached children (Bohlin, Hagekull, and Rydell, 2000). And Bohlin, Hagekull, and Andersson (2005) reported that behaviorally inhibited toddlers are at risk for becoming socially withdrawn during middle childhood, but only if they had an insecure attachment relationship with their primary caregiver in infancy. Relatedly, Seibert and Kerns (2015) reported that young children with avoidant attachments engage in more socially withdrawn behavior as elementary schoolers than either securely or ambivalently attached children. Booth-LaForce and Oxford (2008) demonstrated that insecure toddlers are described by their teachers as more shy throughout the elementary schoolage period. During adolescence, youth who have insecure attachments with their primary caregivers are more likely to be nominated by peers as being socially withdrawn than are youth with secure attachments (Dykas, Ziv, and Cassidy, 2008).

Culture, Attachment, and Social Withdrawal Importantly, the associations between attachment security, social competence, and social withdrawal have been demonstrated to be consistent across a variety of countries and cultures by several studies. For instance, in a study of Portuguese preschoolers, Verissimo, Santos, Fernandes, Shin, and Vaughn (2014) found that attachment security was positively associated with social competence, peer acceptance, and the frequency of engaging in peer interactions. Similarly, Israeli elementary school children who report secure attachment to their mothers are rated by teachers as more socially competent with peers (Scharf, Kerns, Rousseau, and Kivenson-Baron, 2016). Among school-age Chinese children, self-reported secure attachment is associated with greater peer-reported sociability and less shyness, whereas avoidant and ambivalent attachment are related to higher levels of peer-reported shyness (Chen, 2012; Chen and Santo, 2016a). Swedish children with ambivalent attachment status are rated by teachers as less sociable than are securely attached children (Rydell, Bohlin, and Thorell, 2005). Likewise, during early adolescence, self-reported lower attachment security is associated with elevated levels of self-reported shyness in Finland (Ojanen, Findley-Van Nostrand, Bowker, and Markovic, 2017). Thus, research conducted beyond the borders of the United States and Canada has robustly replicated the finding that insecure attachment relationships are associated with socially incompetent behavior and the demonstration of socially withdrawn behavior throughout childhood and adolescence.

The Buffering Effect of a Secure Attachment Relationship In addition to predicting the extent to which children are socially withdrawn, the attachment relationship may serve as a moderator of relations between social withdrawal and negative socioemotional outcomes. Specifically, a secure attachment relationship may buffer socially withdrawn children from developing such internalizing symptoms as anxiety and depression, whereas an insecure attachment may increase the risk of social and emotional difficulty. For example, Gullone, Ollendick, and King (2006) found that social withdrawal was positively associated with depressive symptoms, but that this association was significantly weaker among securely attached children. Likewise, Peter (2016) showed that socially withdrawn children who were securely attached to both mothers and fathers reported low levels of self-critical rumination (a tendency to focus on negative aspects of the self, which is related to depressive symptomology). However, withdrawn children who had an insecure attachment relationship with either parent engaged in higher levels of self-critical rumination that increased over time. In a sample of Dutch children, Muris, van Brakel, Arntz, and Schouten (2011) found that insecure attachment exacerbated the relation between socially inhibited behavior and anxiety symptoms; 473

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socially inhibited children with insecure attachments reported the highest levels of anxiety. Similarly, Chen and Santo (2016b) reported that among Chinese elementary school children, an insecure attachment moderated the relations between social withdrawal and peer difficulties, such that withdrawal was more strongly associated with peer victimization at high levels of avoidant attachment and more strongly associated with peer rejection at high levels of ambivalent attachment. Taken together, these findings suggest that a secure attachment relationship may operate as a protective factor that helps socially withdrawn children cope with the negative social and emotional consequences of withdrawn behavior, whereas an insecure attachment relationship may render withdrawn children particularly susceptible to internalizing problems and peer difficulties.

Summary The quality of attachment relationships that children develop with their primary caregivers seems to play a significant role in children’s ability to engage comfortably and effectively with peers and adults. Securely attached children generally become sociable, socially competent, and well-liked by peers. Insecurely attached children are at risk of having difficulty interacting with peers and ultimately withdrawing from peer interactions. Furthermore, among children who do display withdrawn behavior, attachment security appears to buffer children against negative social experiences and emotional difficulties, whereas insecure attachment exacerbates the risk of socioemotional problems associated with withdrawal. Thus, by providing children with their earliest social experiences and fostering the development of secure or insecure internal working models of social relationships, parents seem to shape children’s strategies for navigating their social world and may steer them either toward or away from the development of social withdrawal.

Parents’ Beliefs About Adaptive and Maladaptive Behaviors The internal working models that guide children’s expression of competent and incompetent, or adaptive and maladaptive, emotional and behavioral expressions, are generally construed as residing within the minds of children. Parents also have internal working models of relationships. These models have been framed within the constructs of parental beliefs, ideas, and cognitions about the development, maintenance, and dissolution of relationships and about the behaviors that might contribute to the quality of relationships. Parental beliefs comprise the ways in which parents think and feel about their children and themselves as parents. They include the causal explanations or attributions parents make for children’s behavior, the socialization goals they have while parenting, the strategies they consider appropriate to use with children (Hastings and Grusec, 1998), their sense of efficacy or competency as parents (Schuengel and Oosterman, 2019), and the emotions they experience in the context of childrearing (Leerkes and Augustine, 2019). These dynamic belief systems contribute to how parents respond to children’s behaviors during interactions and to broader aspects of childrearing, such as the ways in which parents establish the home environment (Bugental and Goodnow, 1998). They are also contextually bound and malleable, as parental beliefs change adaptively across childrearing situations, and children’s behaviors and characteristics contribute to parental beliefs (Hastings and Rubin, 1999). Reviews of the influences of parental beliefs (Hastings, Nuselovici, Rubin, and Cheah, 2010) have highlighted the significance of this domain for understanding socialization processes. There is evidence that parents’ beliefs concerning child development in general, and the development and maintenance of adaptive and maladaptive behavioral and emotional styles in particular, contribute to, predict, and partially explain the development of socially competent and incompetent behaviors in childhood. To this end, research concerned with parents’ ideas about children’s socioemotional development represents an examination of the parents’ own “inner working models” of 474

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relations among social skills, emotion regulation, and social relationships. Not only do belief systems contribute to how parents contingently respond to their children’s behaviors, they also influence the ways in which parents establish broader aspects of the childrearing environment (Rubin and Chung, 2006). Many researchers believe that parenting behaviors are cognitively “driven” (Bornstein, Putnick, and Sawalsky, 2017; Rubin, Hemphill et al., 2006) and that these cognitions are themselves influenced by such factors as parents’ education, socioeconomic status, and ethnicity (Bornstein, 2016); cultural contexts (Mesman, van IJzendoorn, et al., 2016); child gender, age, developmental level, and temperament (Putnam, Sanson, and Rothbart, 2002); and parents’ own history of parent– child relationships (Grusec, Hastings, and Mammone, 1994). In this section, we tackle these issues and consider how parents’ beliefs are associated with children’s social competencies and the lack thereof—specifically, social withdrawal.

Parents’ Beliefs About Social Competence and Social Withdrawal In general, parents tend to view their children optimistically and forecast healthy developmental outcomes for them. Rubin, Hymel, and Mills (1989) found that mothers who considered the development of social skills to be very important had children who were observed to demonstrate social competence in their preschools. These children more frequently initiated peer play, used appropriate kinds of requests to attain their social goals, were more prosocial, and were more successful at gaining peer compliance than their age-mates whose mothers did not place a high priority on the development of social competence. Parents of socially competent children believe that, in early childhood, they should play an active role in the socialization of social skills via teaching and providing peer interaction opportunities (Rubin, Hemphill, et al., 2006). When these parents are asked to think about their young children displaying shyness or social withdrawal, they report feeling surprised or confused, expect the behavior to be transitory and situationally caused (Dix and Grusec, 1985), and say that they would engage with the child in supportive and indirect ways, such as planning future play dates (Rubin and Mills, 1991). However, parents whose preschoolers display socially incompetent behaviors, such as social withdrawal, are less likely to endorse beliefs in the importance of social skills (Rubin et al., 1989). They are more likely to attribute the development of social competence to internal factors (“Children are born that way.”), to believe that incompetent behavior, once attained, is difficult to alter, and to believe that interpersonal skills are best taught through direct instructional means (Rubin et al., 1989).When mothers of socially withdrawn children are asked specifically about their children being shy with peers, they report emotions such as disappointment and guilt and suggest direct intervention strategies, such as involving themselves in the situation to change their children’s immediate behavior (Mills and Rubin, 1990). To a large extent, research on how parents feel about, think about, and consequently deal with children’s social wariness and withdrawal is guided by information-processing approaches to the study of parenting problems (Rubin et al., 1989). According to Bugental (1992), parenting may be a source of considerable stress, especially if the child is viewed as a “problem.” The “problematic” child who demonstrates difficult behaviors may evoke rather different parental emotions and cognitions than would the “typical” child when she or he demonstrates the identical maladaptive behaviors. In the case of typical children, the production of social withdrawal and wariness may activate parental feelings of concern and puzzlement. These affective responses are regulated by the parent’s attempts to understand, rationalize, or justify the child’s behavior and by the parent’s knowledge of the child’s social skills history and the known quality of the child’s social relationships at home, at school, and in the neighborhood. Thus, in the case of non-problematic children, the evocative stimulus produces adaptive, solution-focused parental ideation that results in the parent’s choice of a reasoned, sensitive, and responsive approach to dealing with the problem behavior (Bugental and Happaney, 2002). In 475

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turn, the child views the parent as supportive and learns to better understand how to behave and feel in similar situations as they occur in the future. As such, a reciprocal connection is developed between the ways and means of adult and child social information processing. Mothers of extremely withdrawn preschoolers tend to think about children’s social development in ways that differ considerably from mothers of non-withdrawn children. Expressions of social fearfulness in the peer group may evoke parental feelings of worry, guilt or embarrassment, and perhaps with increasing child age, a growing sense of frustration (Rubin and Mills, 1990, 1992). The parent may be overcome by a strong belief that the child is vulnerable and must be helped in some way (Burgess, Rubin, Cheah, and Nelson, 2005). When asked to indicate how a variety of social skills might best be learned by their preschooler, mothers of withdrawn children were more likely to suggest that they would tell their child directly how to behave and they were less likely to believe that their children learn best by being active participants in, and processors of, their social environments (Rubin and Mills, 1990, 1992).This pattern of parental beliefs appears to be a direct response to their perceptions of their child’s social wariness and fearfulness. Mothers and fathers who view their toddlers as socially wary and shy are less likely to suggest that they would encourage their child’s independence at age 4 years (Rubin, Nelson, Hastings, and Asendorpf, 1999). Furthermore, mothers of behaviorally inhibited toddlers endorse overly protective childrearing strategies (Chen et al., 1998). And if mothers of inhibited toddlers do endorse overprotective strategies, when their children are of preschool age, they react to scenarios in which their children demonstrate withdrawal by suggesting that they would deal with their children’s problematic behaviors through direct, authoritarian means (Hastings and Rubin, 1999). Taken together, the lack of encouragement of independence combined with attitudes pertaining to overprotectiveness may minimize children’s opportunities to explore the environment, think about alternate perspectives, or engage in social “planning.” The body of literature reviewed herein has contributed to the development of a theoretical model which suggests that parents of socially withdrawn children perceive them as vulnerable. We have painted a portrait of mothers (and fathers; Rubin et al., 1999) of socially withdrawn preschoolers as having beliefs that endorse overprotective parenting strategies. If such an endorsement is realized in parental behavior, it would assuredly be detrimental to the child’s developing senses of autonomy and social efficacy, as well as their social competence and positive self-regard (Rubin et al., 2009).

Parental Beliefs and Children’s Age Parents’ beliefs, perceptions, and attitudes change as their children grow older (McNally, Eisenberg, and Harris, 1991; Mills and Rubin, 1992). Parents recognize that advances in social skills occur with age, and therefore they think that older children must be held more responsible than younger children for their undesirable behaviors. For example, with increasing age of the child, mothers tend to react to socially inappropriate behaviors with increasing negative affect, interpreting the behavior as more internal and dispositional, endorsing stricter and more punitive responses (Dix, 1991; Dix and Grusec, 1985). Regarding social withdrawal specifically, and consistent with the notion that belief systems are influenced by parents’ experiences of rearing children, inhibited or fearful toddlers have parents who become less encouraging of their children’s autonomy and independence over the subsequent 2 years (Rubin et al., 1999). Furthermore, mothers who perceive their toddlers to be more fearful are more likely to report that they would respond to preschoolers’ reticent behaviors by getting directly involved in their peer interactions (Hastings and Rubin, 1999). Given the emotions and attributions we have already noted in mothers of inhibited and withdrawn young children, it may be that in attempting to regulate their own reactions to their children’s behaviors, these mothers choose to “keep their house in order” by overregulating their children’s activities. During elementary school (5–9 years), mothers of withdrawn children have described their affective reactions to social withdrawal as involving less surprise and puzzlement than mothers of 476

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non-withdrawn children. These findings are themselves unsurprising given the stability of withdrawal from the early to middle years of childhood (Asendorpf, 1993). Furthermore, Mills and Rubin (1992) found a number of changes in the ways that mothers appraised displays of withdrawal, in the strategies they chose to deal with those behaviors, and in the beliefs that they had about how children learn social skills. Although mothers of withdrawn elementary schoolers also attributed withdrawal to internal personality traits in their children, they no longer suggested that they would react to displays of withdrawal in a power assertive manner (Mills and Rubin, 1993). For example, from the ages of 4 to 6 years, displays of withdrawal became less easily excused as reflecting immaturity or as being caused by sources external to the child (e.g., “Other children would not allow my child to join them in play.”). Instead, there was an increase in the extent to which mothers attributed these behaviors to internal dispositional characteristics. These trait attributions were associated with an increase in mothers’ beliefs that they would not respond to their child’s demonstration of social withdrawal in peer play situations. These findings suggest that, during early childhood, the parent may make active efforts to deal with the child’s social wariness and withdrawal; however, in time, the parent judges her or his efforts to be fruitless. It is important to note that neither pattern of socialization, overprotectiveness in the preschool years nor neglect or dismissing of school-aged children, would be adaptive in helping shy and withdrawn children develop greater social competence.

Cultural Considerations There is now substantial evidence that parents’ cultural identities, experiences, and values help to shape parenting beliefs and subsequent interactions with their children (Bornstein, Putnick, and Sawalsky, 2017; Cheah, Leung, and Zhou, 2013). Consistent with a bioecological perspective (Bronfenbrenner and Morris, 2006), parenting beliefs and practices operate within the context of the surrounding community and culture, and parents’ beliefs are shaped by these contexts. Research in Western cultures typically identifies autonomy and assertiveness as being valued, and social withdrawal and shyness in children is considered maladaptive and undesirable (Rubin, Oh, Menzer, and Ellison, 2011). Yet, some variability across Western countries has been noted (Rubin, Hemphill, et al., 2006). For example, Italian mothers report less strong emotional responses and more internal attributions for children’s shyness than Canadian mothers (Schneider, Attili, Vermigli, and Younger, 1997), and Turkish mothers report the use of indirect strategies and empathic goals in response to social withdrawal (Özdemir and Cheah, 2015). Yet, more attention has been given to contrasting between parents in Western versus Eastern countries. East Asian countries have been viewed as sharing a traditional value system based in Confucianism, in which the family is identified as the fundamental unit of society (Cheah and Park, 2006). In earlier studies of Chinese parents, researchers found that although self-restraint was encouraged, individualism or self-promotion was discouraged (King and Bond, 1985), and that inhibited and withdrawn behaviors in children were viewed as appropriate and valued (Chen, Rubin, and Sun, 1992). Cheah and Rubin (2004) reported that Chinese mothers endorsed external causal attributions for preschoolers’ socially withdrawn behavior and direct socialization goals focused on instilling long-term values and group-focused ideals; in contrast, European American mothers focused on internal attributions and the immediate psychological state of the child. In recent work in urbanized China, however, researchers have reported that, much as is the case in Western cultures, mothers reported that they would respond to children’s withdrawal, reticence, and solitary behaviors with coercion, directiveness, and overprotection (Rubin, Hemphill, et al., 2006). This appears to be a reflection of a cultural shift toward more Western-style values in urban China (Chen, Cen, Li, and He, 2005). Although East Asian, Confucian-based cultures such as Japanese, Mainland Chinese, and South Korean populations share some traditional values (Cho and Shin, 1996) and are often grouped together in cross-cultural research comparing Western and Eastern cultures, research has revealed 477

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variation between them in parenting beliefs.The socialization goals and parenting strategies of South Korean mothers may be more like European American mothers than those of Chinese mothers (Park and Cheah, 2005). For example, in response to scenarios within which their children are described as behaving in a socially withdrawn manner, Chinese mothers typically suggest promoting the child’s functioning for the betterment of the peer group, whereas South Korean and European American mothers prioritize goals of making the child feel happy and self-confident (Cheah and Rubin, 2004; Cheah and Park, 2006). However, differences between South Korean mothers’ parenting beliefs and the beliefs of mothers from Western cultures exist, for example, in the extent to which social withdrawal is attributed to internal versus external causes (Cheah and Rubin, 2004). It is clear from the reviewed literature that culture provides a key contextual source of information that may influence the ways in which parents think about their children’s behaviors (Bornstein and Cheah, 2006). Importantly, cultures can change as they develop, and cross-cultural research on parents’ beliefs and practices should continue to leverage longitudinal designs and diverse measurement strategies.

Summary A picture is emerging of the beliefs of parents of inhibited and socially withdrawn children. Parents who perceive inhibited and socially withdrawn behavior to be undesirable, but attributable to dispositional sources that are indicative of vulnerability, are likely to respond in emotional and behavioral ways that could perpetuate the very behaviors that they wish to change in their children.With young inhibited and withdrawn children, parents are likely to feel worried or anxious about the behaviors and to plan on directly intervening in their children’s social interactions; with older children, parents are likely to feel more frustrated and helpless to change their children’s tendencies. Ultimately, neither of these mindsets would be to the benefit of their children.

Parenting Behaviors with Behaviorally Inhibited and Socially Withdrawn Children The past two decades have borne witness to a notable increase in the amount of research being conducted on the parenting behaviors experienced by behaviorally inhibited and socially withdrawn children.The use of longitudinal studies with repeated measures, adoption samples, genetically informed designs, and experimental procedures have helped to bring greater clarity to the questions of whether parenting behaviors are causal contributors to the development of inhibited and withdrawn children. To the limited extent that there was empirical study of the childrearing behaviors of parents of inhibited and withdrawn children in the latter third of the twentieth century, this work was heavily informed by Baumrind’s (1967, 1971) research on parenting styles. She observed that, relative to the socially comfortable and competent preschool-aged children of authoritative parents who balanced authority with responsiveness, the children of highly controlling but unresponsive and inflexible authoritarian parents tended to be socially anxious, unhappy, and insecure in the company of their peers. Other researchers have similarly reported that children whose parents use authoritarian childrearing practices tend to have low self-esteem and lack spontaneity and confidence with peers (Lamborn et al., 1991). Booth-LaForce and colleagues found that during early adolescence, maternal restrictiveness and power assertion predicted a trajectory of increasing anxious withdrawal over a 4-year period (Booth-LaForce et al., 2012). The kind of parental control that is typically captured in assessments of authoritative and authoritarian parenting styles can be characterized as behavioral control, or the use of “rules and consequences” to manage children’s behavior. A few years prior to Baumrind’s reports, other socialization researchers suggested that social anxiety in children might be particularly engendered by another 478

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parental approach to control: manipulating children’s emotions, threatening their security in the parent–child relationship, restricting their self-directed activities, and undermining their autonomy (Schaeffer, 1959). Attention to this psychological control of children resurfaced toward the end of the twentieth century through the efforts of Barber (Barber, Olsen, and Shagle, 1994), Rubin (Mills and Rubin, 1998), and others. A growing body of research suggests that this intrusive and manipulative control by parents appears to diminish children’s sense of self-efficacy and ability to cope with challenges and increase children’s dependence on parents (Hastings et al., 2010).

Psychological Control and the Development of Shy and Withdrawn Children Much research has been focused on an aspect of psychological control that we have characterized as overprotective or oversolicitous parenting (Rubin, Hastings, Stewart, Henderson, and Chen, 1997). Overprotective parents tend to restrict their children’s behavior and actively encourage dependency. For instance, overprotective parents encourage their children to maintain close proximity to them, and they do not reinforce risk-taking and active exploration in unfamiliar situations. Parents of socially wary or fearful children may sense their children’s difficulties and perceived helplessness, and then might try to support their children directly either by manipulating their children’s behaviors in a highly directive fashion (e.g., telling the child how to act or what to do) or by actually intervening and taking over for the child (e.g., joining play with potential playmates; intervening during peer or object disputes). For example, Rubin and colleagues (1997) observed that mothers who were highly affectionate, controlling, and shielding when such behaviors were neither appropriate nor sensitive— such as during free play and snack time—had toddlers who were more inhibited and clingy when interacting with unfamiliar peers and adults. Furthermore, inhibited toddlers who experienced this intrusive overprotection were, 2 years later, likely to be socially reticent with unfamiliar peers (Rubin, Burgess, and Hastings, 2002). For toddlers whose mothers were not overprotective, toddler inhibition did not predict preschool reticence. Coplan and colleagues (2008) and Degnan and colleagues (2008) later replicated similar concurrent and predictive associations across the toddler to early elementary school-age periods in independent samples. Parental involvement, assistance, and affection are not typically thought of as maladaptive childrearing behaviors, but it is the exaggerated, intrusive, and contextually inappropriate expressions of these behaviors that are the hallmarks of overprotective parenting. Rubin, Cheah, and Fox (2001) illustrated this effectively when they observed maternal warmth, proximity, and control with preschoolers in two contexts: during a challenging teaching task on an activity that was beyond the child’s developmental level and during free play with age-appropriate toys.The former context is one in which preschoolers may need such solicitous behaviors from mothers to stay calm and engaged, whereas the latter context is not. Mothers were not consistent in their displays of solicitous behaviors across the two contexts, and it was only mothers’ solicitous behavior in the non-challenging free play task that predicted preschoolers’ socially reticent behavior with unfamiliar peers. In fact, the same maternal behaviors in the stressful teaching task predicted less reticent behavior with unfamiliar peers.The extent to which maternal solicitousness during free play—that is, inappropriate and exaggerated intrusive control—was detrimental to children’s social competence was further demonstrated in longitudinal analyses showing that this maternal behavior predicted increases in children’s reticent behavior among unfamiliar peers from 4 to 7 years (Cheah, Rubin, and Fox, 1999). Subsequent studies have provided support for the contribution of parental overprotection to children’s socially withdrawn characteristics. Hastings and colleagues (2008) found that mothers’ overprotective behavior at home predicted preschoolers’ socially reticent behavior with familiar peers at preschool and unfamiliar peers in the laboratory, but only for children with lower baseline parasympathetic influence over cardiac activity, or with stronger parasympathetic reactivity to a cognitive 479

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challenge. The parasympathetic nervous system is an important component of the capacity to regulate one’s state of autonomic arousal, and both low baseline and strongly reactive parasympathetic activity have been posited as biomarkers of poor emotion regulation and greater susceptibility to psychological distress (Beauchaine, 2015). Thus, this study suggested that physiologically vulnerable children might be prone to manifesting inhibited and wary behaviors when mothers are highly overprotective. Furthermore, preschoolers’ social wariness predicted mothers’ reports of more anxiety symptoms and teachers’ reports of poorer social skills 4 years later (Hastings, Kahle, and Nuselovici, 2014), but only for those children who, as preschoolers, also had both highly overprotective mothers and low baseline parasympathetic control. The combination of an external, exacerbating socialization agent and an internal, dispositional vulnerability, therefore, contribute to socially withdrawn preschoolers following a trajectory toward maladaptive social-emotional functioning. Others studies have shown more direct associations between overprotective parenting and children’s inhibited or withdrawn tendencies. For example, McShane and Hastings (2009) found that mothers reported more overprotective responses to children’s peer interactions when their preschool-aged sons displayed more anxious behaviors during free play at preschool. Hudson and colleagues found that maternal overinvolvement was concurrently associated with preschoolers’ inhibited behavior toward unfamiliar stimuli and people (Hudson, Dodd, and Bovopoulos, 2011a) and predicted mothers’ reports of inhibition 2 years later (Hudson, Dodd, Lyneham, and Bovopoulos, 2011b). Similarly, with early elementary school-aged children, Muris and colleagues (2011) found that parental overprotection predicted mother-reported inhibited behavior over 1 year. Studies such as these accord with an additive model of risk, suggesting that parental overprotection, or intrusive overcontrol, may increase the likelihood of shy tendencies in all children, not just temperamentally or physiologically susceptible children. In addition to the intrusive and solicitous nature of overprotection, there is another, and perhaps more pernicious, facet to psychological control: parental criticism, derogation, rejection, and emotional coldness. Such actions serve to undermine children’s sense of self-worth and their confidence in the security of a loving parent–child relationship. In one of the first studies to report this link, LaFreniere and Dumas (1992) observed that anxious and withdrawn preschoolers and kindergarteners had mothers who responded critically to their children’s negative behaviors and affect, but were unresponsive to positive behaviors and affect. Mills and Rubin (1998) found that similar behaviors were characteristic of mothers of anxious and withdrawn kindergarten to elementary school-age children. As with overprotection, some studies suggest additive contributions of maternal critical control to children’s social withdrawal, and other studies support an interactive model of critical control being particularly insidious for vulnerable children. As examples of the former, Wagner and colleagues (2016) reported that mothers who were negative, intrusive, and insensitive during the first year of infants’ lives reported that their children were more withdrawn at 3 years, and Booth-LaForce and Oxford (2008) found that mothers’ unsupportive and hostile behaviors toward preschoolers predicted greater social withdrawal, loneliness, peer exclusion, and unpopularity across the elementary school-age years. In accord with interactive models of vulnerability, Hane and colleagues (2008) reported that negativity from mothers of preschoolers magnified the link between preschoolers’ reticent behavior and their social withdrawal at 7 years, and Davis and Buss (2013) found that kindergarteners’ temperamental shyness was only associated with reticent behavior toward unfamiliar peers when mothers responded negatively and unsupportively to children’s negative emotions. Some investigators have examined both overprotective and critical aspects of psychological control in the same studies to determine whether they have distinct or convergent relations with children’s inhibition and withdrawal. Although the predictive effects of overprotection were stronger, Rubin and colleagues (2002) found that maternal criticism and negativity similarly enhanced the stability of inhibited, reticent behavior over 2 years. In their report, McShane and Hastings (2009) noted that maternal overprotection, but not critical parenting, was associated with children’s anxious 480

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tendencies at preschool. Overall, at least in early childhood, the available evidence points toward somewhat stronger ties between children’s withdrawn and anxious characteristics and mothers’ overprotective parenting than is the case for mothers’ critical and derisive parenting.

Beyond Social Withdrawal: Parenting Behavior and the Development of Internalizing Problems and Disorders Behaviorally inhibited, shy, and socially withdrawn children are at risk for developing internalizing problems and disorders, such as social anxiety (Rubin et al., 2009). There is some evidence that this risk may be increased by, or conveyed through, parental psychological control. There are robust associations between maternal psychological control and children’s anxiety symptoms and disorders (Degnan, Almas, and Fox, 2010; van der Bruggen, Stams, and Bögels, 2008), and several of the aforementioned studies indicated that parents’ psychological control was related to children’s internalizing problems and anxiety symptoms in ways that were similar to its relations with children’s reticence and wariness (Hastings et al., 2008, 2014; Hudson et al., 2011a). Bayer and colleagues (2006) reported that maternal overprotection at 2 years was prospectively predictive of children’s internalizing difficulties at 4 years, independent of the associations that toddlers’ inhibited temperament had with both parenting and internalizing problems. Similarly, Mills and colleagues (2012) reported that more critical mothers reported more internalizing problems in their preschool-aged children, and in the same sample an aggregate of critical, punitive, and unsupportive parenting of preschoolers predicted more mother-reported (but not teacher-reported) internalizing problems 4 years later, especially for highly inhibited boys (Hastings et al., 2015). Muris and colleagues (2011) distinguished parents’ overprotective behaviors from their feelings of worry and anxiety about childrearing (e.g., “You are scared when your child does something on his/her own,” p. 161); only the latter was predictive of children’s anxiety symptoms 1 year later. Finally, LewisMorrarty and colleagues (2012) found that an index of stable inhibition from infancy to 7 years predicted symptoms of social anxiety disorder in adolescence, but only for children of mothers who exhibited high levels of intrusive overcontrol at 7 years; maternal intrusive overcontrol also directly predicted the increased likelihood of youth having diagnoses of social anxiety disorders. This study suggests that adolescence is a period of heightened risk for the emergence of clinical anxiety problems for inhibited or withdrawn children with psychologically controlling parents.

Positive Parenting: What Can Parents Do to Attenuate Children’s Inhibition and Withdrawal? Fortunately, researchers have not only looked at what parents do with their children that serves to exacerbate their inhibited and wary tendencies. There is considerable evidence that appropriately engaged parents, who guide their shy and wary children’s autonomous actions through low-power control, can help to promote greater social confidence and competence (Hastings et al., 2010). Typically, this evidence is seen in studies that measure maternal sensitivity, supportiveness, encouragement, structuring, and scaffolding, or more broadly, an authoritative parenting style. Maternal supportiveness and respect for children’s autonomy have been found to be concurrently associated with (McCabe, Clark, and Barnett, 1999) and prospectively predictive of (Booth-LaForce and Oxford, 2008) less socially withdrawn behavior with peers at school. Similarly, among preschoolers, maternal supportiveness has been found to be concurrently (Hastings et al., 2008) and prospectively (Bayer et al., 2006; Wagner et al., 2016) associated with having fewer internalizing problems and being less withdrawn. The benefits of positive parenting may be particularly strong for temperamentally vulnerable children. Chen, Zhang, and colleagues (2014) found that higher maternal supportiveness diminished the associations between temperamental inhibition and being more shy and less socially competent, in a 481

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sample of toddlers from families living in urban centers in China. Davis and Buss (2013) reported that when mothers made more supportive responses to kindergarteners’ displays of negative emotions, shy children were less likely to be reticent in the presence of unfamiliar peers, occupying themselves with constructive solitary play activities instead. Similarly, in analyses of a large sample of families from the NICHD Study of Early Child Care and Youth Development, responsive, stimulating, and structuring maternal behaviors toward infants were found to predict fewer withdrawn behaviors in early childhood specifically for temperamentally slow-to-warm-up infants (Grady, Karraker, and Metzger, 2012). It is important to note, though, that such parental behaviors need to be enacted sensitively and appropriately. Kiel and colleagues (2016) reported a curvilinear relation between maternal encouragement to approach novelty and inhibited toddlers’ anxiety during separation; compared to children with mothers who were either protective and shielding, or were too pushy and insistent, inhibited toddlers of gently encouraging mothers showed the least separation distress (also see Bornstein and Manian, 2013, for the benefits of moderate versus high maternal contingency). The benefits of positive parenting for shy and wary children may even extend beyond children’s sociability and mental health. Low-power control techniques, such as the use of reasoning to elicit compliance from toddlers, have been found to predict the development of greater morality and conscience specifically in fearful and inhibited toddlers (Augustine and Stifter, 2015; Kochanska, 1997; Kochanska, Aksan, and Joy, 2007). The evidence from these studies is both encouraging and practical, especially insofar as the potential to translate research into practice is concerned. Those practitioners who focus on parenting to promote well-being in inhibited and withdrawn children need not only to tell parents what not to do (do not use psychological control). They also need to provide parents with what they can and should do; that is with instruction on alternative, effective childrearing practices that will foster the positive growth of their children.

Causal Effects of Parenting on the Development of Inhibited and Withdrawn Children We have been interpreting the findings of the preceding studies as supportive of a model in which parenting behavior is a determinant of children’s social development. However, even with robust sample sizes, longitudinal designs including repeated measures, and analyses of transactional relationships between parents and children over time, these studies cannot be taken as convincing proof of the causal effects of parenting on children’s social withdrawal. For that, one would need to see consistent findings in studies that include experimental, intervention, or genetically informed designs. (Although the third are not as robust tests of causality as the first two, they serve to rule out the potential for genetic factors accounting for observed associations between parenting behavior and child shyness, wariness, or sociability, such as the genetic relatedness of parents and children or evocative effects of children’s genetic traits.) The Cool Little Kids program was developed as a modularized 6-week parent-training intervention for families of young, behaviorally inhibited children (Rapee, Kennedy, Ingram, Edwards, and Sweeney, 2005).The central aim of the intervention is to decrease parental overprotection and simultaneously to increase parents’ encouragement of child independence. Relative to inhibited children of parents in control groups, greater reductions in anxiety symptoms and diagnoses have been documented in inhibited children of parents who received the intervention in small-group classes (Rapee, Kennedy, Ingram, Edwards, and Sweeney, 2010), even, for girls, up to several years later as adolescents (Rapee, 2013). Similar benefits within early childhood were observed when the parenting modules were delivered in an individualized online format (Morgan, Rapee et al., 2017). However, changes in the targeted parenting behaviors have not yet been shown to account for treatment effects on children’s inhibition or anxiety, so it is difficult to discern the precise mechanism of effect for this promising intervention. 482

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Grady and Karraker (2014) used a “bug in the ear” procedure to manipulate the statements of mothers toward their shy toddlers during a peer interaction task. Each temperamentally shy toddler was paired with two non-shy, same age and same-gender peers; the mothers of the non-shy peers sat in the room but were instructed not to interact with the children. The mothers of shy children were given instructions to issue five warm, praising statements in a minute, or five statements encouraging social interaction and suggesting ways to play with the other children, and shy children’s play behaviors were observed in the subsequent minute. Compared to their play prior to manipulation, shy children displayed less reticent behavior in the minute following encouraging statements, but not following warm statements. Thus, gentle or low-power maternal control through encouragement and guidance can have immediately observable effects on shy toddlers’ reticence with peers. Chronis-Tuscano, Rubin, and colleagues (2015) reported on a pilot study of the efficacy of an intervention program (“The Turtle Program”) targeting both parents’ childrearing and extremely shy or inhibited preschooler’s social and emotional competence. Parents received an 8-week program based on parent–child interaction therapy (PCIT) for social anxiety disorder, while at the same time, preschoolers received social skills and emotion regulation skills training in small groups of extremely shy or inhibited age-mates. Notably, the parent component incorporated exposure practice with the child peer group during treatment so that each parent was coached, via a “bug-in-the-ear” device, in vivo. During this parental coaching, other parents observed from a separate room (via streamed video) for the purpose of vicarious learning. Compared to families in a waitlist control condition, the Turtle Program increased maternal sensitivity and positive affect and decreased children’s inhibition, internalizing problems, and anxiety symptoms as reported by mothers and teachers. In a subsequent report based on the same sample, children in the treatment group were observed, in their preschool settings, to have demonstrated increases in social initiations toward and social play with peers (Barstead, Danko, et al., 2017). However, given that the multimodal treatment program delivered training in effective childrearing behavior for parents and training in self-regulation and social skills for children, it is difficult to discern whether the positive effects of the intervention can be attributed specifically to the parent-training component. Guimond and colleagues (2012) utilized a sample of monozygotic twins to examine how differential parental treatment of genetically identical children predicted the development of their social behaviors. Mothers and fathers reported on their overprotective and harshly punitive behaviors toward each twin at 30 months, and at kindergarten age, twin pairs were observed in a cooperative, shared-toy task with two familiar peers. Boys displayed more reticence if they experienced more overprotective behaviors from mothers or fathers, compared to their genetically identical brothers. Van der Voort and colleagues (2014) used an adoption study to examine how parenting behavior toward children who were genetically unrelated to their parents was predictively related to inhibition and internalizing problems in adolescence. More maternal sensitivity during a challenging puzzle task at 7 years predicted less mother-reported inhibition at 14 years, after accounting for the stability of both inhibition and sensitivity. In turn, lower adolescent inhibition predicted less anxiousdepressed behavior in the youth. Together, this small set of studies has provided clearer evidence for the causal effects of both positive parenting (sensitivity, encouragement) and psychological control on the social behaviors and adjustment of inhibited, shy, and wary children. The findings from these experimental, intervention, and genetically informed designs are largely consistent with those of the correlational and longitudinal studies considered previously. Even while acknowledging the genetic, temperamental, and biological factors that contribute to the initial etiology of inhibited and socially wary tendencies (Hastings and Guyer, 2015; Rubin and Burgess, 2002), it is reasonable and defensible for developmental scientists to state that the ways in which parents interact with and rear their children will have effects on the stability and sequelae of those tendencies. 483

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The Parenting of Fathers of Inhibited and Withdrawn Children In the preceding sections, we noted associations reported in a few studies between paternal parenting and children’s shy and wary characteristics (Guimond et al., 2012; Rubin et al., 1999). Although there have been far fewer investigations of fathers’ behavior than there have been of mothers’, the existing evidence is sufficient for drawing tentative conclusions (Hastings et al., 2010).To begin with the conclusion, fathers’ critical and harsh parenting, as well as their sensitive, structuring, and encouraging parenting, share similar relations with child inhibition and withdrawal as do such behaviors by mothers, whereas evidence for the deleterious effects of fathers’ overprotection is somewhat mixed. Multiple studies have indicated that stricter or stronger behavioral control, more criticism and negativity, and less supportiveness from fathers is associated with preschool- to elementary schoolaged children’s socially withdrawn behaviors with peers and their being less socially competent or liked by peers (Hastings et al., 2008; McDowell, Parke, and Wang, 2003; McShane and Hastings, 2009; Miller, Murry, and Brody, 2005; Rah and Parke, 2008). McShane and Hastings (2009) also had fathers report on their overprotective parenting, but did not find it be robustly associated with young children’s social anxiety or internalizing problems. Curiously, Hastings and colleagues (2008) found that preschoolers’ parasympathetic regulation, as measured by respiratory sinus arrhythmia (RSA), moderated the associations between fathers’ supportive and overprotective parenting and children’s inhibition, wariness, and internalizing problems—but in patterns opposite to what was observed for mothers’ parenting. As the authors observed, “weak vagal suppression demarcated children susceptible to the protective overcontrol [and supportiveness] of fathers but not that of mothers” (p. 59). It is possible that individual differences between children may make them more responsive or susceptible to the influences of fathers versus mothers, an idea that warrants further investigation.

Summary Numerous lines of inquiry have shown that behaviorally inhibited and socially withdrawn children are more likely than socially competent children to experience intrusive, overprotective, critical, and unsupportive parenting from their mothers and fathers. These parenting behaviors are likely to perpetuate and exacerbate children’s inhibited and withdrawn tendencies and may contribute to the emergence of more debilitating internalizing problems. One may ask, then, why is it that parents would engage in such inappropriate actions with their inhibited and withdrawn children?

Determinants of Intrusive, Overprotective, Critical, and Unsupportive Parenting Knowing that the actions of parents have direct consequences for the development of inhibited and withdrawn children, it behooves us to consider factors that may lead parents to engage in childrearing behaviors that are detrimental to the well-being of their children. Children’s withdrawn characteristics have been found to predict parenting behavior. For example, McShane and Hastings (2009) reported that preschoolers’ displays of anxiety at preschool predicted increases in fathers’ overprotective parenting in the subsequent year, whereas preschool teachers’ reports of internalizing problems predicted increases in mothers’ critical parenting. In a longitudinal study using molecular genetics, Propper and colleagues (2012) noted evocative effects of girls’ genotypes on maternal sensitivity. Independent of mothers’ genotypes, girls with what is considered to be an “at-risk” polymorphism of the dopamine receptor gene DRD4 had mothers who displayed less sensitive parenting in infancy and toddlerhood. Five years later, teachers described girls with this DRD4 polymorphism as shyer and more lonely, and maternal sensitivity partially mediated the association between genotype and teachers’ reports. Analogously, in a three-wave longitudinal study with young adolescents, Van Zalk and Kerr (2011) 484

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found that youth-reported shyness in grade 7 predicted youth reports of greater intrusive overcontrol and rejection, and less warmth, from parents in grade 8. In turn, parents’ intrusive overcontrol in grade 8 predicted greater shyness in grade 9. These studies parallel the studies of child effects on parental beliefs examined previously, and they show that children’s shy, withdrawn, and anxious characteristics can result in parental behavior that may result in a self-sustaining “vicious cycle.” Of course, not all parents of inhibited or withdrawn children respond to their children’s wary traits or reticent behaviors with intrusive, overprotecting, or critical parenting behaviors. In their adoption study, van der Voort and colleagues (2014) observed that withdrawn behavior in middle childhood predicted greater maternal sensitivity during parent–child observations in adolescence. The concurrent associations between mothers’ overprotective or oversolicitous parenting and inhibited or withdrawn behavior in toddlers and preschoolers are rather modest (Hastings et al., 2008; Rubin et al., 1997). What is it that distinguishes between parents who respond to shy, wary children in ways that are likely to maintain or exacerbate their wary tendencies and those who enact more sensitive and appropriate encouragement of their children’s autonomy and self-assurance?

Intrapersonal Factors Parental beliefs about children’s social characteristics contribute to parental behavior. Parents who believe (1) that social behaviors are attributable to stable factors that are internal to the child; (2) that direct parental involvement is the best way to manage children’s social behaviors with peers; (3) that they are responsible for—and feel guilty, worried, and embarrassed by—children’s displays of reticence; and (4) that wary children are vulnerable, are likely to behave in ways that further undermine the development of social competence in shy children. Perhaps it is not surprising that parents who think and behave in these ways are themselves likely to have anxious tendencies, neurotic personalities, and internalizing disorders (Coplan, Arbeau, and Armer, 2008; Mills et al., 2012; Murray et al., 2014). In a 20-year longitudinal study, Grunzeweig and colleagues (2009) found that women who had been evaluated as more withdrawn by peers in school were likely to exert more intrusive control during interactions with their own toddler- to kindergarten-aged children. Additional studies suggest that mothers’ physiological capacities for effective emotion regulation may also contribute to their parenting. Kiel and Buss (2013) reported that mothers who showed stronger adrenocortical reactivity to parent–child interactions, as demonstrated by increased salivary cortisol after the interaction relative to before, engaged in more intrusive control with more inhibited toddlers. Root and colleagues (2016) observed that mothers who were themselves more shy and anxious reported using more overprotective parenting with preschoolers only when they also had lower baseline parasympathetic activity. Both stronger adrenocortical reactivity and weaker parasympathetic regulation have been associated with subclinical and clinical levels of anxiety problems (Hastings and Guyer, 2015), such that these studies are consistent with behavioral characterizations of parents who are most prone to using psychological control with their shy and wary children.

Relationship and Contextual Factors Socioeconomic, contextual, and relationship processes have been shown to shape the childrearing behaviors of parents. Economic stress due to lack of financial resources creates feelings of frustration, anger, and helplessness that can be translated into less than optimal childrearing styles (Bornstein, 2016; Magnuson and Duncan, 2019). Stressful economic situations predict parental negativism and inconsistency (Elder,Van Nguyen, and Caspi, 1985).Thus, parents who are financially distressed generally tend to be more irritable and moody than parents who have few financial difficulties (Ackerman, Izard, Schoff,Youngstrom, and Kogos, 1999). They are less nurturant, involved, child-centered, and consistent with their children (Elder et al., 1985). Economic stress also increases interparental 485

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conflict and parents’ feelings of being unsupported by their spouse. Researchers have reported consistently that spousal discord and marital dissatisfaction predict negative parental attitudes about childrearing as well as insensitive, unresponsive parenting behaviors (Emery, 1982; Jouriles et al., 1991), including the use of psychological control, as seen in a sample of immigrant Chinese American and Korean American mothers by Cheah and colleagues (2016). Although family income or socioeconomic status has not often been the focus of developmental scientists who study the parents of inhibited and socially withdrawn children, a few reports have indicated that more attention to the economic resources of families is warranted. In a large sample of families with preschool-aged children in Canada, Mills and colleagues (2012) observed less supportive and more punitive parenting behavior by mothers, more negative maternal emotionality, and more preschooler internalizing problems in families experiencing more socioeconomic stress, as reflected in low income, low occupational status, and low parental education. Intriguingly, independent of the positive association between temperamental inhibition and internalizing problems, they also found that the association between socioeconomic stress and children’s internalizing problems was fully mediated by mothers’ positive parenting. In a follow-up report, Hastings and colleagues (2015) found that, 4 years later, internalizing problems were elevated in children who came from families who had been experiencing more socioeconomic stress in the preschool period, and were most elevated for girls who had been highly temperamentally inhibited as preschoolers. The authors suggested that this was consistent with Zahn-Waxler’s model (Zahn-Waxler et al., 2000) of the multiple dispositional and environmental factors that increase girls’ susceptibility for developing problems of anxiety and depression. Conger and colleagues (2007, 2010) proposed a comprehensive model of family stress processes that charts the interconnections of material hardship, economic stress, strained marital relationships, parent distress, poor parenting behavior, and child risk for emotional, social, and behavioral problems. Roper and colleagues (2016) applied the family stress model in a study of shyness and reticence in Romanian preschool-aged children, and their observations were largely consistent with the model. With significant mediation between each link in the chain, parents experiencing more economic hardship reported more depression, more depressed parents engaged in more marital conflict, parents who experienced more conflict used more psychological control, and the use of psychological control predicted teachers’ reports of children’s shy and reticent behavior with peers. Analogously, BoothLaForce and Oxford (2008) observed a similar chain of relations in their longitudinal analyses of more than 1,000 families from the NICHD Study of Early Child Care and Youth Development. Lower family income and less maternal education during infancy were predictive of children displaying increasing levels of social withdrawal across grades 1–6, and the link between families’ socioeconomic stress during infancy and children’s social withdrawal in the elementary school years was accounted for by lower maternal sensitivity, less secure mother-child attachment relationships, and poorer child self-regulation during the preschool years. Patterns of findings such as these illustrate the need to understand the childrearing behaviors of parents of inhibited, socially withdrawn and shy children as occurring within a complex matrix of intrapersonal, relationship, and socio-contextual influences.

Future Directions in the Study of the Parents of Behaviorally Inhibited and Socially Withdrawn Children In this chapter, we have attempted to describe the family as a complex system that is influenced by its constituent members and by external, socio-ecological forces. Interactions between family members are bidirectional and mutually influential (Cowan, Powell, and Cowan, 1998). This conceptualization of the family as a transactional system represents an evocative starting point for future studies of the development of behavioral inhibition and social withdrawal. What we know about the parents of behaviorally inhibited and withdrawn children fails to capture some of the very simplest tenets of a transactional model of family systems. For instance, relatively little is known about 486

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paternal contributions to problems of psychological overcontrol in children. Although some studies have indicated that fathers’ parenting “matters,” there have been few examinations of the relative contributions of paternal versus maternal beliefs and parenting behaviors to the prediction of internalizing forms of behavior in boys and girls. Furthermore, how the qualities of father-son versus father-daughter attachment relationships and mother-son versus mother-daughter attachment relationships contribute to the prediction of inhibition, withdrawal, and internalizing behavior problems is unknown. There has been even less consideration of how the parenting in other family structures, such as those with grandparent or same-sex parent caregivers, is related to inhibition and withdrawal (Patterson, Farr, and Hastings, 2015). In short, a plethora of questions remains to be addressed visà-vis the breadth of existing parent–child relationships and family interactive patterns to more fully understand the etiology of inhibited, withdrawn, shy behaviors and their sequelae in children. Another relative unknown is the degree to which parents can influence the development, maintenance, and amelioration of social withdrawal at different points in the span of childhood. Are parents better able to influence child behavior during the early rather than mid to late years of childhood? Parents believe they are more influential in contributing to social developmental outcomes during early than late childhood (Mills and Rubin, 1992). Moreover, with increasing child age, parents increasingly attribute child maladjustment to internal, dispositional characteristics of the child (Mills and Rubin, 1993). Clearly, parents think about and interact with their children in different ways at different points in childhood. A catalogue of beliefs and behaviors within and across situations (e.g., at home or in public; free play or during structured activities) for parents of socially competent children and parents of inhibited, withdrawn children during the early, middle, and later years of childhood would be invaluable. This “mapping” of within-group and across-group, cross-age parental characteristics should be on the agendum of those interested in the developmental course of maladaptive behavior and its prevention or intervention. Additionally, researchers have only begun to examine the motivations that underlie socially withdrawn behavior in childhood and adolescence (Coplan and Weeks, 2010). For example, researchers have contrasted children who display social withdrawal because they appear to be shy versus those who appear to be unsociable. In the former case, it is suggested that shy children have conflicted interests in engaging their peers in social interaction—they are caught between strong motivations to approach and avoid their peers. In the latter case, unsociable children have been described as having a low motivation to approach others whilst not being particularly motivated to avoid their peers (Coplan, Prakash, O’Neil, and Armer, 2004). Researchers have rarely distinguished between the motivations that may underlie the expression of solitude in the company of peers in their studies of parent and parent–child relationships. There is a wealth of opportunity to discover the characteristics of the parents of different “types” of withdrawn children. Finally, it is by now well established that behavioral inhibition in early childhood and shy, withdrawn behavior during the childhood and early adolescent years are associated with and predictive of anxiety problems (Rubin et al., 2009). These findings have influenced researchers and practitioners to develop interventions directed at altering parental behavior in an effort to prevent or ameliorate the negative effects of behavioral inhibition and socially reticent, withdrawn behaviors (Chronis-Tuscano et al., 2015). Yet, these parent-directed interventions are few and far between, generally located in Western cultures, and rarely, if ever, directed to a wide range of ethnic groups within Western countries. In summary, many questions remain to be addressed in future studies of the parents of behaviorally inhibited and socially withdrawn children. We have provided some initial leads concerning where we think the immediate research “action” should be.

Conclusions Behavioral inhibition, social withdrawal, and psychologically overcontrolled behavior problems in childhood derive from a complex mix of ecological factors, child characteristics, parent–child 487

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relationships, and parental beliefs and behaviors. In these conclusions, we attempt to put the pieces of the developmental puzzle together by suggesting a conceptually based pathway that may serve as a model for the future study of the relations among parent–child relationships, parenting, and the development of social withdrawal in childhood (see also Rubin et al., 2009). This pathway begins with newborns who may be biologically predisposed to have a low threshold for arousal when confronted with stimulation and novelty. Under conditions of novelty or uncertainty, some babies demonstrate physical and physiological changes that suggest that they are “hyperarousable” (Fox and Calkins, 1993; Kagan, Reznick, and Snidman, 1987)—a characteristic that may make them extremely difficult to soothe and comfort. Some parents find infantile hyperarousability to be aversive or worrisome (Kagan, Reznick, Clarke, Snidman, and Garcia-Coll, 1984); consequently, under some circumstances, parents may react to easily aroused and wary babies with insensitivity, a lack of responsivity, and perhaps overprotectiveness. Each of these parental responses can also be triggered by environmental and personal stressors, and each predicts the development of insecure parent–infant attachment relationships. Thus, an interplay of endogenous, socialization, and early relationships factors, co-existing under an “umbrella” of negative setting conditions, will lead to a sense of felt insecurity. In this way, the internal working models of insecurely attached, temperamentally inhibited children may lead them to “shrink from” (Bowlby, 1973, p. 208) their social milieux. Children who are socially inhibited, and who shrink anxiously away from their peers, preclude themselves from the positive outcomes associated with social exploration and peer play. Thus, one can predict a developmental sequence in which an inhibited, fearful, insecure child avoids interacting with others, including withdrawing from her or his social world of peers. In so doing, the child fails to develop those skills derived from peer interaction and, therefore, becomes increasingly anxious and isolated from the peer group. With age, social reticence or withdrawal becomes increasingly salient to the peer group (Rubin et al., 2009). This deviation from age-appropriate social norms is associated with the establishment of negative peer reputations.Thus, by the mid to late years of childhood, social withdrawal and anxiety are strongly correlated with peer rejection (Rubin et al., 2015). Given their reticence to explore their environments, socially withdrawn children may demonstrate difficulties in getting social “jobs” done or social problems ameliorated. Sensing the child’s difficulties and perceived helplessness, parents may try to aid them very directly either by manipulating their child’s social behaviors in a power assertive, highly directive fashion or by actually intervening and carrying out the child’s social interchanges themselves. Such overcontrolling, overinvolved socialization strategies have long been associated with social withdrawal in childhood. Parental overdirection is likely to maintain rather than ameliorate the problems associated with withdrawal. Being overly directive does not help the child deal first-hand with social interchanges and dilemmas, it prevents the development of a belief system of social self-efficacy, and it perpetuates feelings of insecurity within and outside of the family. Thus, overcontrolled social incompetence may be the product of the joint interactions between inhibited temperament, insecure parent–child relationships, overly directive and overprotective parenting, and family stress. A fearful, wary, inhibited temperament may be deflected in a pathway toward the development of social competence by responsive and sensitive caregiving and by a low-stress environment. Conversely, inhibited temperament is not a necessity for the development of an internalizing behavior pattern. Parental intrusive overcontrol, especially when accompanied by familial stress and lack of social support, may deflect the temperamentally easy-going child toward a pathway of internalizing difficulties. The pathway just described represents a useful heuristic for studying the etiology of social withdrawal in childhood. It is also suggestive of the indirect and direct ways that parents may contribute to the development and maintenance of social withdrawal. However, it should certainly not be taken as the only route to the development of overcontrolled psychological disorders in childhood. It is also important to note that in other cultures, each developmental pathway with its connections between withdrawn behavior and parenting, and potential outcomes, might look quite different. Thus, we 488

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welcome the research community’s support in providing alternative and international perspectives, as well as empirically derived information at an international level, concerning relations among parent–child relationships, parenting cognitions and behaviors, and the ontogeny of childhood social withdrawal.

Acknowledgments Authors Rubin, Smith, and Wagner were supported by National Institute of Mental Health grant R01MH 103253, “A Multi-Component Early Intervention for Socially Inhibited Preschool Children” (PIs Kenneth H. Rubin and Andrea Chronis-Tuscano) during the preparation of this chapter.

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The consistency and concomitants of inhibition: Some of the children, all of the time. Child Development, 68, 467–483. Rubin, K. H., Hemphill, S. A., Chen, X., Hastings, P., Sanson, A., Coco, A. L., . . . Chen, H. (2006). A cross-cultural study of behavioral inhibition in toddlers: East–West–North–South. International Journal of Behavioral Development, 30, 219–226. Rubin, K. H., Hemphill, S. A., Chen, X., Hastings, P., Sanson, A., LoCoco, A., . . . Doh, H. S. (2006). Parenting beliefs and behaviors: Initial findings from the International Consortium for the Study of Social and Emotional Development (ICSSED). In K. H. Rubin and O. B. Chung (Eds.), Parental beliefs, parenting, and child development in cross-cultural perspective (pp. 81–103). London, UK: Psychology Press. Rubin, K. H., Hymel, S., and Mills, R. S. (1989). Sociability and social withdrawal in childhood: Stability and outcomes. Journal of Personality, 57, 237–255. Rubin, K. H., and Mills, R. S. L. (1990). Maternal beliefs about adaptive and maladaptive social behaviors in normal, aggressive, and withdrawn preschoolers. Journal of Abnormal Child Psychology, 18, 419–435. Rubin, K. H., and Mills, R. S. (1991). Conceptualizing developmental pathways to internalizing disorders in childhood. Canadian Journal of Behavioural Science, 23, 300–317. Rubin, K. H., and Mills, S. L. (1992). Parent’s thoughts about children’s socially adaptive and maladaptive behaviors: Stability, change and individual differences. In I. Sigel, J. Goodnow, and A. McGillicuddy-deLisi (Eds.), Parental belief systems (pp. 41–68). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

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The best friendships of shy/withdrawn children: Prevalence, stability, and relationship quality. Journal of Abnormal Child Psychology, 34, 139–153. Rydell, A. M., Bohlin, G., and Thorell, L. B. (2005). Representations of attachment to parents and shyness as predictors of children’s relationships with teachers and peer competence in preschool. Attachment and Human Development, 7, 187–204. Salmivalli, C., Ojanen, T., Haanpää, J., and Peets, K. (2005). “I’m O.K. but you’re not” and other peer-relational schemas: Explaining individual differences in children’s social goals. Developmental Psychology, 41, 363–375. Schaeffer, E. S. (1959). A circumplex model of maternal behavior. Journal of Abnormal and Social Psychology, 59, 226–235. Scharf, M., Kerns, K. A., Rousseau, S., and Kivenson-Baron, I. (2016). Mother-child attachment and social anxiety: Associations with friendship skills and peer competence of Arab children. School Psychology International, 7, 271–288. Schneider, B. H., Attili, G.,Vermigli, P., and Younger, A. (1997). A comparison of middle class English-Canadian and Italian mothers’ beliefs about children’s peer directed aggression and social withdrawal. International Journal of Behavioral Development, 21, 133–154. Schuengel, and Oosterman. (2019). Parenting Self-Efficacy. In M. H. Bornstein (Ed.), Handbook of parenting Vol. 3: Being and becoming a parent (3rd ed., pp. 654–680). New York, NY: Routledge. Seibert, A., and Kerns, K. (2015). Early mother–child attachment: Longitudinal prediction to the quality of peer relationships in middle childhood. International Journal of Behavioral Development, 39, 130–138. Spangler, G., and Schieche, M. (1998). Emotional and adrenocortical responses of infants to the strange situation: The differential function of emotional expression. International Journal of Behavioral Development, 22, 681–706. Stevenson-Hinde, J. (1989). Behavioral inhibition: Issues of context. In J. S. Reznick (Ed.), Perspectives on behavioral inhibition (pp. 125–138). Chicago: University of Chicago Press. Stewart, S. L., and Rubin, K. H. (1995).The social problem solving skills of anxious-withdrawn children. Development and Psychopathology, 7, 323–336. Thompson, R. A., and Goodvin, R. (2016). Social support and developmental psychopathology. In D. Cicchetti (Ed.), Developmental psychopathology (Vol. 4, pp. 1–50). New York, NY: John Wiley and Sons. van der Bruggen, C. O., Stams, G. J. J. M., and Bögels, S. M. (2008). Research review: The relation between child and parent anxiety and parental control: A meta-analytic review. Journal of Child Psychology and Psychiatry, 49, 1257–1269. van der Voort, A., Linting, M., Juffer, F., Bakersman-Kranenburg, M. J., Schoenmaker, C., and van IJzendoorn, M. H. (2014). The development of adolescents’ internalizing behavior: Longitudinal effects of maternal sensitivity and child inhibition. Journal of Youth and Adolescence, 43, 528–540. 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15 PARENTING AGGRESSIVE CHILDREN Tina Malti, Ju-Hyun Song, Tyler Colasante, and Sebastian P. Dys

Introduction Parenting children with challenging, disobedient, and aggressive behaviors has never been easy. Contemporary views on how to rear children who display such behaviors are heavily influenced by social, cultural, and historical constructions of childhood and ideas about normative and atypical development. This is particularly true when it comes to questions surrounding discipline. Themes of strong-willed children who prove difficult to discipline can be found in children’s books, art, and scientific literature across cultures and time. In the early nineteenth century, fairy tales often depicted scenes of temper tantrums, disobedience, and aggression, as well as a range of parental reactions— from mild discipline to harsh punishment and even abandonment. The children’s book Shockheaded Peter (Hoffmann, 1845) depicts a series of tales about children, each ending with a clear message conveying the disastrous consequences of not obeying parental rules. Sucking your thumb when told not to, for example, may lead to getting it cut off by the tailor. Parents today would certainly find such tales disturbing, but, at the time, they were meant to advise parents on childrearing. In psychology, the powerful role of parents in a child’s obedience to and internalization of societal rules can be traced back to psychoanalytic theory. Theorists traditionally conceptualized parents as authority figures and “ideal” children as those who would follow parental rules. With increasing emphasis on attachment and the quality of parent–child relationships, the notion of nurturing became central to ideas of minimal prerequisites for children’s healthy development and behavioral adaptation (Winnicott, 1953). Research on parenting children with aggressive behaviors has evolved considerably over the past few decades, resulting in considerable knowledge about effective strategies to steer children away from such conduct across development. In this chapter, we discuss contemporary views and research on the influences of parenting on aggression and antisocial behaviors from early childhood to adolescence, with a dimensional approach emphasizing control- and support-related parenting behaviors. First, we define the key concepts of childhood aggression and parenting. We then move to theories linking parenting and children’s aggression, followed by an overview of major empirical findings on this topic. Here, we discuss mechanisms underlying associations between parenting and children’s aggression and their implications for parenting practices. Next, we discuss the current state of parenting interventions for reducing childhood aggression. We conclude with promising future directions for research in this area.

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Definitions of Key Terms in Parenting and Child and Adolescent Aggression Aggression in Childhood and Adolescence In the field of developmental psychopathology, aggression is often discussed under the umbrella term of externalizing behavior, which encompasses all antagonistic acts—aggressive, defiant, disruptive, hyperactive, and impulsive—toward the child’s environment. Aggression per se refers to behaviors that intentionally cause physical or psychological harm and/or distress to others, oneself, or objects in the environment, although it centers on harming others (Krahé, 2013). In childhood, common examples of aggression include hitting, biting, and teasing; in adolescence, these behaviors usually become refined, manifesting in relational aggression and cyberbullying. Aggression has been deconstructed into many subtypes over the years, such as overt, covert, physical, relational, reactive, and proactive (Malti and Rubin, 2018), although the latter two have garnered significant attention from researchers because they offer both a description and an explanation of aggressive subtypes. Specifically, reactive versus proactive subtypes describe aggressive behaviors that are more versus less emotionally charged, respectively, and explain such acts as chiefly stemming from provocation or self-interests, respectively (Dodge, Coie, and Lynam, 2006).

Developmental Trajectories of Aggression Across one’s lifespan, physical aggression is believed to be highest in the preschool years (Tremblay et al., 2004). Such acts are apparent as early as the first year, peak in the second year, and decline from the third year onward (dubbed the “early childhood aggression curve”; Alink et al., 2006). This normative decline likely stems from the onset and insurgence of core social-emotional skills, such as emotion regulation, theory of mind, and moral motivation (Eisenberg, 2000; Malti, 2016). Relational aggression, however, tends to emerge and peak later in development, as social-cognitive skills sharpen and social networks broaden (Eisner and Malti, 2015; Malti and Rubin, 2018). Despite these normative trends, there are still significant intraindividual differences in patterns of aggression from childhood to adolescence. Children tend to follow one of four trajectories: highstable (~10%), low-stable (~50–60%), high-/moderate-decreasing (~20%), or low-increasing (~10%; Bongers, Koot, van der Ende, and Verhulst, 2004). These trajectories aptly capture the distinction between childhood- and adolescent-onset aggression made in Moffitt’s (1993, 2003) developmental taxonomy. Childhood-onset aggression (i.e., the high-stable trajectory) tends to persist across the lifetime and predict long-term maladjustment, whereas adolescent-onset aggression (i.e., the lowincreasing trajectory) tapers off into adulthood and more often relates to concurrent adjustment issues. Reactive and proactive aggression appear to follow trajectories largely similar to those of generalized aggression (Barker, Tremblay, Nagin,Vitaro, and Lacourse, 2006; Cui, Colasante, Malti, Ribeaud, and Eisner, 2016; Fite, Colder, Lochman, and Wells, 2008). For example, children followed three trajectories of reactive and proactive aggression from age 7 to 12: high-decreasing (25%/11%), lowincreasing (8%/8%), and low-stable (59%/81%), and some showed a high-stable trajectory (8%) of reactive aggression only (Cui et al., 2016). The overlap of these trajectories—particularly that proactively aggressive children were also high in reactive aggression and not vice versa—aligns with the notion that subtypes of aggression co-occur substantially within the same child (Card and Little, 2006). Exactly which aggressive course a child will follow likely depends on his or her ability to navigate social conflicts, quality of parenting, and interrelations thereof.

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Parenting From a developmental perspective, it has often been argued that parenting involves two core dimensions: control and support (Maccoby and Martin, 1983; Paulussen-Hoogeboom, Stams, Hermanns, and Peetsma, 2007; Smetana, Campione-Barr, and Metzger, 2006). The control dimension encompasses regulating children’s behaviors through rules and supervision (e.g., discipline). Negative forms of control include asserting power over or psychologically controlling and overreacting to children in ways that hinder their abilities to explore and express their own ideas and feelings. Such strategies likely impede children’s autonomy and social-emotional development. Conversely, setting fair and consistent limits for children is considered a positive form of control, which is essential for teaching them to regulate their impulsive or destructive behavior. The support dimension comprises parental warmth and involvement, which are critical to forming a positive parent–child relationship. This is particularly important for parents of aggressive children because support erodes their oppositional tendencies, increasing the chances they will be open to their parents’ discipline and values (Maccoby, 2015). As children move into adolescence, parents and adolescents may face new challenges, such as renegotiating the balance between parental control and children’s autonomy. Nevertheless, developmental research on aggression has to date heavily focused on and emphasized the importance of intervening early in life to disrupt children’s problematic behavioral pathways (Eisner and Malti, 2015). For this reason, we primarily focus on early parent–child relations in this chapter.

Central Theoretical Issues in Parenting Aggressive Children Meta-Level Theories: Social Learning Theory and Attachment Theory Longitudinal studies suggest that children with high risk for persistent aggressive behavior can be identified by their temperamental factors and observed behaviors as early as age 3 (Campbell et al., 2006; Shaw, Gilliom, Ingoldsby, and Nagin, 2003). Identifying early-onset aggression is valuable because maladaptive parenting practices and children’s problem behaviors tend to be more malleable in the early years (Shaw and Taraban, 2017). The quality of the early parent–child relationship has implications for children’s long-term behavioral adjustment. For example, children who experience highly directive and negative parent–child interactions are at a higher risk for impaired self-regulation and escalating patterns of coercive interactions with others (e.g., parents, siblings, and peers) that may significantly impair their social lives (Olson, Choe, and Sameroff, 2017; Smith et al., 2014). The strength of the link between parenting and children’s aggression tends to diminish from childhood to adolescence as children gain cognitive skills and autonomy, become less reactive to parental emotion socialization, and are more influenced by peer interactions (Dodge, Greenberg, Malone, and The Conduct Problems Prevention Research Group, 2008; Johnson, Hawes, Eisenberg, Kohlhoff, and Dudeney, 2017). However, the importance of early parental socialization for the onset and maintenance of children’s aggressive behavior has gained more robust support in recent years (Boldt, Kochanska, and Jonas, 2017; Shaw, 2013). Social learning theory and attachment theory are the two most established approaches to explaining how the early parent–child relationship shapes the development of childhood aggression.

Social Learning Theory The social learning perspective—based on observational learning ideas—assumes that children learn aggressive strategies by imitating parents’ harsh and punitive disciplines, and that parents implicitly communicate the idea that these behaviors are acceptable (Bandura, 1973; Dodge, Pettit, Bates, and 498

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Valente, 1995). Patterson’s (1982) coercion theory extends this idea by emphasizing the bidirectionality of negative interactions between parents and children. A coercive cycle is characterized by an escalating pattern of hostile exchanges between the reactive child and his or her parents. This cycle impedes the child’s emotion regulation, which then provokes parents to respond with hostility (Dadds and Rhodes, 2008). Parents’ use of hostility during such exchanges reinforces disruptive behaviors, which can lead children to use aggressive behavior outside the family context (Dishion and Patterson, 2016; Pardini, 2011). The social information processing model also suggests that children who often engage in harsh parent–child interactions tend to experience higher hostile attribution bias in ambiguous social situations, which, in turn, increases their aggressive (re)actions (Crick and Dodge, 1994).

Attachment Theory Attachment theory emphasizes the role of the parent–child relationship in forming children’s cognitive and affective psychological schema through which they construct their social experiences, known collectively as an internal working model (Bowlby, 1969). Internal working models are believed to lay the groundwork for how children organize thoughts, feelings, and behaviors in their relationships with others. The attachment relationship is also thought to function as the emotional context for parents’ communication of rules and regulation of children’s aggression across childhood and adolescence. Infants differ in their sense of attachment security based on their caregiver’s responsiveness to their needs. Sensitive and responsive caregivers foster a sense of security and comfort, which fosters the development of competent self-regulation and sensitivity to others’ needs (e.g., sympathy; Hastings, Miller, and Troxel, 2015). In contrast, caregivers who show low sensitivity and responsiveness are likely to form insecure attachment relationships with their infant, which leads to a distrustful internal working model, little motivation to comply with the caregiver’s requests, and poor emotion regulation in the infant (Aguilar, Sroufe, Egeland, and Carlson, 2000). Children who are insecurely attached to their caregivers tend to lack coherent solutions for resolving distress and thus resort to aggressive strategies. Upon being reacquainted with their parents after a separation, for example, children with disorganized attachment used punitive-controlling behavior to gain their attention and involvement (Main and Cassidy, 1988), and such children have been rated as more aggressive in middle childhood (Bureau and Moss, 2010). Attachment insecurity is a significant proximal risk for developing aggression, as it may increase children’s tendency to approach social situations with anger and mistrust (Dodge and Coie, 1987). A meta-analytic review found a robust negative link between attachment security and childhood behavior problems among those up to 12 years of age (Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, and Roisman, 2010). A plethora of research has documented that both negative parenting behaviors and insecure infant attachment are key factors contributing to aggressive behaviors in childhood and adolescence. It is still unclear, however, whether attachment is an independent predictor of disruptive behavior, because some parenting characteristics are likely to underlie both attachment insecurity and the development of aggressive behaviors (Fearon et al., 2010). Some researchers have argued that the continuous quality of parental care may be the driving force behind persistent effects of early attachment security on later behavioral problems (Belsky and Fearon, 2002). Alternatively, attachment security has been shown to moderate the effects of parenting behaviors on children’s aggression. For example, children who experienced early coercive parenting were more likely to engage in later behavioral problems, but only if they were insecurely attached to their caregivers (Boldt et al., 2017; Kochanska, Barry, Stellern, and O’Bleness, 2009). It is likely that insecurely attached aggressive children perceive negative parenting behaviors through the lens of their internal working model, which is constructed based on their early attachment relationships (Bowlby, 1969). 499

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Social learning perspectives and attachment theory have helped delineate the social-cognitive processes and emotional mechanisms underlying the link between dimensions of parenting and children’s aggressive behavior. Researchers have also turned to understanding how specific parenting practices contribute to aggression through various pathways and psychological processes. In the following sections, we discuss the central research findings regarding the control and support dimensions of general parenting quality, followed by specific parenting practices that are relevant to the development and maintenance of aggression in childhood and adolescence.

Research Findings in Parenting and Child and Adolescent Aggression Parenting Dimension: Control Parental control can take form as a wide range of behaviors. It can vary in its degree (e.g., harsh versus uninvolved), parent–child mutuality (e.g., power assertion versus induction), and target (e.g., psychological versus behavioral; Barber, 1996). Here, we examine parental control as it relates to children’s aggressive behavior with an emphasis on degree of control and parent–child mutuality.

Harsh and Uninvolved Parenting Harsh and overreactive parenting exacerbates children’s aggressive behavior. Parents who mismanage their frustration toward their children by yelling, threatening, spanking, or criticizing (Reuben et al., 2016) often increase anger and distress in children (Scaramella and Leve, 2004). In turn, these children may become hyper-vigilant to threat cues and misinterpret others’ intentions as hostile (Dodge et al., 1995). This pattern can lower their threshold for acting aggressively toward others. For example, experiencing harsh maternal discipline at 17 months predicted children’s proactive and reactive aggressive behaviors at age 6 independent of their negative emotionality (Vitaro, Barker, Boivin, Brendgen, and Tremblay, 2006). As a form of punitive parenting, corporal punishment has also been associated with increasing aggressive behaviors (for a review, see Gershoff, 2002), even after controlling for initial levels of aggression and its reciprocal effect on parenting (Maguire-Jack, Gromoske, and Berger, 2012). Children can become excessively aroused if they chronically experience corporal punishment or overreactive parenting, which interferes with their internalization of prosocial parental messages (Gershoff, 2002). Similarly, as an extreme form of harsh parenting, physical abuse has been strongly linked to increased risks for aggression and later antisocial behavior (for a narrative review, see Gilbert et al., 2009). A meta-analytic and conceptual review reported that both children and adolescents show higher relational aggression when they experienced harsh parenting from mothers and fathers, potentially through compromising their positive sense of self, attachment security, and emotion regulation skills (Kawabata, Alink, Tseng, van IJzendoorn, and Crick, 2011). Neglectful and uninvolved parenting styles have also been associated with the development of aggression, as a lack of control provides insufficient guidelines for children to regulate their impulses. In general, this association appears to be relatively small in magnitude, but tends to be larger among children from economically disadvantaged families (Kawabata et al., 2011). Researchers have proposed that parental monitoring reduces the negative impacts of neighborhood risks (e.g., violence, residential instability, and limited social networks) on the development of aggression. For example, among low-income families in impoverished neighborhoods, children who received low maternal monitoring in toddlerhood were more likely to show higher externalizing problems at age 5 (Supplee, Unikel, and Shaw, 2007). Therefore, those interested in understanding the development of aggression should consider parenting practices in the context of distal influences (e.g., neighborhood risk). 500

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Discipline Perhaps the component of parental control most central to children’s aggression is discipline. By the time they are 2, children regularly receive discipline from their parents for harming others—by some estimates, more than 10 times a day (Hoffman, 2000; Parens, 1979). Parents are particularly equipped to impact their children’s moral internalization because of their biosocial connection, existing relationship, and opportunities to monitor their social behaviors (Kuczynski and Grusec, 1997; Pratt et al., 2017). There are three primary approaches to parental discipline: (1) power assertion, (2) love withdrawal, and (3) induction. Power assertion typically involves threatening or using force or depriving children of possessions or privileges (Hoffman and Saltzstein, 1967). Although power assertion typically enables parents to quickly change children’s immediate behavior, its frequent use appears to hinder children’s moral development (Brody and Shaffer, 1982; Janssen, Janssens, and Gerris, 1992). Its reliance on power and force may (1) build resentment toward those in positions of power, (2) prompt children to act with force when they want to change another’s behavior, and (3) foster a moral orientation centered on external detection and punishment (Eisenberg and Valiente, 2002). Power assertion is most commonly used with boys and in families that are large or low in social status (Ball, Smetana, Sturge-Apple, Suor, and Skibo, 2017; Chen, Wu, Chen, Wang, and Cen, 2001). Love withdrawal involves removing attention or emotional support from children. This may be expressed directly—for example, by showing children dislike—or indirectly—for instance, by showing children less affection.When parents use power assertion, children tend to feel anger and fear over punishment; when parents use love withdrawal, children tend to feel anxiety over their relationship with their parents (Hoffman, 1983). Historically, most theorists believed love withdrawal was unassociated with moral development. Induction involves showing children their behavior was wrong by prompting children to recognize how their actions caused another’s distress. By underscoring others’ distress, induction arouses children’s empathy; by connecting one’s actions to the victim’s distress, it arouses children’s feelings of responsibility and by extension, complex negative emotions, such as guilt. Children’s negative feelings can reduce aggressive behavior as they may prompt children to consider the consequences of acting aggressively in future social conflicts.Through this reflection, children may arouse anticipatory moral emotions, motivating them to refrain from aggressing (Malti and Krettenauer, 2013). In most cases, studies have found positive relationships between parental power assertion and children’s antisocial and aggressive behavior. Most studies show that parents who use power assertion have children who show more antisocial and aggressive behavior (Chen et al., 2001; Kochanska, Brock, and Boldt, 2016). By comparison, there are very few studies examining love withdrawal: parents’ use of this technique seems unrelated to many aspects of their children’s moral development (Krevans and Gibbs, 1996; Patrick and Gibbs, 2012), although it may elicit more relational aggression (Casas et al., 2006). Overall, parents who use induction seem to have children who behave less aggressively and antisocially (Choe, Olson, and Sameroff, 2013; Kerr, Lopez, Olson, and Sameroff, 2004). These relations are, however, moderated by variables including parents’ and children’s characteristics (e.g., gender and temperament), socioeconomic status, and the situation eliciting the discipline encounter (Kochanska et al., 2016; Towe-Goodman and Teti, 2008). These inconsistent effects have been accounted for by two primary explanations. The first suggests that the optimal disciplinary approach may involve a blend of techniques. For instance, because parental inductions require children to feel sufficient pressure to attend to their parents’ message (Hoffman, 2000), some degree of power assertion may be necessary to compel children to attend. Moreover, the success of any given approach may depend on timing. For instance, in highly arousing situations, it may be preferable for parents to use inductions well after children have transgressed, when both parents and children are calm.This notion may explain why parents use more commanding than reasoning when children are highly emotional and distracted (Chapman, 1979). 501

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A second explanation shifts focus from parents toward children. It argues that the effect of discipline depends on (1) the degree to which children accurately perceive their parents’ messages and (2) how willing children are to comply with those messages (Grusec and Goodnow, 1994). First, children more accurately interpret parental messages that are developmentally appropriate, clear, frequent, and consistent (Grusec, 2002).These qualities help children understand and keep salient how parents wish to change their behavior. Second, children are more likely to comply with parental messages that are—among other characteristics—reasonable, motivating, and non-threatening (to children’s self-esteem and relationships with their parents).Thus, the ostensible link between parents’ use of disciplinary strategies and children’s moral development may result from children being more perceptive and receptive to messages from one disciplinary style (e.g., induction) over another (e.g., power assertion). In support of this notion, across cultures, children tend to prefer inductive discipline, with many children believing that other strategies, such as love withdrawal, harm their self-worth (Helwig, To, Wang, Liu, and Yang, 2014; Siegal and Cowen, 1984). Furthermore, individual differences in how well children interpret and internalize messages from each disciplinary approach may explain some inconsistencies between these approaches and moral outcomes. To date, many studies have measured disciplinary techniques in response to children’s global behavior, not just their transgressions. This approach may muddy the link between these techniques and aggression, as children regard parental control over issues involving aggression and fairness as more justified compared to control over personal issues (e.g., with whom children can be friends, what kind of clothes they wear). Furthermore, research examining all three disciplinary techniques is scarce, and more studies ought to consider new approaches to testing optimal blends of discipline techniques for reducing children’s aggressive behavior. Lastly, future studies should consider children’s active roles in disciplinary encounters in conjunction with the characteristics of their parents and the situations at hand.

Parenting Dimension: Support As components of the support dimension, warmth and sensitivity have received substantial attention in the literature on parenting and children’s social-emotional outcomes (Eisenberg et al., 1998; Gottman et al., 1996; Katz et al., 2012). Warm and sensitive parenting, which is at the core of secure parent–infant attachment relationships, is believed to help children modulate arousal and internalize skills for self-regulation (Chang, Olson, Sameroff, and Sexton, 2011). Such aspects of parenting are especially fundamental during infancy and early childhood as children transition from heavy reliance on caregivers for external regulation of arousal to more independent forms of self-regulation (Brownell and Kopp, 2007). When toddlers and preschoolers experience lower levels of responsive parenting, they display more disruptive behaviors (Kochanska and Kim, 2013); when they experience sensitive caregiving, they exhibit more self-regulation and less externalizing problems across childhood and adolescence (Bernier, Carlson, and Whipple, 2010; Haltigan, Roisman, and Fraley, 2013). Besides promoting abilities to modulate arousal, warm and responsive parents can prevent or alleviate children’s disruptive behaviors through several other processes. According to attachment theory, a warm and sensitive relationship with the caregiver enhances children’s willingness to comply with the parents’ requests and fosters a prosocial schema of emotional connectedness with others (Eisenberg et al., 1998; Kochanska and Murray, 2000; Laible and Thompson, 2002). From the social learning perspective, parents can also model competent negotiation and conflict-resolution skills through supportive parenting behaviors, helping children manage interpersonal problems without relying on aggressive or noncompliant strategies (Stormshak, Bierman, McMahon, and Lengua, 2000). Also, children who experienced more supportive parenting at age 6 were, 1 year later, less likely to judge hypothetical moral transgressors as deserving punishment, suggesting that positive

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parenting behaviors contribute to more mature moral development in children (Malti, Eisenberg, Kim, and Buchmann, 2013), which can reduce aggression (Eisner and Malti, 2015).

Specific Parenting Practices and Aggression In addition to the general parenting domains of control and support, the literature focuses on specific parenting practices for emotion socialization (Johnson et al., 2017). Emotion socialization is defined as a process by which parents or other socializing agents (e.g., peers) transfer skills and knowledge for regulating and expressing emotional arousal in socially acceptable ways (Eisenberg et al., 1998). It is important to understand the role of emotion socialization given that emotional deficits are at the core of childhood externalizing problems, including aggression. Such deficits arise when poor regulation is combined with extremes of arousal (i.e., underarousal and overarousal), which are temperamentally based as well as shaped by early parenting (Morris, Silk, Steinberg, Myers, and Robinson, 2007; Rothbart, Sheese, Rueda, and Posner, 2011). Thus, specific parenting behaviors influencing children’s emotional experiences, such as reactions to children’s emotions and emotional coaching, play important roles in the progression of childhood aggression (Johnson et al., 2017).

Reactions to Children’s Negative Emotions Parental reactions to children’s negative emotional arousal provide children with information about how they should manage emotions in distressing situations. The socialization of negative emotion is particularly relevant because anger sits at the core of aggressive behavior (Cole, Teti, and ZahnWaxler, 2003). Indeed, a review of maternal reactions to children’s negative emotions and conduct problems found that parents who display unsupportive responses (e.g., punitive, minimizing, and dismissing) were more likely to have children with conduct problems compared to parents who show supportive responses (e.g., emotion-focused reactions, problem-focused reactions, and expressive encouragement; Johnson et al., 2017). This result aligns with well-established literature suggesting that supportive reactions to children’s distress are conducive to their emotion regulation and effortful control (Davidov and Grusec, 2006), whereas unsupportive reactions are related to increased negative emotion expression and dysregulated arousal (Eisenberg, Fabes, and Murphy, 1996; Fabes, Leonard, Kupanoff, and Martin, 2001). Therefore, the link between unsupportive parental reactions and children’s aggression is likely mediated by children’s capacity for regulating negative emotions.

Emotion Discussion and Coaching Parents can teach children about emotions indirectly, through their reactions to children’s expressed emotions, or directly, by discussing emotional experiences and coaching children how to cope with negative emotions. The discussion of negative emotions has been found to involve frequent references to the causes of emotions and others’ perspectives (Lagattuta and Wellman, 2002; Laible, 2011), which can help reduce aggressive behaviors. Indeed, preschoolers who discuss emotions with their mothers show less physical aggression (Garner, Dunsmore, and Southam-Gerrow, 2008); likewise, preschoolers who show competent perspective-taking abilities show lower hostile attribution bias (Choe, Lane, Grabell, and Olson, 2013). Emotion coaching, which is guided by parents’ own meta-emotion philosophy (i.e., awareness of emotions, beliefs about emotional expression), also affects how parents resolve conflicts and build intimacy with their children (Gottman, Katz, and Hooven, 1996). For this reason, social learningbased programs have introduced emotion coaching for parents as a way to help them discuss emotions with their children more effectively (Gottman et al., 1996).

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Parenting and Aggression From Childhood to Adolescence Parenting practices that have been identified as maladaptive in childhood (e.g., harsh discipline, corporal punishment, low warmth, and lack of supervision) are similarly related to aggression in late childhood and adolescence (Fearon et al., 2010; Kawabata et al., 2011). In longitudinal studies of boys, poor parental supervision and low involvement were related to higher conduct problems in both childhood and adolescence (Burke, Pardini, and Loeber, 2008), and adolescents’ perceptions of greater parental nurturance predicted a decrease in aggression between 10 and 15 years (Arim, Dahinten, Marshall, and Shapka, 2011). A noticeable developmental shift is that parental influences on children gradually diminish through adolescence, whereas children’s influences on parenting behavior simultaneously increase. This shift in flow of effects may result from children’s cognitive maturation and influences from other socializing agents (e.g., peers; Collins and Laursen, 2004; Kerr, Stattin, and Özdemir, 2012). For example, adolescents’ physical and relational aggression were both positively related to their perceptions of mothers’ psychologically controlling parenting 2 years later, but not vice versa (Albrecht, Galambos, and Jansson, 2007). In a study with a clinic-referred sample of adolescents using repeated measures from 7 to 12 years of age, boys’ conduct problems influenced poor parental supervision more strongly than parental supervision impacted boys’ conduct problems (Burke et al., 2008). Some researchers also suspect that parents’ negative (e.g., harsh) discipline may be more susceptible to changes in adolescent conduct problems (as opposed to their positive parenting [e.g., warmth]), and thus warmth may have a steadier effect on adolescent behavior (Arim et al., 2011). The transition from childhood to adolescence (i.e., around 10–12 years) may be a particularly important period for exploring the role of parenting on aggression.

Bidirectional Interactions Between Parent and Child Although characteristics such as warmth, sensitivity, and power assertion have been useful for describing individual differences in parenting behaviors, growing evidence supports the reciprocal nature of parent–child dyads. From a more interactive perspective, both children and parents contribute to the quality of their interactions as one party reacts to the other’s characteristics and vice versa (Kuczynski, Parkin, and Pitman, 2015; Sameroff, 2010). In such dialectical interactions, parents and children act on their own interpretations of the situation. Accordingly, parents often parent their aggressive child using a range of approaches, engaging in dynamic problem solving in response to their constantly developing children. Supporting empirical findings show that maternal ratings of children’s behavior problems in preschool and kindergarten positively predict punitive and hostile (i.e., physical) forms of maternal discipline at school entry, which are associated with increases in children’s behavior problems (Choe, Olson, and Sameroff, 2013; Snyder, Cramer, Afrank, and Patterson, 2005). Also, children who display a more irritable temperament at fifth grade elicit higher levels of inconsistent discipline from their parents 1 year later (Lengua and Kovacs, 2005). Another study using latent growth models found that higher initial levels of children’s aggression at age 10 were associated with longitudinal increases and decreases in parental overreactivity and warmth, respectively, and vice versa (De Haan, Prinzie, and Deković, 2012). Collectively, these studies support the bidirectionality of parent–child interactions across childhood, which is often overlooked in research and intervention practices.

Child-Level Characteristics as a Moderating Mechanism Parenting does not operate in isolation, but in conjunction with child characteristics (Bates and Pettit, 2015). In this section, we outline major child-level characteristics that are likely to influence the extent to which parenting strategies combat children’s aggression.

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Temperament One mechanism that inherently factors into parenting and childhood aggression is individual children’s predispositions. Children neither interpret, experience, nor react to a similar parenting environment in the same way. Instead, child characteristics amplify, dampen, or modify the influence of parenting approaches on aggressive behavior. For example, among those with low effortful control early on, children did not show high externalizing problems at school entry if they experienced early maternal warmth (Reuben et al., 2016). Meanwhile, children with difficult temperaments showed a steeper decrease in externalizing problems from age 2 to 5 if their mothers were highly sensitive (Mesman et al., 2009). These findings suggest that children with higher temperamental risks may benefit more from the protective effects of positive parenting. At the same time, emotionally reactive and overaroused children tend to be more vulnerable to coercive parenting behavior due to dysregulated emotional responses, which can lead to increased aggression (Scaramella and Leve, 2004). For instance, children show higher externalizing behavior at school entry only if they display moderate to high levels of externalizing behavior and receive negative parenting in their preschool years (CombsRonto, Olson, Lukenheimer, and Sameroff, 2009). A meta-analysis on the moderating effects of temperament (including children under 18 years) found that expected associations of both negative and positive parenting with externalizing problems were stronger for children who have high levels of negative emotionality (Slagt, Dubas, Deković, and van Aken, 2016). Also, temperamentally fearless boys who experience low positive parenting at age 2 are more likely to show moral emotional deficiencies (i.e., callous-unemotional behavior, which is predictive of antisocial behavior; Frick, Ray, Thornton, and Kahn, 2014) 2 years later (Waller, Shaw, and Hyde, 2017). Collectively, both affective overarousal and underarousal can alter the nature of parenting effects on aggression.

Gene X Environment An expanding body of research attempts to understand the moderating effects of genetic variants on the link between parents’ behaviors and children’s aggressive behaviors (Caspi et al., 2002; Hyde, 2015). Because genetic variants are related to differential functioning of the neural systems underlying motivational, emotional, and reward processes (e.g., dopaminergic and serotonin systems), they can shape children’s susceptibility to parenting practices. For example, a meta-analytic review of the moderating effect of monoamine oxidase-A (MAOA) variation on the link between childhood maltreatment and aggressive behavior in childhood and adolescence found that early adversity predicts antisocial outcomes more strongly for boys with a low-activity MAOA genotype (Byrd and Manuck, 2014). Due to the small effect sizes of single genetic variants, however, a trend in this area of research is to use polygenic risk or plasticity scores by combining information regarding multiple genetic variants (Chabris, Lee, Cesarini, Benjamin, and Laibson, 2015). For example, 4- to 8-year-old boys who have higher polygenic plasticity scores based on multiple dopaminergic genes show the greatest reductions in externalizing behavior after a parenting intervention program (Chhangur et al., 2017).

Gender Compared to girls, boys are reported to have a higher risk for conduct problems as early as age 4, which has led some researchers to suspect that boys generally have a greater risk for maladjustment during early childhood, given their higher rates of other difficulties, including language delays, learning disabilities, inattention, and impulsivity (Shaw, 2013). Alternatively, boys may be more vulnerable to early negative parenting relative to girls, leading to more aggression. For example, among 5- to 10-year-olds, inconsistent discipline is only related to higher conduct problems for boys (Tung, Li, and Lee, 2012). Such findings may be related to early gender differences in the development of

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adaptive social-emotional skills for stress regulation; boys tend to engage in confrontational aggressive behavior when faced with social stressors, whereas girls are more likely to seek social support to manage distress (Taylor et al., 2000). Some evidence suggests that boys display poorer effortful control than girls in childhood (e.g., Else-Quest et al., 2006), which may limit their abilities to use adaptive cognitive and emotional skills and thereby regulate their frustration during negative disciplinary encounters (Tung et al., 2012). It is difficult, however, to draw firm conclusions about such gender differences due to limited empirical work on parenting and conduct problems focusing on girls (De Haan et al., 2012).

Moral Emotions Children’s capacity to feel other-oriented concern and/or express self-conscious emotions following transgressions (e.g., guilt) may moderate the effects of parenting on aggression (Malti, 2016). For example, 4- to 8-year-old boys with conduct problems combined with low empathy and guilt (assessed using a measure of callous-unemotional [CU] characteristics) were less affected by a parent training intervention on discipline than children with conduct problems alone (Hawes and Dadds, 2005). It may be the case that children with moral emotional deficiencies are more malleable to parenting interventions even earlier in development (Shaw, 2013). Also, because aggressive children who have low moral emotions are less responsive to negative parental punishment, supportive parenting strategies may be more effective (Frick et al., 2014).The affective quality of the parent–child relationship can be particularly important for the internalization of parental and societal rules (Fowles and Kochanska, 2000) and conduct problems (Schneider, Cavell, and Hughes, 2003) in children who are relatively underaroused and indifferent to parents’ limit setting (Pasalich, Dadds, Hawes, and Brennan, 2011). Thus, fostering warmth in parent–child relationships—by responding to them sensitively—may be the most promising target of interventions for reducing aggressive behaviors in children with low empathy and guilt.

Parenting as a Mediating Mechanism Effects of contextual or other proximal factors on aggression are mediated by parenting quality. Here, we focus on poverty, family adversity, and parental psychopathology as developmentally salient factors for children’s aggression and how their effects are mediated through parenting.

Low Socioeconomic Status A family’s socioeconomic status (SES) can impact their children’s development directly—by the kinds of opportunities children have—or indirectly—through the type of parenting that children receive (Lareau, 2002; Magnuson and Duncan, 2002). Children from low SES families directly encounter many environmental risk factors—such as community violence—and lack many protective factors—such as healthy peer relations—for behaving aggressively (Cooley-Quille, Boyd, Frantz, and Walsh, 2001; Miller-Johnson et al., 2002). Indirectly, SES-related disadvantages compromise parents’ psychological functioning and childrearing (for a review, see Shaw and Shelleby, 2014). Besides financial hardships, families with low SES experience more violence, less calm and stable living situations, and more parental incarceration (Duncan and Brooks-Gunn, 2000). Relatedly, parents who face economic difficulties are more likely to experience mental illness, marital issues, and selfmedication with drugs or alcohol (Barnett, 2008; Bøe et al., 2014). The struggle of facing such challenges and meeting their family’s basic needs bleeds through into the practices of low SES parents; they are usually less able to provide adequate warmth, consistency, and supervision for their children, shortcomings which lead to more conduct problems for their children (Conger, Conger, and Martin, 2010; Shaw and Shelleby, 2014). 506

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Despite the multidimensional influence of SES on children’s aggressive behavior, parenting can buffer this relationship. Parents with better emotional well-being and those who use more positive parenting have children who show less aggressive behavior (Bøe et al., 2014). The influence of parenting, however, can only go so far; parents’ use of positive childrearing may have no influence on childhood aggression under circumstances of high violence or extreme poverty (Kliewer et al., 2004; Labella, Narayan, McCormick, Desjardins, and Masten, 2017). In summary, low SES poses many challenges to parents and children—hurdles which often harm parents’ childrearing and increases children’s aggression. Parents who maintain their emotional wellbeing and use positive parenting practices can mitigate the effects of low SES; however, this appears to hold true only for those facing less severe violence or poverty.

Family Adversity Independent from dealing with poverty, parents who experience family conflict and distress can increase early aggressive behavior in children through negative parenting practices (Averdijk, Malti, Ribeaud, and Eisner, 2012; Shaw, Hyde, and Brennan, 2012). Family conflict and hostility between parents can interfere with sensitive parenting and “spill over” to their relationships with children; parents experience emotional distress from marital conflict, which can transfer anger and tension to their parenting, thereby increasing children’s aggressive tendencies (Margolin, Christensen, and John, 1996; Stover et al., 2012). Some studies also suggest that children and adolescents tend to be highly sensitive to parental conflict itself, which directly increases risks for internalizing and aggressive problem behaviors (Rhoades, 2008). Others consider harsh parenting, poor limit setting, and less sensitive parenting as potential mediating mechanisms of the link between family conflict and children’s aggression (Buehler and Gerard, 2002). That is, family risk factors can increase parental life stress, lower parental efficacy, and negatively impact the quality of the parent–child relationship (Davies, Sturge-Apple, Cicchetti, Manning, and Vonhold, 2012). Mothers who report high levels of distress are observed as being more hostile, more intrusive, and less responsive toward their toddlers in everyday interactions (Campbell et al., 2004). Moreover, they often rely on power assertive techniques to handle disruptive behaviors (Gershoff, 2002; Rijlaarsdam et al., 2013).

Caregiver Psychopathology Caregivers who suffer from psychopathology are at a risk for engaging in higher punitive or inconsistent discipline, more critical parenting, and poorer child monitoring (for a meta-analytic review, see Lovejoy, Graczyk, O’Hare, and Neuman, 2000). For example, Davies and colleagues (2012) showed that parental antisocial personality is a risk factor for toddlers’ aggression, both directly and indirectly through interparental aggression and unresponsive parenting and while controlling for sociodemographic disadvantages. In addition, mothers who are depressed tend to display insensitive parenting and build an insecure attachment relationship with their child (Elgar, McGrath,Waschbusch, Stewart, and Curtis, 2004). Depressive mothers also use less inductive discipline and lower warmth, which can hamper children’s self-regulatory capacities and other-oriented emotions that can protect against the emergence and maintenance of aggressive behaviors (Choe et al., 2013; Hoffman, 2000; Malti, Sette, and Dys, 2016).

Cultural Considerations for Parenting Aggressive Children The sociocultural perspective conceptualizes the role of parental socialization as a mediator of the links between culture and child development (Chen, Fu, and Zhao, 2015; Cole and Tan, 2015). Societal values are internalized by parents, reflected in their socialization beliefs, goals, and practices, and 507

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translated into children’s development. From early on in development, parents evaluate children’s behaviors (e.g., social initiative, self-control) based on culturally defined social competences and respond accordingly to regulate these behaviors to match societal expectations (Chen and French, 2008). In this section, we discuss between- and within-culture variations in values and parental socialization and their links to children’s emotional and behavioral development related to aggression. In examining cross-cultural differences and similarities, the individual–collectivism spectrum has been used to describe the relationships between individuals and societies (Markus and Kitayama, 2001). Although individualism and collectivism coexist in every society, their balance differs across cultures. More individualistic, self-oriented societies, including European and North American countries, emphasize autonomy and self-assertion. In these cultures, self-focused emotions, such as anger, pride, and disgust, are more accepted by parents because they imply autonomous expressions of the self, which provide emotion coaching opportunities for parents to gradually scaffold their regulation (Friedlmeier, Corapci, and Cole, 2011). On the other hand, collectivistic, group-oriented societies, such as East Asian countries, place greater value on controlling the self and maintaining close ties with others, while less appreciating social initiative as it may interfere with interpersonal harmony (Friedlmeier et al., 2011). Collectivistic parents also talk with their child about others’ emotions more than the child’s own emotions and emphasize emotion display rules and interpersonal sensitivity while promoting the expression of other-oriented emotions, such as sympathy, to foster interpersonal competence (Chan, Bowes, and Wyver, 2009; Wang, 2006). In cultures where expression of individual needs and desires are considered highly important, aggressive behavior facilitating goal achievement might be more accepted than in cultures where group dependency and harmony are emphasized. Indeed, a meta-analysis comparing levels of aggression across cultures found that individualistic cultures showed higher levels of aggression than collectivistic cultures both in children and adults (Bergeron and Schneider, 2005). Nonetheless, some evidence suggests that overall levels of violence tend to be higher in cultures where caregivers frequently use physical discipline, which is often the case in collectivistic cultures (Lansford and Dodge, 2008).Thus, it may not be a simple main effect of individualism or physical discipline that determines the level of aggression in children in a given culture, but rather a combination of multiple factors at family and cultural levels affecting parental socialization goals and parent–child relationships. Although parents want their children to become competent at emotional and behavioral control regardless of culture, they have different beliefs about the optimal level of emotional control, which is reflected in their reactions to children’s expressions of negative emotion and aggressive behavior. Parents in individualistic cultures, such as European and American mothers, report disappointment by their child’s aggression, whereas parents in collectivistic cultures, such as Chinese mothers, report higher anger in response to such behavior (Cheah and Rubin, 2004; Friedlmeier et al., 2011). Similarly, parents in highly group-oriented cultures tend to be less tolerant of their children’s aggressive behaviors in a hypothetical conflict situation (e.g., hitting back when s/he was hit by a peer) and more likely to intervene, whereas parents in more self-oriented cultures are more likely to allow or ignore such acts (Hackett and Hackett, 1993). Because of different societal values and socialization goals, aggressive children are regarded as more disruptive and problematic in some types of cultures—namely collectivistic—and are thus more often regulated by parents and teachers through harsh and controlling disciplines (Bergeron and Schneider, 2005). Both parents and children from group-oriented cultures often perceive harsh parenting as a legitimate parental assertion of authority. This is partly because such parents consider promoting children’s remorse over violating social norms and empathy for others as moral duties of their own (Gershoff et al., 2010; Wang, 2006). Thus, acknowledging differences in perceptions of harsh parenting across cultures is important because whether such parenting is perceived by children as normative or abusive can result in different consequences for children’s adjustment (Dwairy and Achoui, 2010; Lansford et al., 2010). Parental warmth seems to be more consistently related to lower 508

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aggression in children of different cultures. A meta-analytic review of children’s perceived parental warmth and psychological adjustment between the ages of 9 and 18 across 16 countries found that children who perceived higher parental warmth showed lower hostility and aggression—without significant cross-national heterogeneity (Khaleque, 2013). What seems universal, then, is that harsh parenting in the absence of warmth is detrimental for children’s adjustment and linked to more aggression (Cole and Tan, 2015; Lansford et al., 2010). Besides cross-national cultural differences, there are within-nation cultural differences as a function of economic status and social class. For example, low-income parents exhibit more open disapproval of anger and harsher parental control to “toughen” their children or enforce compliance and are motivated by the need to protect their children from neighborhood risks (Cole and Tan, 2015; Hill and Herman-Stahl, 2002; Kelley, Power, and Wimbush, 1992). Therefore, the links between parenting practices and child and adolescent aggression need to be understood within as well as between cultural contexts, while considering contextual influences on socialization goals and consequences to move beyond simply listing cultural differences in parenting childhood aggression. In summary, a society’s or subculture’s values influence family environments and interactions among family members and thus contribute to children’s sociability and self-control, including their aggressive behavior. At the same time, cultural norms and traditions affect the relations between parenting and child and adolescent aggression.

Practical and Methodological Considerations in Studying Parenting and Child and Adolescent Aggression Parenting Interventions Several meta-analyses and reviews have been conducted on the efficacy and effectiveness of parenting interventions for reducing children’s aggression and related conduct problems (Dretzke et al., 2009; Gardner, Montgomery, and Knerr, 2016; Knerr, Gardner, and Cluver, 2013; Tarver, Daley, Lockwood, and Sayal, 2014; van Aar, Leijten, Orobio de Castro, and Overbeek, 2017). Such interventions are typically directed at parents and parent–child interactions, and focus on aspects of parenting recognized as protective against childhood aggression, such as limit setting, positive discipline, and warmth (Kaminski et al., 2008). As a successful example,The Incredible Years program aims to reduce conduct problems in children, ranging from infants to school age, with group-based sessions that focus on strengthening parent–child interactions, reducing harsh discipline, and fostering parents’ abilities to promote social, emotional, and language development (e.g., through emotion discussions and inductive strategies; Webster-Stratton and Reid, 2010). A meta-analysis of 57 randomly controlled trials showed sizeable decreases in aggression in favor of parenting intervention groups (Dretzke et al., 2009). Brief and sometimes self-administered programs, which have become increasingly popular as traditional parenting interventions experience low participation, high attrition, and rare implementation by non-psychologists, have yielded significant reductions in parent-reported externalizing outcomes across eight studies (Tully and Hunt, 2016; for a meta-analysis of self-administered interventions, specifically, see Tarver et al., 2014). Most parenting intervention studies examine children younger than 12 years of age (Dretzke et al., 2009), likely because parenting programs are most effective up to and including middle childhood (Ogden and Hagen, 2008). A few factors may explain this developmental sensitivity. First, younger children may be more dependent on their parents, thus boosting the efficacy of parenting-focused interventions in the younger years (Ogden and Hagen, 2008). Second, existing parenting programs may be designed for younger children—either inadvertently or advertently—thus prompting the need for explicit developmental tailoring (for a similar argument, see Malti, Chaparro, Zuffianò, and Colasante, 2016). Most parents who take part in intervention studies are self-referred (Dretzke et al., 509

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2009), so it is difficult to determine whether the results of such studies generalize to a broader range of families. For example, parents who are unaware of their resources or unmotivated to seek help are unlikely to enroll in intervention studies (for a review of parenting programs in low- and middleincome countries, which are less common in comparison to high-income countries, see Knerr et al., 2013). Nonetheless, some parenting programs are effective across cultures, suggesting that extensive cultural adaptation may not be necessary for success (Gardner et al., 2016). As for real-world implications, it remains unclear whether intervention-related mean-level reductions in children’s externalizing behavior reflect clinically meaningful outcomes (Dretzke et al., 2009). More studies are needed to assess the relations between such behavioral changes and other indicators of well-being (e.g., academic functioning). In a similar vein, a meta-analysis of 40 randomly controlled trials revealed sustained effects 3 years after parenting interventions (van Aar et al., 2017). However, despite significant heterogeneity in post-intervention change (i.e., most interventions evidenced declines or stability in child disruptive behavior over time, but others evidenced inclines), none of the tested moderators (i.e., intervention characteristics) explained such differences. The main (related) conclusions of the meta-analyses and systematic reviews conducted to date have been the need to compare different parenting programs and to gain a better understanding of mechanisms of change. In the Dretzke et al. (2009) analysis, heterogeneity across studies that compared programs precluded meaningful conclusions regarding the relative efficacy of distinct programs and/or aspects of their delivery. For similar reasons, Tully and Hunt (2016) were unable to meta-analytically quantify the results of the brief interventions they reviewed to compare them with longer interventions. Thus, it appears the rapid expansion of group-based parent-training programs has preceded evidence for their relative efficacy.This issue should be investigated further because such “light touch” interventions are more cost-effective, have more upside for adherence and scalability, and can be offered as the first step of a tiered approach that provides more intensive interventions to those who need it the most (Haaga, 2000). With respect to understanding mechanisms of change, a component-focused meta-analysis found that—after controlling for differences in research design—parenting intervention components focused on helping children communicate emotions and helping parents maintain consistent discipline were associated with larger effect sizes, whereas those based on problem solving and promoting children’s cognitive, academic, and social skills tended to yield smaller effects (Kaminski et al., 2008). Other studies have employed more complex statistical techniques to better understand the conditions under which interventions are most likely to be effective. For example, Stoltz et al. (2013a) used mediation, moderation, and moderated mediation analyses to explore how, for whom, and under which circumstances an intervention (i.e., Stay Cool Kids; see Stoltz et al., 2013b) reduced children’s aggression. The intervention was associated with less aggressive behavior through an increase in maternal involvement, but this was only the case for children with less extreme scores on extraversion (i.e., for whom the intervention worked under the abovementioned circumstances), presumably because less extraverted children are more inclined to inhibit their behavior under proper instruction from parents (Tackett, 2006). Interventions like the ones discussed here could follow a number of avenues to improve their programs and evaluations. One such opportunity is to systematically test and compare individual intervention strategies to broaden our understanding of the mechanisms through which these strategies exert a desired influence. For instance, do programs helping children communicate their emotions reduce aggression by improving children’s emotional awareness, expressive vocabulary, self-esteem, or all three? Deepening this understanding will allow program developers to customize more systematically intervention programs based on children’s characteristics (also see Child-Level Characteristics as a Moderating Mechanism in this chapter). Although there has been an increasing call to tailor programs based on children’s developmental level—and not simply their chronological age (see Malti et al., 2016)—less attention has been paid to 510

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tailoring based on parent and family characteristics. Parents of lower socioeconomic status are more likely to use inconsistent or suboptimal discipline approaches (Hoff, Laursen, and Tardif, 2002). Fitting intervention approaches to such parents’ characteristics and needs may improve their trust and commitment to the program, thus reducing their children’s aggression. Last, program evaluators ought to more rigorously consider the ecological validity of their samples. For instance, most parents who participate in intervention programs are self-referred (Dretzke et al., 2009) and likely differ from their non-participating counterparts in terms of parental awareness and involvement. For these samples, observed intervention effects may not translate to families facing more severe community challenges, such as poverty, gang violence, and drug abuse. Essentially, those families most in need of interventions might not benefit from them. For these reasons, intervention scientists need to be especially creative in findings ways to recruit low SES families, perhaps by embedding their programs into ongoing, widespread community practices (Shaw, 2013).

Methodological Considerations in Parenting Aggressive Children Parenting research in general faces a number of pressing methodological issues. Here, we highlight a few that we believe are most pertinent to research on parenting aggressive children. First, sophisticated statistical techniques should be adopted on a larger scale. It is important for the field to continue moving beyond unidirectional parent-to-child and child-to-parent effects and assess the bidirectional complexities of parent–child interactions around aggressive outbursts (Kuczynski et al., 2015). Children’s aggressive behavior and facets of parenting should be represented as latent variables in longitudinal frameworks to assess their true reciprocal relations across time (reducing measurement error; see Zuffianò, Colasante, Buchmann, and Malti, 2017). It may also be interesting to consider triadic reciprocal effects between children and both parents (Gordon and Feldman, 2008). Given the importance of consistent parenting for aggressive children (Grusec, 2002; Lovejoy et al., 2000), such effects may be particularly impactful when parents have discrepant parenting styles or are “first timers” and therefore have styles that are fluid or in formation; Don, Biehle, and Mickelson, 2013). Incorporating developmental theory and findings into the design of such studies is also necessary to increase the likelihood of capturing age-graded processes when they are most likely to occur (e.g., peaking physical aggression in early childhood [Tremblay et al., 2004] and heightened relational aggression in early adolescence [Eisner and Malti, 2015]; also see Deković, Stoltz, Schuiringa, Manders, and Asscher, 2012). A developmental approach could also help explain the relative susceptibility of children’s aggressive behaviors to parenting across time and the likely flow or direction of effects between parents and children in different developmental periods. Finally, the bounty of moderating and mediating variables discussed in—and beyond—this chapter suggests that less direct analytic approaches (e.g., ones assessing conditional indirect effects) are needed to capture the complex reality of parenting childhood aggression. Second, the design of parenting measures and interventions should be sensitive to cultural (and socioeconomic) differences in parenting, including varying perceptions of children’s aggressive behavior (see Tamis-LeMonda, Briggs, McClowry, and Snow, 2008). For example, the Parenting Dimensions Inventory—developed with European-American parents—yielded psychometrically sound subscales with both American and Japanese samples, although clusters of Japanese mothers had dimensional profiles that could not be captured by Baumrind’s traditional parenting styles (Power, Kobayashi-Winata, and Kelley, 1992). Similarly, while some parenting interventions have shown promising effects across cultures (Gardner et al., 2016), the exact mechanisms of change—or routes to success—underlying positive intervention effects may differ between cultures (also see Cultural Considerations for Parenting Aggressive Children in this chapter). Understanding and accounting for these cultural nuances could enhance the cultural precision of interventions (Stewart and Bond, 2002). 511

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Third, the relative dominance of self-reported questionnaire responses in parenting studies leaves them susceptible to validity issues—and this may be amplified when it comes to reporting aggressive (i.e., less socially desirable) behaviors. Observational methods address the recall-related limitations of self-reports because parent–child interactions are recorded as they occur, which allows for the added strength of real-time dyadic measurement (Kuczynski et al., 2015), but they are still susceptible to desirability biases (Gardner, 2000). Ecological momentary assessments with electronic and webbased technologies (e.g., smartphones and tablets) allow for real-time collection of audio, video, and self-reported data in the comfort of participants’ natural environments, which enhances ecological validity (Gordon and Feldman, 2008). Still, parents with the most aggressive children may be too preoccupied and/or stressed to complete momentary assessments. Missing data should be carefully scrutinized and addressed. It may also be beneficial for the self-reported components of such studies to be designed with fewer items to report and/or less intensive reporting schedules (e.g., daily versus hourly; see Colasante, Zuffianò, and Malti, 2016).

Future Directions in Parenting Aggressive Children Much progress has been made in the study of parenting effects on aggression in children and adolescents; nonetheless, several research areas warrant further exploration. A first question is how differential parenting styles and parent–child interactions contribute to the emergence of aggression, including its intensity during different developmental periods (e.g., early childhood versus midadolescence), distinct trajectories of overt aggression and its various subtypes (e.g., highly stable versus decreasing or low stable), and over extended periods (i.e., long-term outcomes). A second question is how social-emotional processes at multiple levels of analysis (i.e., including physiology, subjective experience, and interactions) mediate the links between parenting and the development of children’s aggressive behavior. Recent developmental psychophysiological research is beginning to provide a richer picture of the physiological and affective foundations of childhood aggression (Colasante and Malti, 2017). In addition, there is evidence that parenting styles affect children’s and adolescents’ emotion regulation (Morris et al., 2007). Integrating these research efforts will yield beneficial information regarding the mechanisms underlying the role of parent–child interactions in shaping children’s aggression. A third question concerns the role of children’s genetically based differences and how they affect their experiences in the parent–child relationship.This genetic vulnerability becomes especially intriguing from the perspective of cross-context comparisons. It is already known that certain children are more susceptible to experiences of destructive parenting (Belsky and Pluess, 2009), which affects later aggressive behavior (Caspi et al., 2002). However, less is known about whether genetic moderation effects in the relation between parenting and aggression differ across national contexts, and if so, why. Ultimately, research on the moderators and mediators of the parenting-childhood aggression link can help disentangle the risk and protective factors that parenting interventions should target when trying to reduce aggression in childhood and adolescence. For example, risk factors in the family and wider social contexts—such as poverty, criminal neighborhoods, and lacking economic and social resources—negatively affect parents’ caregiving. By identifying such central risk and protective factors, intervention strategies and techniques can be tailored accordingly and may more effectively enable parents to respond to their children with the control and support necessary to promote healthy behavioral development. Last, future research on the transportability of rigorous parenting interventions across different contexts is warranted. To date, it is not clear if the same programs and strategies that have shown evidence in one context are equally effective in different contexts. Because parental cultural beliefs, cultural norms and practices, and potential program developer biases are factors that can be assumed to influence program effectiveness, more research on transportability across countries and diverse 512

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communities is necessary (Malti, Noam, Beelmann, and Sommer, 2016; Sundell, Beelmann, Hasson, and von Thiele Schwarz, 2016). This research may involve tailoring to known risk and protective factors in a specific context, as well as coherence between program content and program administration, such as sensitivity to diverse family populations when promoting parenting skills (Kumpfer, Magãlhaes, Xie, and Sheetal, 2016).

Conclusions Aggressive behaviors in childhood and adolescence can have substantial and enduring negative effects on children themselves, families, and society.Thus, it is widely acknowledged that a better understanding of the risk and protective factors, including parenting and the wider family context, for childhood aggression is important. Over the last century, conceptions about how to rear children with challenging behaviors have arguably changed. What has remained constant is that parenting children with aggression is not an easy task. This chapter reviewed central theories and research on parenting and aggression in childhood and adolescence and discussed issues in parenting intervention research. Developmental research over the last half century has generated fundamental knowledge regarding associations between parenting and aggressive behavior in childhood and adolescence. There is also evidence for parental contributions to developmental trajectories of aggression. In addition, research on psychological, social, and genetic processes that link parenting and aggression in childhood and adolescence has been conducted. This research includes factors such as children’s social-cognitive development, resources in the family environment, and genetic susceptibility to the effects of parenting. Taken together, these findings have contributed to the development of interventions that aim to help caregivers reduce and prevent aggression and related behavior problems in children and adolescents. Future research linking parenting and trajectories of aggression, as well as exploring mechanisms that potentially underlie these associations, will generate more in-depth information on how and why parenting affects children’s and adolescents’ aggression. This research will be beneficially integrated with efforts to enhance parenting and the quality of parent–child relationships. This can help intervention research further utilize evidence regarding how differences in parenting and children’s experiences matter for intervention efficacy. Ultimately, this agendum will generate more knowledge regarding when, how, and for whom particular intervention strategies and practices work.

Acknowledgments We thank Anisha Aery, University of Toronto, for editorial assistance with the chapter.This work was supported by a New Investigator Salary Award and Foundation Grant from the Canadian Institutes of Health Research (CIHR) awarded to Tina Malti (Grant Number: FDN-148389), and funds from the Social Sciences and Humanities Research Council of Canada (SSHRC) to Tyler Colasante, and the Natural Sciences and Engineering Research Council of Canada (NSERC) to Sebastian Dys.

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Tina Malti et al. Supplee, L. H., Unikel, E. B., and Shaw, D. S. (2007). Physical environmental adversity and the protective role of maternal monitoring in relation to early child conduct problems. Journal of Applied Developmental Psychology, 28, 166–183. doi: 10.1016/j.appdev.2006.12.001. Tackett, J. L. (2006). Evaluating models of the personality-psychopathology relationship in children and adolescents. Clinical Psychology Review, 26(5), 584–599. doi:10.1016/j.cpr.2006.04.003. Tamis-LeMonda, C., Briggs, R. D., McClowry, S. G., and Snow, D. L. (2008). Challenges to the study of african american parenting: Conceptualization, sampling, research approaches, measurement, and design. Parenting: Science and Practice, 8(4), 319–358. doi:10.1080/15295190802612599. Tarver, J., Daley, D., Lockwood, J., and Sayal, K. (2014). Are self-directed parenting interventions sufficient for externalising behaviour problems in childhood? A systematic review and meta-analysis. European Child and Adolescent Psychiatry, 23(12), 1123–1137. doi:10.1007/s00787-014-0556-5. Taylor, S. E., Klein, L. C., Lewis, B. P., Gruenewald,T. L., Gurung, R. A. R., and Updegraff, J. A. (2000). Biobehavioral responses to stress in females:Tend-and-befriend, not fight-or-flight. Psychological Review, 107, 411–429. doi:10.1037//0033-295X.107.3.411. Towe-Goodman, N. R., and Teti, D. M. (2008). Power assertive discipline, maternal emotional involvement, and child adjustment. Journal of Family Psychology, 22(4), 648. doi:10.1037/a0012661. Tremblay, R. E., Nagin, D. S., Séguin, J. R., Zoccolillo, M., Zelazo, P. D., Boivin, M., . . . Japel, C. (2004). Physical aggression during early childhood: Trajectories and predictors. Pediatrics, 114(1), e43–e50. doi:10.1542/ peds.114.1.e43. Tully, L. A., and Hunt, C. (2016). Brief parenting interventions for children at risk of externalizing behavior problems: A systematic review. Journal of Child and Family Studies, 25(3), 705–719. doi:10.1007/ s10826-015-0284-6. Tung, I., Li, J. J., and Lee, S. S. (2012). Child sex moderates the association between negative parenting and childhood conduct problems. Aggressive Behavior, 38, 239–251. doi:10.1002/ab.21423. van Aar, J., Leijten, P., Orobio de Castro, B., and Overbeek, G. (2017). Sustained, fade-out or sleeper effects? A systematic review and meta-analysis of parenting interventions for disruptive child behavior. Clinical Psychology Review, 51, 153–163. doi:10.1016/j.cpr.2016.11.006. Vitaro, F., Barker, E. D., Boivin, M., Brendgen, M., and Tremblay, R. E. (2006). Do early difficult temperament and harsh parenting differentially predict reactive and proactive aggression? Journal of Abnormal Child Psychology, 34, 681–691. doi:10.1007/s10802-006-9055-6. Waller, R., Shaw, D. S., and Hyde, L. W. (2017). Observed fearlessness and positive parenting interact to predict childhood callous-unemotional behaviors among low-income boys. Journal of Child Psychology and Psychiatry, 58, 282–291. doi:10.1111/jcpp.12666. Wang, Q. (2006). Relations of maternal style and child self-concept to autobiographical memories in Chinese, Chinese immigrant, and European American 3-year-olds. Child Development, 77, 1794–1809. doi:10.1111/j.1467-8624.2006.00974.x. Webster-Stratton, C., and Reid, M. (2010). Adapting The Incredible Years, an evidence-based parenting programme, for families involved in the child welfare system. Journal of Children’s Services, 5(1), 25–42. doi:10.5042/jcs.2010.0115. Winnicott, D. W. (1953). Transitional objects and transitional phenomena. International Journal of Psychoanalysis, 34, 89–97. Zuffianò, A., Colasante, T., Buchmann, M., and Malti, T. (2017). The co-development of sympathy and overt aggression from middle childhood to early adolescence. Developmental Psychology. Advance online publication. doi:10.1037/dev0000417.

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16 PARENTING AND AUTISM SPECTRUM DISORDER James B. McCauley, Peter Mundy, and Marjorie Solomon

Introduction Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with variable expression that is defined by the presence of social, communicative, and behavioral challenges. Individuals with ASD exhibit repetitive behaviors or restricted interests and have enduring difficulties in communicating and interacting with other people. These characteristics can create unique challenges for parents and families of children with autism. For instance, children with ASD can be unusually reactive to sensory stimulation or resistant to changes in preferred activities, either of which can disrupt the typical schedule of daily activities. Parents’ adjustments to these behaviors can lead to increased daily family stress and isolation due to hesitancy to participate in the typical range of social or community activities outside the home (Schaaf, Toth-Cohen, Johnson, Outten, and Benevides, 2011). Parents and siblings may also face difficulties developing a sense of relatedness with children with ASD. A core symptom of ASD is an impairment of joint attention defined as a decreased tendency to spontaneously share experience with others through eye contact and positive affect (Kasari, Sigman, Mundy, and Yirmiya, 1990; Mundy, Sigman, Ungerer, and Sherman, 1986). This symptom does not appear to impact child-parent attachment (Capps, Sigman, and Mundy, 1994). However, greater intensities of this symptom are associated with parent reports of a decreased sense of relatedness and intersubjectivity with their children (Mundy, Sigman, and Kasari, 1994). Thus, the symptom profiles associated with ASD can be expected to have unique effects on parents and families (Cridland, Jones, Magee, and Caputi, 2014; Karst and Van Hecke, 2012; Woodman, Smith, Greenberg, and Mailick, 2015). Observations such as these raise the possibility of a significant role for family process research in understanding factors that influence the course of development of children with autism (Osborne, McHugh, Saunders, and Reed, 2008). Parents may also need assistance to best acclimate to the complications of ASD to maintain optimal quality of life for their children and themselves (A. H. Solomon and Chung, 2012). Despite the difficulties and unique parenting challenges, it is fair to say that research on parenting and family process is not a prominent part of the contemporary literature on ASD. There are at least three reasons that parenting and family research has not been emphasized in the contemporary literature. The modern history of research on autism began with a misinformed hypothesis that suggested that parenting played a primary role in the etiology of autism (Bettelheim, 1967). Although evidence did not support this hypothesis (Rimland, 1964), the negative repercussions of this erroneous idea had a chilling effect on better informed and more useful approaches to

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this important topic. Another reason for scant family research is that it became increasingly clear after the 1970s that ASD has a biological neurodevelopmental etiology (Abrahams and Geschwind, 2008; Gliga, Jones, Bedford, Charman, and Johnson, 2014). The biological nature of ASD suggested to many that research on family process is unlikely to be of significant impact if the prognosis of ASD was driven by genetic factors. However, research on other conditions with biological neurodevelopmental etiologies belies that notion. A case in point, research on schizophrenia, has long indicated that studies of family process research can inform understanding individual differences in prognosis and treatment response (Pitschel-Walz, Leucht, Bäuml, Kissling, and Engel, 2001). Indeed, to some significant extent the communication systems school of family therapy grew out of seminal research on schizophrenia (Bateson, Jackson, Haley, and Weakland, 1956). Finally, the intellectual disability and the social-cognitive deficits associated with ASD suggest that the importance of family process research may only apply to a small subset of affected children. However, epidemiological research now indicates that 68% of second grade children with ASD are verbally fluent and functioning in the borderline to above-average range of intelligence (Christensen et al., 2016). Moreover, data have begun to accumulate that family factors affect the outcome of children with ASD regardless of intellectual disability or social cognitive status (Karst et al., 2015; Woodman et al., 2015). To support the next generation of research on the role of parenting and family factors in research on ASD, this chapter reviews the current understanding of the transactional relation between the impact of symptoms of ASD on family and how family process can impact the child’s development. To provide a theoretical foundation for this chapter, it is useful to consider two models of ASD and development. The first is the moderator model of autism (Burnette et al., 2011; Mundy, 2016; Mundy, Henderson, Inge, and Coman, 2007). The development of ASD is characterized by a wide range of individual differences or heterogeneity of outcomes (Jeste and Geschwind, 2014).The moderator model of autism assumes that heterogeneity is the interaction of multiple syndrome-specific, largely biological etiological factors, with syndrome nonspecific environmental and biological factors (see Figure 16.1). The syndrome-specific path of this model involves the interaction among multiple causal processes, which involve multiple major genetic determinants and variable expressivity as well as penetrance of gene expression caused by largely unknown epigenetic gene-to-gene and

Ae1 ICP1

ICP2

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Figure 16.1  Heterogeneity in autism may arise from at least two sources: syndrome-specific initial causal processes (ICPs) and non-syndrome-specific modifier processes (MPs).Varied constellations of genetic and neurodevelopmental ICPs contribute to differences in ASD expression at different ages across the course of autism in individuals. In addition, phenotypic variability in the expression of autism at any age (Ae1, Ae2, . . .) may be caused by the interactions of the ICPs of autism with non-syndrome-specific MPs, such as variation in the temperament dimensions of avoidance and approach tendencies associated with the behavioral inhibition and activation systems respectively (Burnette et al., 2011)

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gene-to-environment interactions. The interactions of these biological factors alone gives rise to some portion of the heterogeneity of ASD (Geschwind, 2011). Complicating matters, the moderator model suggests that processes not specific to the biological etiology of ASD also have a significant effect on the heterogeneity of ASD. For example, the symptoms of ASD may vary in interaction with dimensions of temperament that are not necessarily specific to the syndrome (Burnette et al., 2011; Schwartz et al., 2009).The literature reviewed in this chapter indicates that parenting and family factors may be considered another major non-etiological moderator of the course and outcome of ASD across children (Osborne et al., 2008; Tunali and Power, 2002; Zaidman-Zait et al., 2014). The second model that helps to organize information on ASD and development is derived from transactional models of development (Sameroff and Mackenzie, 2003). Recognition of the transactional or dynamic nature of causal processes in family interactions emphasizes some of the importance of advancing research on parenting and family factors on ASD. A model of the role of these transactional processes is illustrated in Figure 16.2. The left side of this model depicts (1) the nonrecursive or reciprocal effects of the characteristics of a child with ASD and the level of parent stress and coping and (2) their reciprocal causal paths with the child’s response to intervention during the preschool, elementary school, or high school period of development. A non-exhaustive list of examples of research that inform the assumptions of this component of the model include (1) observations of the bidirectional nature of parenting stress and the behaviors problems of children with ASD

Child Characteriscs • • • • • •

CHILD OUTCOMES • Social-Communicaon • Adapve • Cognive • Stress & Comorbidity

Language/Cognion Externalizer Internalizer Hypo/Hyper Responses Sleep GI Health

Intervenon for Ausm Spectrum Disorder

ASD Diagnosis

Parent-Family Outcomes • Family Funconing • Parent-Child Relaons • Parent Efficacy • Parent Stress and Mental health

Parent Stress & Coping • Stress • Internal Resources • External Resources • Coping • Appraisal, Beliefs • Efficacy

Figure 16.2  A rationale for more studies on parenting and family process in research on ASD is illustrated in this model of causal pathways between parenting/family factors, intervention responses and effects, and child outcomes. The left side of the model illustrates assumptions pertinent to early, preschool intervention parenting stress and that child characteristics have reciprocal causal relations, which can both affect and be affected by early intervention. However, with exceptions (Keen et al., 2010), early intervention research rarely includes the resources for the robust examination of these putative effects. The right side of the illustration reflects a modification of the model proposed by Karst and Van Hecke (2012). The assumptions of this model explicitly call for more precise measures of parenting and family functioning (e.g., coping) to be measured as outcomes of intervention and moderators of intervention in school-aged children and youth with ASD. Studies illustrating this approach to research on parenting and family function in ASD research are rare, but increasing (Blackledge and Hayes, 2006; Karst et al., 2015; Solomon et al., 2008)

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(Zaidman-Zait et al., 2014), (2) the negative impact of parent stress on early intervention for children with ASD (Osborne et al., 2008), and (3) studies that suggest that intervention for parents can reduce stress (Keen, Couzens, Muspratt, and Rodger, 2010). The remaining causal paths illustrated in the model suggest that three factors interact in a reciprocal fashion with longer-term outcomes of children with ASD. These include (1) child characteristics, (2) parent and family stress, coping, and related outcomes, and (3) the interventions provided for children with ASD. Examples of observations that suggest these presumptive reciprocal causal paths include (1) a child-focused social-skills intervention can have significant effects on parent stress, efficacy, and the executive functioning of families (Karst et al., 2015), (2) parental and family variables can moderate treatment effects in 8- to 13-year-old children with ASD (de Veld et al., 2017), (3) parent–child interaction therapy can have positive effects on adaptability of children with ASD aged 5–12 years as well as on parent perceptions of children and parent positive affect (M. Solomon, Ono, Timmer, and Goodlin-Jones, 2008), and (4) treatments that impact parents’ appraisal and beliefs about parenting children with ASD may facilitate family coping (Blackledge and Hayes, 2006;Tunali and Power, 2002). The model depicted in Figure 16.2 is only a conceptual starting place for the discussion of current and future directions of parent/family studies in research on ASD, as the current literature is neither sufficiently comprehensive nor rigorous. Nevertheless, the expansion of research on family processes holds the promise of improving lifespan support and outcomes for individuals with autism. As a final introductory note, the changes in the diagnosis and measurement of autism make it difficult to summarize with clarity a literature that is still emerging. The diagnostic requirements and measurement for autism have steadily changed throughout the last few decades to reflect a refined distinction from other disorders with clear genetic components and improved classification of behavior. A major shift within autism research occurred in the early 1980s, as the term infantile autism was acknowledged for the first time in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and was officially distinguished from childhood schizophrenia (American Psychiatric Association [APA], 1980). By the late 1980s, the term infantile autism was replaced with autism disorder, and a checklist of criteria was developed to standardize the diagnosis (APA, 1987). The most recent change with the DSM-5 eliminated a distinction between Asperger’s disorder and autism spectrum disorder, while also allowing clinicians and researchers to declare comorbidity between ASD and attention deficit hyperactivity disorder to be identified (APA, 2013). The diagnosis of ASD is commonly assessed with a standardized interview with a clinician with the use of the second edition of the Autism Diagnostic Observation Schedule(ADOS-2; Lord, Rutter, DiLavore, Risi, Gotham and Bishop, 2012). The ADOS-2 relies on clinician observations of restricted and repetitive behaviors and of social affect, for which the interview is modulated to account for varying levels of language and cognitive abilities. Researchers and clinicians will also use structured interviews with parents, such as the Autism Diagnostic Interview-Revised (ADI-R; Rutter, Le Couteur, and Lord, 2003), and use parent questionnaires, such as the Social Communication Questionnaire (Rutter, Bailey, and Lord, 2003), to corroborate diagnoses of ASD. Each of these measurement tools have strengths and weaknesses, and there is little consensus on best practices outside of recommendations for a multiple method approach (Ozonoff, Goodlin-Jones, and Solomon, 2005). To better understand the status of parenting/family research, this chapter is topically organized as follows. We begin with a brief review of the history of the misinformed hypothesis about the role of family process in the etiology of autism.This component of the review recognizes that family process does not play a fundamental in the etiology of autism. Nevertheless, around the world the need to continue to work toward decreasing processes that stigmatize some families of children with autism remains. The second section of the chapter follows with an overview of the many factors that are associated with stress in the families and lives of parents rearing children with ASD. A discussion of the variables related to the coping and resilience in the face of stress follows with notations to the emerging cross-cultural literature on coping. The third section of the chapter examines studies of 526

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the processes of parenting and family interactions with respect to the development of children with autism. Here, research on transactions of parenting and family processes and autism interventions are considered. This section also focuses on the shifting nature of parenting across the preschool, schoolage, and adult periods of development of the family member with ASD.

Historical Views on Parenting Children With Autism Over the past seven decades, perceptions about the nature and etiology of autism have shifted between the current model of autism as caused by biological processes, perhaps in interaction with environmental factors, and the notion that the latter are the singular cause of autism (Strathearn, 2009). In this section of the chapter, we discuss an initial model of autism that proposed that family process caused autism. This initial conceptualization of the role of family processes in autism was problematic.Without the advantage of evidenced-based science, psychodynamic theory led to a misconstrual of the role of parenting in the etiology of ASD. Kanner (1943) originally described what he called early infantile autism as likely arising from innate biological processes, as many of the symptoms were pervasive from an early age. However, the psychodynamic perspective (the zeitgeist perspective in psychology at the time) was not aligned with a biological perspective on psychiatric conditions. A major pillar of psychodynamic theory was that the experiences a child has in the early years with caregivers was foremost among factors that gave rise to individual differences in psychological and behavioral differences in development (Frank, 1965; Cohler and Paul, 2019). Moreover, Kanner (1949) was tasked by his contemporaries with clearly differentiating ASD from “organic” disorders such as Heller’s disease, schizophrenia, and aphasia. As a result, Kanner adopted elements of the psychodynamic approach and suggested that some personality characteristics of the parents, such as a lack of warmth displayed by mothers and fathers or their mechanical approach to parenting, may be responsible for characteristics of ASD: They lacked the warmth which the babies needed. The children did not seem to fit into their established scheme of living. The mothers felt duty-bound to carry out to the letter the rules and regulations which they were given by their obstetricians and pediatricians. They were anxious to do a good job, and this meant mechanized service of the kind which is rendered by an over conscientious gasoline station attendant. (Kanner, 1949, p. 425) To his credit, Kanner (1949) recognized inconsistencies in this hypothesis, for example by stating that it was not clear “why some of these parents have been able to rear children who did not withdraw” (p. 426). Nevertheless, many psychiatrists began to emphasize that a lack of parental engagement was the source of autistic behavior in children. Kanner himself remained more equivocal about the role of parenting (see Rimland, 1964). In The Empty Fortress, Bettelheim (1967) suggested the extreme and very unfortunate comparison between the type of care that led to ASD and his and others’ experiences as victims in the Dachau concentration camp: I believe the initial cause of withdrawal is rather the child’s correct interpretation of the negative emotions with which the most significant figures in his life approach him. This in turn, evokes rage in the child until he begins—as even mature persons do—to interpret the world in the image of his anger. All of us do that occasionally, and all children do it more than occasionally.The tragedy of children fated to become autistic is that such a view of the world happens to be correct for their world; and this is at so early an age that they lack any other, more benign experience to counterbalance it. (Bettelheim, 1967, p. 66) 527

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Commonly referred to as the “refrigerator mother theory,” the conception of parents of children with autism as aloof or uncaring was subsequently adopted by the medical community. Many psychiatrists and medical professionals considered autism to be an entirely functional and reversible condition caused by psychologically absent mothering, and supported the need for children with severe autistic behaviors to receive active and intrusive treatment focusing on physical stimulation in structured environments (Bettelheim, 1974; Goldfarb, 1961; Kaufman, Rosenblum, Heims, and Willer, 1957; Kysar, 1968; Ward, 1970). The psychodynamic view of ASD had many untoward effects on research and clinical practice for ASD. Not the least of these was that the refrigerator mother theory led to scapegoating parents (Kysar, 1968; Schopler, 1971). However, by the mid-1960s data from empirical group comparison studies of parent behaviors and attitudes did not support this characterization of parents of children with ASD. Frank (1965) pointed out that variations of the parenting etiology hypothesis had been applied to many types of atypical development including schizophrenia, but that 40 years of research failed to provide compelling evidence for the assumption that parenting is a causal factor of symptom presentation. More directly, a comparison between family factors of parents of young children with autism or with dysphasia (a language disorder characterized by deficiencies in the production of speech) revealed no differences between groups in amount of family separation, problems of finance, parental mental state, or interpersonal relationships (A. Cox, Rutter, Newman, and Bartak, 1975). Studies of parental attitudes and childrearing practices also reported only minimal differences between parents of children with autism, with typical development, and with other developmental conditions (Anthony, 1958; Cantwell, Baker, and Rutter, 1978; Holroyd and McArthur, 1976; Pitfield and Oppenheim, 1964). A third set of studies employing observational methods of family interactions also called into question the narrative that autism was caused by poor parenting. Byassee and Murrell (1975) found no differences between families of typically developing children and children with autism in interaction patterns and agreements during a choice-making activity. Using parent interviews and home observations, Cantwell, Baker, and Rutter (1979) found similar interaction patterns between families of children with autism and families of children with dysphasia. These studies foreshadowed work in the late 1980s and early 1990s that described very minor differences in attachment behaviors between dyads affected by autism or other clinical and developmental disorders (Rogers, Ozonoff, and Maslin-Cole, 1991; Shapiro, Sherman, Calamari, and Koch, 1987; Sigman and Mundy, 1989; Sigman and Ungerer, 1984). The psychodynamic view had the initial dominant voice in describing the etiology of autism, but researchers eventually returned to the hypothesis that ASD was the result of atypical biological developmental processes that affected sensory and perceptual systems (Anthony, 1958; Ornitz and Ritvo, 1968; Rimland, 1964; Rutter, 1968). A new neurodevelopmental model of autism took hold as the prevailing etiologic model by the late 1970s (Cohen, Caparulo, and Shaywitz, 1978; Damasio and Maurer, 1978). Today, researchers recognize that the etiology of autism is complex with genetic and prenatal environmental factors affecting the development of the brain at different stages, leading to the development of the heterogeneous behavioral phenotypes of individuals with autism (Belmonte et al., 2004; Lyall, Schmidt, and Hertz-Picciotto, 2014). During the shift of focus toward more rigorous clinical research, parents began to voice their perspectives. Park (1967) described how she reared and taught her daughter within this historical context and how she challenged the medical establishment’s conclusions about autism. Her book empowered parents to question psychodynamic interpretations of autism and to form advocacy networks. Between early 1990 and 2006, parents formed foundations with clinicians and researchers that helped to fund vast amounts of research at academic institutions. Foundations such as the National Alliance for Autism Research, Cure Autism Now, and Autism Speaks raised public awareness of autism and lobbied Congress to leverage funding from private donations with increased public spending for advancing autism science and parent resources. 528

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In the 1940s when autism was first recognized, psychological (e.g., operant learning theory) and psychiatric models of development (psychodynamic theory) primarily emphasized the role of responses to environmental factors in shaping human development. It is perhaps not surprising then that a misleading model of family process causation in autism held sway for the first 3 decades of the discovery of the nature of autism. At this point in the science of ASD, though, it is important to distinguish between claims that parent behaviors cause autism behavior and claims that parent behaviors may influence the course, expression, or prognosis of autism in children. The former claim has never been empirically supported, but the latter is less controversial. Nonetheless, a complete understanding of how families can moderate the course or expression of autism is not yet at hand. Of course, it is also important that to recognize that the effects of autism on a child’s development can moderate the course of family functions and functioning. Consequently, it is not surprising that a sizable portion of the contemporary literature on parenting and family process in research on ASD has focused on family stress and resilience.

Parent and Family Stress, Resilience, and Coping With Autism There are substantial but varying levels and sources of stress for families and parents with children with autism. Viewing the family as a system allows researchers to probe how the behaviors of one member of the family can reorganize the dynamics of the whole system (M. J. Cox and Paley, 1997; Kerig, 2019). Several researchers have called for the adoption of a family systems perspective for framing investigations of autism and parenting (Bristol, 1985; Cridland et al., 2014). How families adapt to the challenges associated with children with autism can create a wide variance in both family functioning and child behavior. For example, a child with increasing tendencies toward aggression can exacerbate parenting stress and marital conflict as negative interactions in the family become more frequent. Another family in a similar situation may rely on spousal support for coping, leading to increased closeness in their relationship. The family systems perspective provides a dynamic view of children’s development as affected by interactions or transactions between parents on children and children on parents. The gradual recognition and adoption of this perspective has led to recognition of the importance of studying the reciprocal effects of stress in families of children with ASD. For example, if left unchecked, family/parent stress can moderate and even reduce effects of behavioral improvement for some children with autism in early intervention (Osborne et al., 2008). Conversely, parent-implemented interventions that bolster a sense of parenting efficacy can lead to reductions in perceived stress in parents (Keen et al., 2010). Thus, researchers have begun to recognize the need to better understand levels of stress and quality of family functioning because they may moderate intervention effectiveness and important outcomes of intervention effectiveness for children with ASD (Karst and Van Hecke, 2012).The dynamic and transaction process of stress in families with children with ASD often begins with the diagnostic process.

Impact of the Diagnosis Families encounter emotional and institutional barriers when seeking or accepting a diagnosis for their child. Receiving a diagnosis of ASD can be an especially arduous process. Whereas some childhood disabilities feature distinct physiological indicators present at birth or in the postpartum period, the behavioral concerns present in autism are variable, and many are not apparent until toddlerhood or later. Researchers have demonstrated efficacy and stability in the diagnosis of ASD in 24-monthold children and can reliably observe behaviors characteristic of ASD as early as 12 months in infant siblings of children with ASD, who are a high-risk sample (A. Cox et al., 1999; Ozonoff et al., 2010). However, parents often need resources and persistence when discussing concerns with 529

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their pediatricians to attain an early diagnosis. Parents from higher socioeconomic or educational backgrounds bring concerns to their doctors at an earlier age (Moh and Magiati, 2012), and more ethnically diverse families receive diagnoses much later (Daniels and Mandell, 2014). Many parents with children eventually diagnosed with autism voice their concerns about their child to their pediatricians within the child’s first 2 years (De Giacomo and Fombonne, 1998), and their concerns are informative for later diagnoses (Ozonoff et al., 2009). Yet, parents’ reports of their concerns about their children’s development may not initially be acted on by medical professionals (Caronna, Augustyn, and Zuckerman, 2007; Howlin and Moore, 1997; Ozonoff et al., 2010; Zuckerman, Lindly, and Sinche, 2015). This delay is problematic because a lost opportunity for early identification can delay the types of earlier intervention that can have tremendous effects on development in multiple domains (Estes et al., 2009; Reichow, 2012). Parents often report that the diagnostic process could be easier and less complicated (Osborne and Reed, 2008). Autism spectrum disorders are difficult for clinicians to diagnose due to heterogeneity and severity of behaviors. For some parents, receiving a diagnosis can be a source of relief, as it offers a causal explanation for their concerns (Midence and O’Niell, 1999). For others, the ambiguity of their child’s symptoms can lead to stressful encounters with pediatricians or uncertainty of how to proceed. Parents of children with higher levels of symptoms report lower stress during the diagnostic process than parents of children with fewer symptoms (Siklos and Kerns, 2007). Parents and clinicians may more easily observe problems when children are more severely affected by autism, but parents may experience barriers attaining an acceptable diagnosis for a more verbally or cognitively skilled child. Alongside some of these institutional barriers, the diagnostic process comes with emotional burdens that are tied to parents’ identity, expectations, and newfound fears. The reception of a diagnosis can mirror emotional processes accompanying grief, including shock, denial, guilt, adaptation, and acceptance (Blacher, 1984; Seligman and Darling, 1989). According to the ambiguous loss framework, the diagnosis of autism confers emotional challenges associated with expectations and caregiver identity (Boss, 2007; Boss and Greenberg, 1984). Parents report having to adjust their expectations of their child’s future functioning to be more realistic (Luther, Canham, and Cureton, 2005). In addition, parents must come to the realization that their role as caregiver is likely to be more involved and challenging throughout their child’s development (O’Brien, 2007). Most parents of children with autism are resolved to the diagnosis or have come to accept the new status of their child and of their role and expectations (Poslawsky, Naber,Van Daalen, and Van Engeland, 2014). However, parents who do not employ this type of cognitive reappraisal can face significant challenges coping with parenting tasks and developing positive relationships with their child (Marvin and Pianta, 1996). They demonstrate less sensitivity during interactions with their children (Feniger-Schaal and Oppenheim, 2013). In addition, parents expressed reluctance to pursue a diagnosis to maintain their perspective that their child is “normal” (Russell and Norwich, 2012). The need for social support from spouses, family members, and support groups is highest immediately after receiving a diagnosis to help resolve feelings (Seligman and Darling, 1989). Rearing a child with a diagnosis of a lifelong disorder is considered an ambiguous loss for parents (Boss, 2007). Ambiguous loss, defined as a loss without closure or certainty, is one example of psychological stress endured by parents of children with disabilities, including parents of children with ASD. Parents lose expectations for their children to approach normative milestones at the same time as other same-aged children and can feel emotional distress on the realization of lifelong caregiving responsibilities. Parents of children with autism and other disabilities can invest many of their own resources into their children, at times at the cost of their own care. Constant caregiving can cause dissolution of self-identity separate from their child in a process which has been dubbed “identity ambiguity” (Boss and Greenberg, 1984). The process by which the boundaries of a parent’s identity dissolve is likely enhanced due to caregiving demands that occur in multiple contexts. In the 530

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household, parents face a variety of challenges associated with routines, which can have profound impacts on parent stress and efficacy (Dabrowska and Pisula, 2010; Karst and Van Hecke, 2012) and on the quality of the marital relationship (Hartley, Papp, Blumenstock, Floyd, and Goetz, 2016; Hock, Timm, and Ramisch, 2012). In the school and broader community, parents must be consistent advocates for additional services for their child (Ryan and Cole, 2009) and must address stigma by reframing the negative or unusual perceptions of others into positive presentations of their children (Gray, 2002; Rocque, 2010). Processes such as ambiguous loss and identity ambiguity help researchers identify cognitive mediators between individual characteristics and family processes. For example, O’Brien (2007) found that high levels of identity ambiguity predict increased levels of depressive symptoms and perceptions of child-related stress.

Stigma Although the causal role of parenting in the etiology of autism has been widely rebuked, families of children with autism continue to report feeling stigmatized, scrutinized, and blamed for their child’s behavior by both community members and extended family members (Gray, 2002; Hinshaw, 2005; Neely-Barnes, Hall, Roberts, and Graff, 2011). The science says that complex biological processes, rather than parenting, cause autism; however, the specifics of the biological causes remain ambiguous. This ambiguity can be an additional source of stress because it is human nature to strive to understand the causes (meaning) of traumatic events (C. G. Davis, Nolen-Hoeksema, and Larson, 1998). Self-blame and guilt can arise in parents of children with autism if they view their child’s condition as caused by their past choices or behaviors (Dale, Jahoda, and Knott, 2006).These feelings of guilt may be associated with negative parent ratings of self-efficacy (Kuhn and Carter, 2006), which in turn promotes parental fatigue (Giallo, Wood, Jellett, and Porter, 2013), depression, and anxiety (Hastings and Brown, 2002). Cross-cultural research in China, Iran, Pakistan, India, and Korea has also captured how parents can be stigmatized and blamed for their child with autism and how cultural barriers impede a family from receiving appropriate care (Dehnavi, Malekpour, Faramarz, and Talebi, 2011; McCabe, 2007; Minhas et al., 2015). In China, families of children formally diagnosed with autism can be confronted by public schools that refuse to admit the children (McCabe, 2007; K Tait, Mundia, and Fung, 2014). Chinese parents report making personal sacrifices to provide education to their children and feeling the need to hide or reject the diagnosis of their child due to embarrassment and shame (McCabe, 2007; Kathleen Tait, Fung, Hu, Sweller, and Wang, 2016). To combat this perceived stigma, a parentto-parent group was found to boost acceptance and emotional support among parents of children with autism in China (McCabe, 2008). Parents have a pivotal role in de-stigmatizing and reframing autism to others. Many parents report becoming advocates and activists for autism (Ryan and Cole, 2009) and express positive beliefs about their child’s abilities to others (Russell and Norwich, 2012).There is general acceptance of the medical etiology of autism in parents, but some have rejected clinical or societal attempts to “normalize” autism and instead urge others to respect the cognitive differences among children (Langan, 2011). How these different approaches and attitudes toward stigma and autism affect parent mental health, parent interactions with their child, and parent tendency to seek intervention for their children is currently unknown.

Economic Impact Financial stress is a prominent source of disruption in positive family processes (Conger, Conger, and Martin, 2010), and parenting a child with autism is associated with enduring financial costs. These include insurance premiums and copays for treatments and services, prescription medicine, 531

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lost employment time and opportunities for both parents and children with autism, residential and respite care, and voluntary interventions and treatments (Ganz, 2007). Children with autism often have greater numbers of hospital visits and can pay higher amounts in health care related fees (Croen, Najjar, Ray, Lotspeich, and Bernal, 2006). Depending on local laws, some costs can be offset by government assistance. In U.S. dollars (using year of publication exchange rates), the annual per capita costs to support individuals on the spectrum are estimated to be over $17,000 in the United States (Lavelle et al., 2014), close to $40,000 in the United Kingdom (Knapp, Romeo, and Beecham, 2009), and over $65,000 in Sweden (Järbrink, 2007). When therapy is not covered by insurance or government programs, families can end up forfeiting retirement benefits or declaring bankruptcy to afford therapy for their child (Sharpe and Baker, 2007). Lost employment time and opportunities affect both parents, but mothers of children with autism report significant adversity in attaining and maintaining work. D. L. Baker and Drapela (2010) found that mothers of children with autism report not taking employment opportunities, working fewer hours, taking absences, or being reprimanded at work for time missed to care for their child. One study estimated the costs associated with lost or interrupted employment to be $18,720 annually for caregivers of children with autism and $1,896 annually for caregivers of adults in the United States (Buescher, Cidav, Knapp, and Mandell, 2014). Parents also invest time and resources in caregiving activities and interventions that draw them away from their careers.

Impact on Marital Satisfaction Spousal interactions and support are important moderators of many parent outcomes. The specific stressors involved with rearing a child on the autism spectrum can create opportunities for strain and growth in couple relationships. In terms of mean level differences, couples with a child with autism have overall decreased marital satisfaction (Benson and Kersh, 2011; Bristol, 1987) and higher rates of divorce than do parents of typically developing children (Hartley et al., 2010). However, the extent of marital problems may be overestimated or more contextually nuanced, as in a nationally representative sample showing that children with autism have no increased risk for living with parents who are separated or divorced (Freedman, Kalb, Zablotsky, and Stuart, 2012). Limited qualitative evidence suggests that challenges associated with parenting a child with autism help some couples become more intimate and committed to each other (Hock et al., 2012). The spousal relationship can have considerable effects on the functioning of families of children with autism. Decreased marital satisfaction in families of children with autism can negatively impact perceptions of parenting efficacy (Benson and Kersh, 2011) and exacerbate parenting stress and internalizing symptoms (Bristol, 1987; Lickenbrock, Ekas, and Whitman, 2011; Weitlauf,Vehorn, Taylor, and Warren, 2014). Spousal support is central to a family member’s ability to cope, and the effectiveness of how spouses provide this support may moderate how having a child with autism impacts the relationship. For example, higher levels of perceived social and emotional support are associated with greater relationship satisfaction for couples with a child with autism (Ekas,Timmons, Pruitt, Ghilain, and Alessandri, 2015). On a daily level, rearing a child with autism can be associated with multiple difficulties that require couples to communicate and solve problems together effectively, such as during a child’s presentation of problem behaviors. Hartley et al. (2016) examined diaries of parents of children with autism over 2 weeks for problem-solving interactions. They found that couples most frequently engaged in problem-solving interactions about their child with autism compared to other topics. However, couple interactions that were associated with higher levels of distress were not primarily due to child behaviors, but rather surrounding topics that all parents find distressing, such as communication, commitment, and habits. This evidence suggests that having a child with autism might not be the origin of a couple’s distressing interactions, but could create more opportunities for distressing interactions to occur, thus exacerbating the existing problems between partners. 532

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Parenting Stress and Effects on Child Behavior Parenting stress is broadly conceptualized as stress that arises out of the daily demands associated with parenting (Deater-Deckard, 1998). Researchers consistently find that mothers and fathers of children with autism can harbor more parenting stress than parents of typically developing children and parents of children with other developmental delays, such as Down syndrome (Bristol and Schopler, 1983; Dumas, Wolf, Fisman, and Culligan, 1991; Estes et al., 2009; Hayes and Watson, 2013; Koegel et al., 1992; J. L. Sanders and Morgan, 1997; Wolf, Noh, Fisman, and Speechley, 1989). Some have suggested that the specific behavioral profile associated with autism provokes greater amounts of parenting stress in these families (Seltzer, Abbeduto, Krauss, Greenberg, and Swe, 2004), and autism symptoms are associated with increased ratings of parenting stress (Bebko, Konstantareas, and Springer, 1987; Hastings and Johnson, 2001; Szatmari, Archer, Fisman, and Streiner, 1994). Specifically, delays in social responsiveness and social communication appear to be the symptoms with the strongest relations to ratings of parenting stress for both mothers and fathers (N. O. Davis and Carter, 2008; Kasari and Sigman, 1997). Parents often find social interactions with their children inherently rewarding, and if their children do not give feedback in terms of laughing, smiling, or calming down after they are upset, this could cause parents to feel they have a lack of control in or a lack of reward from parenting tasks and consequently feel more stressed. However, specific problem behaviors outside of the core features of autism—such as aggression, self-injury, and conduct problems—also have strong relations to increased parenting stress (Beck, Hastings, Daley, and Stevenson, 2004; Blacher and McIntyre, 2006; N. L. Freeman, Perry, and Factor, 1991; Konstantareas and Homatidis, 1989). When describing parenting stress as an outcome, researchers need to continue distinguishing between core features of autism, such as social communication deficits, and problem behaviors to specify whether the phenomenon affects all families with children with autism, as targeted treatments for aggression differ from treatments for social responsiveness. Researchers have started to address two major limitations in the current parenting stress literature. First, much of the data examining parenting stress and child behavior is cross-sectional, making it difficult to determine the direction of the associations or whether the associations are bidirectional. Lecavalier, Leone, and Wiltz (2006) found evidence for bidirectional associations between conduct problems, such as defiant or aggressive behaviors, and parenting stress over a 1-year period. Second, different measurement tools and conceptualizations of parenting stress have been used in the literature. Much of the literature on parenting stress in families with children with autism uses the short version of the Parenting Stress Index (PSI-SF; Abidin, 1995). The PSI-SF includes subscales for (1) child behaviors, reflecting perceptions of temperamental characteristics and compliance, (2) parent distress, reflecting perceptions of competence, social support, and restrictions on other life roles, and (3) dysfunctional interactions, reflecting perceptions about interactions with children.These subscales comprise the PSI-SF total score, but studies have used this measure differently when assessing parenting stress. For example, some studies have used the total score of the PSI when making claims about parenting stress, whereas others only use the parent distress subscale. Using the total score could be troublesome when examining whether child behaviors relate to parenting stress as both measures include information about child characteristics. Specifying stress caused from parenting tasks allows for more refined analyses on the mechanisms involved. Overcoming both limitations, Zaidman-Zait et al. (2014) used longitudinal data and latent factors of the PSI-SF to investigate the temporal associations between parenting stress and child behaviors. Noting concerns about the psychometric properties of the PSI-SF in parents of children with autism (Zaidman-Zait et al., 2010), a factor analysis was used on PSI-SF responses and five latent factors emerged, but the team focused on two factors derived from the parent subscale to model relations to child externalizing behavior. The first factor, general distress, included items that described stress as a 533

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product of a parent’s individual characteristics, such as isolation. The second factor, parenting distress, included items that described stress specifically derived from parenting tasks and feelings. Parental general distress predicted later child externalizing behaviors, but child behavior did not predict later general distress. In terms of stress specific to parenting, there was evidence of lagged relations in which externalizing behaviors predicted stress, which then predicted more externalizing behaviors. Parenting stress is thus a predictor and an outcome of child behavior problems, but more studies are needed to examine how parenting stress changes parenting behaviors or interactions with children. For example, parenting stress could lead to increased hostility in the parent–child interaction, which could evoke more aggressive or self-injurious behaviors.

Stress and Mental Health of Parents Sources of stress may vary, but negative consequences of stress may be substantial: Compared to the general population, parents of children with autism have increased risks for developing depression and anxiety (Benson, 2006; Bitsika and Sharpley, 2004; Estes et al., 2009; Hastings and Brown, 2002; Montes and Halterman, 2007; Sharpley, Bitsika, and Efremidis, 1997; Wolf et al., 1989), experience more physical health problems (Eisenhower, Baker, and Blacher, 2009; Giallo et al., 2013), and report lower personal well-being (Blacher and McIntyre, 2006). Researchers have examined the specific correlates of mental health problems in parents and find inconsistent evidence on whether child characteristics are predictors of parent internalizing symptoms or well-being. There is some evidence that with increasing age and decreasing symptoms of the child, the well-being of parents may improve (Barker et al., 2011). Yet other studies find no association between age or autism severity and parenting stress (McStay, Trembath, and Dissanayake, 2014; Peters-Scheffer, Didden, and Korzilius, 2012) or that spousal relationship quality and parenting stress are stronger predictors of maternal depression than child behavior problems (Weitlauf et al., 2014). These inconsistencies may be due to the reliance on cross-sectional data to explain age-related phenomena. Longitudinal evidence suggests that maternal well-being improves, and distress decreases, with increased age of the child, but that many mothers remain at elevated levels of distress (Lounds, Seltzer, Greenberg, and Shattuck, 2007). In this study, the declines in behavioral problems, but not autism severity, were related to decreasing anxiety and depressive symptoms for mothers.The improvement in maternal wellbeing may be a product of decreased time spent managing disruptive or destructive behaviors. There are important distinctions between mothers and fathers when looking at the relations between child characteristics, parenting stress, and mental health. Father-child relationship quality is more associated with child characteristics, such as symptom severity, than mother-child relationship quality (Hartley, Barker, Seltzer, Greenberg, and Floyd, 2011). In addition, mothers experience more anxiety and depressive symptoms but report more positive perceptions of their children than do fathers (Hastings et al., 2005). These parent differences might reflect differences in the willingness to empathize or accept children with autism between mothers and fathers or in the levels of engagement with the daily activities associated with rearing a child with autism. After learning of a diagnosis of autism, fathers can become less involved with the caregiving activities (Bristol, Gallagher, and Schopler, 1988; Rodrigue, Morgan, and Geffken, 1992).Yet other evidence shows that, although both mothers and fathers report similar amounts of parenting burden, mothers report feeling closer to their child with autism (Hartley et al., 2011). For mothers, a sense of closeness and positive experiences are related to decreased parenting stress (Kayfitz, Gragg, and Orr, 2010). Many fathers express concerns about the struggle to remain as an engaged partner in rearing a child with autism, alongside worries that they have limited time outside of work to become involved with treatments or consultations with professionals (Meadan, Stoner, and Angell, 2015). Family-oriented treatment approaches need to consider the role of both spouses in training programs to help offset the increased burden on mothers and the decreased positivity in fathers. 534

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Parents of children with autism have genetic similarities to their children, which further obscure reports of mental health problems. Parents of children with autism may have similar behavioral features as their children, such as increased social anxiety, referred to as the broader autism phenotype (Piven, Palmer, Jacobi, Childress, and Arndt, 1997). The broader autism phenotype is noteworthy when considering how parenting stress relates to mental health problems. Parents of children with autism may have the same genetic risks for developing depression and anxiety as their children or may have reduced capabilities to access social support networks or coping skills (Ingersoll and Hambrick, 2011). Interventions at the family level that teach strategies for coping could confer mental health benefits to both children and parents.

Coping and Resilience Not surprisingly, the evident stress of caring for a child affected by ASD is common across nations and cultures. Studies from India, China, and Taiwan (Divan,Vajaratkar, Desai, Strik-Lievers, and Patel, 2012; Lin, Orsmond, Coster, and Cohn, 2011; Wang, Michaels, and Day, 2011) report data on parenting stress that is comparable to the reports of parents in the United States, United Kingdom, Australia, and Europe (Bayat, 2007; Higgins, Bailey, and Pearce, 2005; Kuhaneck, Burroughs, Wright, Lemanczyk, and Darragh, 2010; Ruiz-Robledillo, De Andrés-García, Pérez-Blasco, González-Bono, and Moya-Albiol, 2014). Importantly, beyond simply documenting the types and levels of parenting stress, a literature has begun to accumulate on coping and individual differences in resilience across caregivers of children with ASD (Table 16.1). An immediate goal of this research is to understand the degree to which individual differences in coping and resilience affect child, parent, and family outcomes. Longer-term goals of the research are to inform intervention development to (1) reduce the negative effects of stress on parent physical and emotional health, (2) improve the quality of life for all members of the family of child with ASD, and (3) potentiate the capacity of parents to be more active and effective participants in treatment and advocacy for children with ASD. The last goal may be especially important to the development of effective, comprehensive lifespan approaches to intervention for ASD. Parents play a vital role in providing effective and comprehensive intervention for their children with ASD across the lifespan (Green et al., 2017; Kasari et al., 2014; Ruppert, Machalicek, Hansen, Raulston, and Frantz, 2016). However, little is known about how individual differences in parenting stress and coping may affect parent’s implementation of intervention for children and adults with ASD, or how and when parent participation in intervention affects parent stress, coping, and resilience (Grindle, Kovshoff, Hastings, and Remington, 2009; McConachie and Diggle, 2007; Ruppert et al., 2016). Studies have examined the demographic characteristics of parents implementing interventions and reported that, in U.S. studies, parent demographics may not be representative of the U.S. population (Robertson, Sobeck,Wynkoop, and Schwartz, 2017), and those demographic characteristics may be associated with differences in treatment adherence (Carr et al., 2016). However, few studies have yet to systematically study parent coping and resilience as explicit outcomes, mediators, or moderators of parent-implemented intervention for children with ASD (Karst and Van Hecke, 2012). This may be an important gap in the current literature. Parent attributions are central to coping and resilience (Table 16.1), and attributions can have significant moderating effects on stress, motivation, effective problem solving, and effective parenting (Azar, Reitz, and Goslin, 2008; Bugental and Corpuz, 2019; Dunn, Burbine, Bowers, and TantleffDunn, 2001; Dweck and Leggett, 1988; M. R. Sanders, Markie-Dadds, and Turner, 2003; Weiner, 2010). Consequently, in research protocols that enlist parents as interventionists, parent attributions that affect coping may be an important target for intervention, and/or an important factor to consider in terms of a measure of intervention response. 535

Method

Focus Group, No Child Data

Interview, Child Data, Parent Data

Interview, Standardized Measures, Group Comparison, Parent Data, Child Data

Three open-ended questions

Family Adaptability and Cohesion Evaluation Scales (FACES II), Coping Health Inventory for Patients (CHIP) Child and Parent Data

Study

Kuhaneck et al., 2010

Divan et al., 2012

Tunali and Power, 2002

Bayat, 2007

Higgins et al. 2005 Australia

USA

USA

India

UK

Nation

53 Parents

29 Mothers w/ASD child 29 Mothers w/TD child 167 Parents Child & Parent Data

7 mothers 1 father 2 couples

11 mothers

Participants

Table 16.1  Cross-cultural studies of coping in parents and families of children with ASD*

Coping: Intentional stress relief (e.g., exercise, socializing); Planning ahead; Sharing responsibilities; Gathering knowledge; See the child, not the label; Gratitude for positives. Stress: Diagnosis shock & disbelief; Withdrawal from socializing; Neglect of family relations; Health & mental health problems. Coping: External professional advice; Religious support; Traditional Indian medicine; Sharing experience with others. Stress: Difficulty understanding child behavior. Coping: Place less emphasis on career success; More leisure time with family; Less emphasis on others’ opinions; More emphasis on spousal support; More tolerance of ambiguity. Stress: Meeting daily goals; Behavior problems; Financial effects of ASD on the family, parents’ personal lives, and their child; Problems; Fights with the system; Acceptance; Careers on hold; Worries about the future; Depression vs. love & adjustment; Child has no friends. Coping: Making meaning of adversity; Becoming more compassionate; Spiritual & belief system; Affirmation of strength; Becoming an advocate; Child as source of pride and honor. Family Effect Ratings: 30% Negative, 28% Positive, 8% Neither, 34% Both. Ratings of Effect on Parents: 21% Negative, 39% Positive, 6% Neither, 34% Both. Stress: Financial; Marital relationship; Withdrawal from socialization; Lack of understanding; Child behaviors ranked from least to most stressful (repetitive behavior, withdrawal behavior, misbehavior in public, aggression). Coping: Self-Esteem; Optimism; Spousal support; Marital happiness; Family cohesion; Family adaptability.

Primary Stress & Coping Methods

China (PRC)

Taiwan USA

COPE Scale, Questionnaire on Resources and Stress (QRS)

Family Adaptation & Cohesion Scales (FACES II), Center for Epidemiological Studies Depression scale, Profile of Mood States Anxiety Subscale, Autism Behavior Checklist, Antonucci Convoy Model of Social Support, COPE Scale, Child & Parent Data

Wang et al. 2011

Lin et al. 2011

Spain

General Health Questionnaire, Brief Resilient Coping Scale (BRCS), Medical Outcomes Study Social Support Survey, Stressful Life Events General Form, Caregiver Burden Inventory, Barthel Index of dependence on Caregiver, Autism Quotient. Child & Parent Data

Ruiz-Robledillo et al. 2014

UK

28 items Brief Cope Inventory, Hospital Anxiety and Depression Scale, Child & Parent Data

Hastings et al. 2005

76 Mothers 325 Mothers

Parents (93%) Grand Parents ASD = 137 IDD = 135 DD = 52 Physical = 44

40 Mothers 27 Fathers

48 mothers 41 fathers 26 mothers 20 fathers

(Continued)

Preschool Coping: Active avoidance; Planning/problem focused coping; Change of perspective & humor; Comfort in religion/dissociation. School Age Coping Active avoidance was associated with higher parent ratings of anxiety, depression & stress. Change of perspective & humor was associated with less evidence of depression. Preschool Coping: Active avoidance; Planning/problem-focused coping; Change of perspective & humor; Comfort in religion/dissociation. School Age Coping: Active avoidance was associated with higher parent ratings of anxiety, depression & stress. Change of perspective & humor was associated with less evidence of depression. Coping-BRCS Items: I look for creative ways to alter difficult situations; Regardless of what 67 Youth and happens to me I believe I can control my young adults reactions; I believe I can grow in positive ways by dealing with difficult situations; I actively look for ways to replace losses I encounter in life. Results: Parent self-ratings on BRSC, 31% higher resilience, 25% medium resilience, 44% lower resilience. Higher resilience associated with lower morning cortisol, better perceived physical and emotional health, and more emotional and tangible social supports (see study for details about mediators). Stress: Caregivers of children with ASD reported reported more stress from parent & family problems and child characteristics on the QRS than did parents of children with IDD. Coping: Parents of children with ASD were less likely to use denial and behavioral disengagement, and more likely to use planning than parents of children with IDD. Coping: Full COPE scales; Problem focused (planning, positive reinterpretation, of competing activities); Emotion focused (denial, venting emotions, mental and behavioral disengagement). Results: Cultural/national differences were for problem- and emotionfocused coping as well as family adaptation and cohesion. In addition to cultural factors, problem-focused coping was positively related to family functioning and emotional coping was negative related to family functions.

COPE Scale, Positive Affect Scale, Depression Scale, Pessimism Scale, Child and Parent Data

Two measures of meaningfulness & purpose in life, Family Relations Scale, Ways of Coping Questionnaire Child & Parent Data

Parenting Stress Index, Interview Questions: Parent—Child Relations, Coping with Parenting, Parent Support, Family Communication & Violence, Child Prosocial Skills, Parent Data COPE scale, Depression Scale, Profile of Mood States, Scales of Psychological Well Being

Abbeduto et al. 2004

Sivberg 2002

Montes and Halterman 2017

USA ASD Toddlers N = 151 ASD Teens N = 201

USA

Sweden

USA

Nation

Mothers

Parents ASD = 364 Con = 61408

Parents ASD = 66 Control = 66

235 Mothers ASD = 174 Fragile X = 22 DS = 39 (Down syndrome)

Participants

Coping: Problem Focused: Active coping; Planning; Suppression of competing activities; Positive reinterpretation; Growth. Emotion Focused: Denial; Behavioral disengagement; Mental disengagement. Results: ASD mothers reported more pessimism and depression than DS mothers; ASD mothers reported less reciprocated perceived closeness than fragile X and DS mothers. Parent report of problem-focused coping positively related to parent report of mother-child relationship quality (including reciprocated closeness) and negatively related to pessimism and depression. Emotion-focused coping displays the opposite pattern of associations. Coping: Confrontation; Distancing; Self-control social support; Accept responsibility; Escape; Problem solving; Reappraisal. Results: The groups were significantly different on most of the meaning of life, family relations, and coping measures. There was little evidence associations between differences in coping and measures of family relations and meaningful/purpose of life. However, later dimensions were associated. Mothers of children with ASD reported more stress and more frequently reported fair to poor mental health. Mothers of ASD were more likely to report close relationship and better coping with parenting after adjusting for reports of child’s social skills and demographic variables. ASD was not associated with lower social support for parenting, how serious family disagreements were handled, or household violence. Coping: See Abbeduto et al. 2004. Results: Lower levels of emotion focused coping was associated with better maternal well-being, regardless of child symptoms. Coping style moderated the impact of adolescent symptoms.

Primary Stress & Coping Methods

* Table does not provide an exhaustive annotation of studies of coping in parents of children with ASD.

Smith et al. 2008

Method

Study

Table 16.1 (Continued)

Parenting and Autism Spectrum Disorder

The range of individual differences that parents express with regard to the impact of caring for a child with ASD and coping with stress is illustrated in the results of two studies. Bayat (2007) interviewed 167 parents of children with ASD and found nearly equal proportions of parents reporting negative, positive, or both types of effects on their family or themselves as a parent (see Table 16.1). In terms of coping, Ruiz-Robledillo et al. (2014) used the Brief Resilience Scale (B. W. Smith et al., 2008) to assess coping in parents of youth and young adults with ASD (Table 16.1). Together, 31% of the parents gave evidence of higher resilience/lower stress, 44% had higher stress/lower resilience, and 25% fell in an intermediate group. Coping in research on parents with children with ASD refers to a variety of cognitive and behavioral strategies parents use to manage their stress (Table 16.1). Folkman and Lazarus (1980) differentiated between problem-focused and emotion-focused styles of coping.These two styles of coping have been measured in several studies of parents with ASD (Table 16.1) using measures such as the COPE scale (Carver, Scheier, and Weintraub, 1989), which measures problem-focused (PF) and emotionfocused (EF) coping with items rated on a 4-point scale from don’t do this at all to do this a lot. The PF subscales include items for Reinterpretation and Growth (e.g., “I try to grow as a person as a result of experience.”); Active Coping (e.g., “I’ve been concentrating my efforts on doing something about my situation.”); Positive Reframing (e.g., “I’ve been trying to see things in a different more positive light.”); Acceptance (e.g., “I’ve been learning to live with things.”); Planning (e.g., “I’ve been trying to come up with a strategy about what to do.”); and Suppression of Competing Activities (e.g., “I focus on dealing with this problem, and if necessary let other things slide a little.”). The EF subscales include items for Behavior Disengagement (e.g., “I give up the attempt to get what I want.”); Mental Disengagement (e.g., “I daydream about things other than this.”); and Denial (“I say to myself  ‘this isn’t real.’ ”). Lin et al. (2011) used these scales to examine coping in mothers of children with ASD in Taiwan and the United States. Mothers in Taiwan reported significantly greater frequency of use of problem- and emotion-focused coping than did mothers in the United States. Nevertheless, emotionfocused coping was associated with reports for more negative family functioning by parents in both countries. Other researchers have also reported evidence that emotion-focused coping is related to increases in perceived stress and depression for parents of children with autism (Abbeduto et al., 2004; Dabrowska and Pisula, 2010; Dunn et al., 2001; Hastings et al., 2005; Smith, Seltzer, Tager-Flusberg, Greenberg, and Carter, 2008). Alternatively, problem-focused coping reportedly is associated with beneficial effects for parents (Abbeduto et al., 2004; Dabrowska and Pisula, 2010; Dunn et al., 2001), although at least one study reported inconsistent effects in this regard (Pottie and Ingram, 2008). Parents of children with autism may use more avoidance and fewer problem-solving strategies than do mothers of typically developing children (Sivberg, 2002). However, at least one study reported that parents of children with ASD are more likely to use problem-focused and less likely to use emotionfocused coping than do parents of children with intellectual and developmental disabilities (Wang et al., 2011). Current data also suggest that coping may change with the age of children. L. E. Smith, M. M. Seltzer, et al. (2008) reported longitudinal data that suggest that behavioral disengagement may become a more common coping method for parents of adolescents relative to their coping with toddlers. In another longitudinal study, Benson (2014) reported that parental reports of stress tended to increase as children with ASD moved into adolescence, regardless of the coping style reported by parents. However, parents engaging in cognitive reframing, especially of adolescents’ problematic behaviors, was related to a more positive sense of efficacy and to less distress. Parental reports of increased use of disengagement were associated with their reports of a decreased positive sense of parenting. This type of descriptive data is an essential starting point for research on the impact of parent stress and coping on the outcomes of ASD. It remains to be seen, however, if intervention to support coping and resilience in parents can contribute to a new multi-pronged approach to intervention for ASD. Noteworthy first steps in that direction have begun to appear in the literature. Cogent discussions of why family systems concepts of ambiguous loss, resilience, and traumatic growth are 539

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important to research and intervention for autism have been published (Cridland et al., 2014; A. H. Solomon and Chung, 2012). In addition, data on parent and family outcomes in child-focused interventions have begun to appear in the ASD treatment literature. Studies have reported positive effects of training parents to implement intervention on parent mental health (Tonge et al., 2006), parent perceptions and shared positive affect with their ASD children (M. Solomon et al., 2008), and the effect of the Program for Education and Enrichment of Relational Skills (PEERS) on parent efficacy and family functioning (Karst et al., 2015). Another set of studies has explored intervention methods that specifically target parent coping and resilience. A professionally administered parent-focused program to reduce parent stress and improve parent self-efficacy after diagnosis with 2- to 4-year-olds was reported to be more effective than a self-directed video-based intervention (Keen et al., 2010). Bekhet (2017) reported a feasibility study of an online positive thinking intervention for caregivers of children with ASD. Some evidence of the efficacy of Riding the Rapids, a group-delivered support intervention for parents of children with ASD and other disabilities, has been reported in non-randomized controlled study (Stuttard et al., 2014). Finally, Blackledge and Hayes (2006) argued for the applicability of Acceptance and Commitment Therapy (ACT) to address stress and improve coping among parents of children with ASD. ACT is a mindfulness-based cognitive behavioral therapy that emphasizes acceptance of unpleasant emotions and thoughts while serving to clarify personally held values and goals to facilitate moving toward those values and goals. A meta-analysis of 19 randomized control trials provided evidence for the effects of ACT in the treatment of anxiety, depression, and chronic medical disabilities (Powers, Vörding, and Emmelkamp, 2009). Blackledge and Hayes (2006) reported preliminary evidence for the positive impact of a 2-day (14-hour) ACT workshop on stress and mental health in 20 caregivers that was retained 3 months after the workshop. One of the noteworthy characteristics of ACT is that it appears to target key elements of positive focused coping that descriptive studies suggest are related to better parent and family outcomes (Table 16.1). So this approach, along with others such as Riding the Rapids and PEERS, has clear potential to address parent stress, coping, and resilience as part of an intervention for ASD. However, much more research, including randomized control trials of interventions, will be needed to more fully appraise this potential.

Summary The increased risk for economic, marital, community, and mental health stress among parents with ASD seems intuitive. Consequently, some may dismiss research on stress in parents of affected children as simply descriptive studies of the obvious. However, to do so would be incorrect. Parents play a vital if not the most central role in the intervention and optimization of the development of children with autism. Their capacity to play this role pivots on their resiliency to the multivariate nature of the stress of raising an affected child. Therefore, understanding stress and resiliency among parents is a fundamental topic of intervention research for children with ASD. In this regard, we have begun to understand that (1) there are significant individual differences among parents in their stress resiliency, (2) resilient parents adopt a common set of cognitive, metacognitive, and social community supports, and (3) this common set of resiliency processes is apparent across cultural, ethnic, and racial groups of parents. Finally, the field has begun to recognize that the development of systematic interventions to increase resiliency among a greater proportion of parents may be a singularly important ancillary to all treatments for children affected by ASD.

Parent–Child Interactive Process and Autism Stress, coping, and resilience are important foci for research on parenting children with ASD. However, to understand parenting of children with ASD it is also necessary to understand how the 540

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social-communication and cognitive characteristics of ASD may affect the dynamic process of caregiver-child interactions across the lifespan. In early childhood, children diagnosed with autism have delays in the development of many social and communicative skills when compared to typically developing children.These skills include using eye contact (Sterling et al., 2008), imitating others (Rogers, Hepburn, Stackhouse, and Wehner, 2003), establishing joint attention (Mundy et al., 1986), developing receptive and expressive communication (Pickles, Anderson, and Lord, 2014; Tager-Flusberg, 1989), identifying emotions (Hobson, Ouston, and Lee, 1988), forming and recalling autobiographical memories (Lind, 2010), developing emotion regulation (DeGangi, Breinbauer, Roosevelt, Porges, and Greenspan, 2000; Loveland, 2005), and theory of mind (Baron-Cohen, Leslie, and Frith, 1985). Children are learning and honing these skills during their interactions with their parents, so they are inextricably tied to the context of parent–child relationships (Thompson, 2006). Apart from studies of language development and joint attention, few studies have examined the longitudinal associations between these problem areas and family processes, such as with the quality of the parent–child relationship. In this section of the chapter, we provide a review of research findings that contribute to our current understanding of parent–child interactions in families of children with autism.

Attachment Attachment theory describes how early relationships can have enduring effects on child development. According to attachment theory, infants need to develop a sense of security (calming emotional state) in the presence of at least one primary caregiver to learn how to regulate their emotions in novel or challenging situations. Individual differences in the degree to which infants attain a sense of a consistent, safe, and calming influence with a primary caregiver are thought to influence their subsequent development of emotion regulation as well as expectations and perceptions of future interactions with others (Ainsworth, Blehar, Waters, and Wall, 1978; Bowlby, 1973). The psychodynamic view lent itself to the perception of autism as a disorder of attachment as that construct emerged in the developmental literature of the 1970s. Coincidentally, clinical researchers in the 1970s began to observe clear indications of separation distress, which is a sign of attachment, in children with autism who were hospitalized for medical or behavioral treatments (Sigman, personal communication). These preliminary observations motivated a sequence of studies using the Strange Situation attachment paradigm (Ainsworth et al., 1978) to examine the response of children with ASD to systematic separations and reunions with caregivers. In assessments with the Strange Situation, young children with autism displayed more comfortseeking behaviors and physical contact after separations from their parents than from strangers (Capps et al., 1994; Sigman and Mundy, 1989; Sigman and Ungerer, 1984). Moreover, these and other studies (Rogers et al., 1991) indicated children with children with autism did not differ from children with other developmental disorders in terms of behavioral evidence of secure or insecure attachment classifications. Sufficient subsequent studies enabled meta-analytic methods to reveal a more nuanced picture of attachment in ASD. Rutgers, Bakermans-Kranenburg, van IJzendoorn, and BerckelaerOnnes (2004) reported that, across 16 studies, children with ASD displayed more evidence of insecure attachment, such as lack of response to their caregiver’s departure and/or avoidance on return or were less easily consoled on reunion with parents, or inconsistent disorganized responses to separation and reunion. However, this effect was moderated by IQ such that more evidence of insecure attachment was evident in children with ASD and intellectual disabilities, but not evident in children without intellectual disability (Rutgers et al., 2004). Higher rates of insecure attachment had been observed in children with intellectual disability but without ASD in previous research (B. E.Vaughn et al., 1994). This combination of findings suggested that evidence of atypical attachment in ASD might be more a consequence of comorbid intellectual disability than ASD per se. 541

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Similar research has indicated that attachment security in children with ASD is moderated by the intensity of social symptoms (Rutgers et al., 2004; van IJzendoorn et al., 2007) and that some children with ASD may be less likely to approach or seek comfort from their parents on reunion (Grzadzinski, Luyster, Spencer, and Lord, 2014). However, several studies have also reported that relationships between parents and their children with ASD have similar attachment characteristics to parents and children with typical development, as observed by child and parent report (Bauminger, Solomon, and Rogers, 2010; Chandler and Dissanayake, 2014; Keenan, Newman, Gray, and Rinehart, 2016). Observations of attachment to parents in children with ASD were fundamental to clarifying the nature of the social disturbance in this syndrome. Attachment is a transactional relationship between the parent and child (Sameroff and Mackenzie, 2003). Both children’s actions and parental sensitivity— the abilities to interpret and respond to a child’s physical and emotional needs and the awareness and response of children to parent sensitivity—are central to the development of secure attachments (Ainsworth et al., 1978). Observations that children with ASD were no more disturbed in attachment than were children with intellectual disabilities indicated that children with ASD retained a capacity to respond to a fundamental aspect of caregiving and social behavior. This pattern of findings was inconsistent with the notion that ASD was characterized by “a pervasive lack of responsiveness to others” (APA, 1980). Instead, ASD began to be perceived in terms of heterogeneity of social presentation and specific rather pervasive atypicalities of social responsiveness and development (Mundy and Sigman, 1989). Although evidence of attachment varied within children with the diagnosis of ASD, evidence of more optimal attachment was related to symbolic play development (Naber et al., 2008) and more parental sensitivity but also more child social initiations (Capps et al., 1994). However, characteristics of infants eventually diagnosed with ASD may help to explain some of the observed variations in attachment relationships in the ASD population. Research has captured atypical acoustic features and differences in adult responses in the recordings of infants that were later diagnosed with ASD as compared to typically developing infants (Esposito and Venuti, 2009), and these atypical vocalizations have been observed during the separation phase of the Strange Situation paradigm in infants at higher risk for developing ASD (Esposito, del Carmen Rostagno, Venuit, Haltigan, and Messinger, 2014). When listening to the cries of infants later diagnosed with ASD, studies have found that adults perceive more distress in these cries than in typically developing infants or infants with developmental delays (Esposito, Nakazawa, Venuti, and Bornstein, 2013; Esposito,Venuti, and Bornstein, 2011), use more effortful processing from areas in the brain involved with comprehension and emotion to interpret the cries of infants with ASD as compared to typically developing infants (Venuti, Caria, Esposito, De Pisapia, Bornstein, and de Falco, 2012), and experience more physiological arousal (Esposito, Valenzi, Islam, and Bornstein, 2015). The perceptions of atypical infant distress may then influence atypical, slower, or non-optimal parent responses. Indeed, mothers of 13-month-old infants later diagnosed with ASD themselves vocalized more often in response to cries than did mothers of typically developing children, who used more rocking or patting behaviors (Esposito and Venuti, 2009). Although more research is needed, these studies have at least three distinct implications: (1) infant cries may be an early biomarker for the later development of ASD, (2) the difficulties and distress adults experience when listening to the cries of infants with ASD may be the first experience of parenting stress or of low parent self-efficacy, and (3) atypical infant vocalizations may have enduring effects on the development of the parent–child attachment. Research also demonstrated that parent knowledge, perception, and attributions about their child’s behavior had an impact on their sense of the attachment relationship. Siller, Swanson, Gerber, Hutman, and Sigman (2014) observed that after teaching parents how to notice and interpret communication from the child during play activities, there were increases in maternal perceptions of secure attachment. In addition, mothers who demonstrated greater insight into the nature of their child’s problems and who were more accepting of their child’s diagnoses of autism were more likely 542

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to have securely attached children (Oppenheim, Koren-Karie, Dolev, and Yirmiya, 2008). Furthermore, Oppenheim, Koren-Karie, Dolev, and Yirmiya (2012) reported that maternal sensitivity mediated the link between mother’s insightfulness and their child’s attachment behavior. In summary, most young children with autism develop attachment relationships with their parents (but attachment may be moderated by IQ and related symptom severity), and a subset of children demonstrates more disorganized or insecure attachment styles. However, there is little evidence of autism-specific effects on child-caregiver attachment. It is not yet clear to what degree differences in child behavior associated with cognitive development affect parent behavior in the dynamics of attachment formation in children with ASD. However, the presence of attachment in many children with ASD argues for a significant transactional impact of parent and child behavior in the development of children with ASD. Some of the literature on attachment suggests that some aspects of parent coping (acceptance) may be integral to optimal transactional parent–child development in caregiving for ASD. Bringing research on parent coping together with the study of child attachment may be a revealing combination in future research.

Parent–Child Interactions Beyond the paradigmatic confines of the attachment literature is an equally rich literature on several other facets of parent–children interactions in the modern study of ASD. One specific characteristic of ASD is that affected children do not employ as much attention to caregivers or social partners as do children with other developmental disabilities or typical development (Dawson et al., 2004; Kasari, Sigman, and Yirmiya, 1993; Klin, Jones, Schultz, Volkmar, and Cohen, 2002; Mundy et al., 1986). This developmental disturbance impairs their ability to adopt a common perspective, or point of reference with other people. Difficulty in adopting or recognizing a common point of reference significantly impairs the capacity of children with ASD to adopt a common point of focus with parents in interactions, to learn from instruction provided by parents (Baldwin, 1995), and to spontaneously share experience with their parents (Mundy, 2016). This specific dimension of the social disturbance of ASD is referred to as “joint attention.” Joint attention disturbance is fundamental to the nature of autism (Mundy, Sullivan, and Mastergeorge, 2009), its diagnosis (Gotham, Risi, Pickles, and Lord, 2007), and the difficulty parents can experience in interacting with children. Of course, like all aspects of the phenotype, children with ASD vary in the growth and development of joint attention (Kasari, Paparella, Freeman, and Jahromi, 2008; Mundy, Sigman, and Kasari, 1990). Not surprisingly, perhaps, individual differences in joint attention in ASD have been observed to be associated with parent ratings of child social relatedness (Mundy et al., 1994). Given our understanding of joint attention impairment in ASD, it is also not surprising that parents find it difficult to engage or teach new behaviors to their young children with ASD during play. Because joint attention is a major symptom dimension of autism (Gotham et al., 2007), autism severity has been related to lower quality of parent–child interactions, including less dyadic communication, coordination, and emotional expression (Beurkens, Hobson, and Hobson, 2013). Children with autism also focus more on objects than play partners (Kasari, Gulsrud, Wong, Kwon, and Locke, 2010).These child characteristics may make it hard for parents to keep children engaged as an equal social partner without controlling the behavior of their children. Along this line of reasoning, Doussard-Roosevelt, Joe, Bazhenova, and Porges (2003) found that parents of children with autism used more physical contact and fewer attempts to engage using verbalizations than did parents of children without autism. Less direct approaches to managing a child’s attention may be critical to facilitating engagement and interaction with children with ASD. Imitating or mirroring the behavioral acts of young children with ASD appears to increase their joint attention (Dawson and Adams, 1984; Tiegerman and Primavera, 1984). Scaffolding joint attention by parents through imitation is possible, but without additional support, parents of children with autism have difficulties achieving 543

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levels of sophisticated play with their children comparable to those observed typical parent–child dyads (S. Freeman and Kasari, 2013). Freeman and Kasari (2013) also found that parents of children with autism were more controlling and used more suggestions during play than did parents of children with typical development, but these behaviors led to less parent–child joint engagement with toys during play with their children. Parents may use more control during interactions with their children with autism because control can lead to more compliance. Indirect commands, in which parents give polite requests or suggestions for their children to change their behavior, have been observed to be followed by compliance for children with typical development but to noncompliant behavior in higher functioning children with ASD (Bryce and Jahromi, 2013). Parents of children with ASD who use direct commands receive the most compliance from their children, but overall children with ASD have lower rates of compliance than do children with typical development. Nevertheless, parent’s ability to regulate attention without physical prompting may be beneficial for later peer interactions for preschool-aged children with autism. Meek, Robinson, and Jahromi (2012) reported that parent’s use of lower control attention regulation was predictive of higher joint engagement in their children, which was positively related to social competence with peers 1 year later. In a sequence of studies, Siller and Sigman (2002, 2008) examined the extent to which the tendency of parents to adopt the focus of attention of their children with ASD, or direct the attention of their child during object play, was related to their children’s rate of word learning. They found that following rather than directing the attention of their children to refer to objects during play predicted gains in their children’s verbal communication skills (Siller and Sigman, 2008). The effects reported by Siller and Sigman are not specific to children with ASD. Rather they mirror work by Tomasello and colleagues that demonstrate how language learning in typically developing children is optimized through gaze following to recognize the manifest interest of their children and providing learning opportunities congruent with the current interest of the child (Tomasello, Carpenter, Call, Behne, and Moll, 2005). The results from various studies of parent–ASD child interactions support research on the effectiveness of child-directed approaches to intervention, such as pivotal-response training (Hardan et al., 2015; Koegel and Kern Koegel, 2006). Moreover, they have informed a new generation of early intervention research. Recognition of joint attention as central to problems in learning and relatedness in children with ASD has led many researchers to develop targeted and effective treatments for this dimension of development (Murza, Schwartz, Hahs-Vaughn, and Nye, 2016). One of these, Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER; Goods, Ishijima, Chang, and Kasari, 2013), has been examined in numerous randomized controlled trials that provide evidence for its efficacy. JASPER provides parents with a new child-focused approach to parenting that begins with mirroring or imitation of the child and using that as a pivot to scaffold increased joint attention, sharing of experience, and elements of referential cognition necessary to improving children’s response to language learning opportunities. Kasari et al. (2015) compared parent-implemented JASPER with a parent-psychoeducational intervention (PEI) that included a stress reduction module. JASPER was superior to PEI in facilitating child-parent joint engagement and child play. Positive effects also generalized to the child’s initiation of joint engagement in their preschool classroom. Alternatively, PEI was superior to JASPER in parents’ reports of reductions in child-related stress. This is one of several studies to examine the effects of parent-implemented early intervention on parent stress (McConachie and Diggle, 2007) but one of the few to compare the effects of different intervention methods. Although the effect size of the group differences in stress was small, these results at least raise questions of whether it may be useful to consider the addition of stress reduction modules to child-focused interventions as a more comprehensive family approach to early intervention. Perceived stress reduction, though, is only one of many parent measurement dimensions to consider as outcomes, mediators, and/or moderators of 544

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intervention. For example, joint attention was associated with parent’s ratings of the relatedness of their children with ASD. It may be that a parent-implemented joint attention intervention impacts parents’ sense of relatedness to their children and/or reduces distress about their effectiveness as parents without mitigating their perceptions of the concrete nature of the stress of parenting a child with significant behavioral challenges.

Parent-Implemented Interventions In general, parent education programs and parent-implemented interventions have the potential to alleviate psychological distress of parents (Keen et al., 2010). As with JASPER, they may be especially effective in facilitating the development of socially relevant skills in children (Ingersoll and Gergans, 2007), and they offer an especially useful approach where community services for children with ASD are not plentiful (Brookman-Frazee,Vismara, Drahota, Stahmer, and Openden, 2009). However, parent-delivered interventions can also lead directly to positive changes in parent–child interactions. For example, interventions focused on families and relationships have been related to increases in maternal emotional responsiveness during parent–child interactions, which then predicted improvements in child social development (Mahoney, Boyce, Fewell, Spiker, and Wheeden, 1998; Mahoney and Perales, 2003). Other studies have found that parent-implemented interventions elicited more patterned interactions of sustained positive affect between parents and children (M. Solomon et al., 2008;Vernon, Koegel, Dauterman, and Stolen, 2012). Some research has reported that parent-implemented interventions are not as effective as therapistimplemented interventions in improving child outcomes (McConachie and Diggle, 2007; Rogers et al., 2012). Yet, there have been calls to reconsider how parent-implemented interventions are developed or to include more relevant parenting outcomes when testing intervention effectiveness (Brookman-Frazee, Stahmer, Baker-Ericzen, and Tsai, 2006; Karst and Van Hecke, 2012; Stahmer and Pellecchia, 2015). For example, it may be beneficial to develop interventions that coach parenting skills that can be implemented incidentally in varied situations, rather than didactically or in a curriculumbased fashion (Stahmer and Pellecchia, 2015). This view conforms to elements of the literature on parent–child interactions, which describe the benefits of unstructured play time with parents over structured activities for children with ASD (Blacher, Baker, and Kaladjian, 2013). Younger children may especially benefit from unstructured play time with their parents to develop stronger language and communicative skills when didactic or behavioral interventions may not yet be appropriate. As an example of incorporating family-level outcomes, Keen et al. (2010) conducted a 6-month parent intervention focused on providing education surrounding parenting stress and competence. In addition to parent gains in self-efficacy, children made more gains in social communication and adaptive behaviors when their parents received professional support after the recent diagnosis of their child, compared to children whose parents received the information on videos. By employing parent and children measures, this study illustrates how parent interventions may improve child and family functioning. Future studies of parent interventions will no doubt include a wider variety of outcomes than just parent stress measures. Measures of change in parent coping, resilience, attributions of child behaviors, and direct observations of parent–child interactions can all be useful. Indeed, all may be necessary because there are currently too few studies with adequate research designs to clarify how different parent coaching or parent-implemented interventions impact parenting and the interactions of families affected by ASD (McConachie and Diggle, 2007). Of course, in addition to examining how parent-implemented interventions for children affect parenting, the converse is also true. However, few studies of interventions are specifically designed to improve parenting of children with ASD. One example is from a report of a randomized control study of the Stepping Stones Triple P (SSTP) Positive Parent Program with families of 59 4- to 8-year-old children with ASD (Whittingham, Sofronoff, Sheffield and Sanders, 2009). SSTP is a 545

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version of the evidence-based Triple P Parent program designed to improve behavioral development for children with disabilities through changes in parenting practices. Triple P involves teaching parents to use descriptive praise, planned ignoring, and other strategies, and SSTP incorporates additional strategies to address social-communication behavior in children with ASD. Whittingham et al. (2009) reported moderate to strong size of treatment effects for the SSTP intervention on measures of child behavior problems, parental negative reactivity, inconsistent reactivity, over-reliance on talking, as well as parent efficacy and satisfaction. These are promising results for the impact of direct intervention with parenting process variables for both parents and children with ASD. Clearly, the literature on parenting in ASD would benefit from more studies of this kind.

Summary Family process research with preschool children with ASD has been revealing with regard to fundamental questions about the nature of autism as well as its diagnosis and intervention. Kanner (1949) used the phrase “a persistent lack of responsiveness” to describe the social behavior of children with ASD (p. 418). Later, APA (1980) instantiated the phrase “a pervasive lack of responsiveness to others” as the primary description of the social symptoms of ASD. That narrow representation of the social symptom picture of autism held until social interaction studies, and most importantly parent–child attachment studies, indicated that the social impairment of autism were not pervasive, but much more nuanced (Mundy and Sigman, 1989b). Parent–child interaction studies, as well as other experimental studies, indicated that children with autism were not as socially engaged as other children were. Social engagement was defined as paying attention to the same referent, or joint attention to objects and events. These observations help turn the field from the notion of pervasive social impairments to the understanding that problems with social attention, especially joint attention, were a central feature of the social symptoms of autism. Joint attention is central to intersubjectivity, or a sense of shared experience between two of more people. Not surprisingly, then, it became apparent that problems in joint attention during parent–child interactions might be fundamental to a lack of sense of relatedness that parents and others experience in interaction with children with ASD (Mundy et al. 1994). Perhaps most importantly, recent research has revealed that joint attention impairments are malleable in many children with ASD, and parent–child interaction interventions can be fundamental in effecting change in joint attention development. Change in this pivotal aspect of parent–child interaction not only improves children’s social engagement and ability to learn from other people, but also has a positive impact on parent well-being. As noted earlier, the latter, as well as the former, can have significant long-term benefits for children with autism. The evidence from these studies has contributed to the realization that family-level outcomes, as well as child-level outcomes, are important to measure in any intervention for children with ASD, and especially parent-implemented interventions.

Family Processes and Autism in Adolescence and Adulthood Parenting and family process changes with age of all members of the family. One pivotal period of change for all occurs during children’s transition from childhood to adolescence (Barber, Maughan, and Olsen, 2005). As is the case for many children, adolescence can be particularly problematic for individuals with autism spectrum disorder. An increased emphasis on social interactions outside the family among typically developing peers can accentuate the social problems experienced by these children. Changes in social demands of adolescents can be difficult to accommodate. Compared to adolescents with typical development, adolescents with autism have significant difficulties establishing and maintaining peer relationships, report feeling more lonely, and experience more frequent victimization from peers (Bauminger and Kasari, 2000; Bauminger et al., 2008; Cappadocia, Weiss, 546

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and Pepler, 2012; Zablotsky, Bradshaw, Anderson, and Law, 2013). Parents are uniquely situated to provide opportunities for children to meet and to support the development of friendships in middle childhood and adolescence. These observations notwithstanding, there is a paucity of evidence-based details about the adolescent development of children with ASD and the parenting of these adolescents (Seltzer, Shattuck, Abbeduto, and Greenberg, 2004). In general, modest improvements in cognitive and social behaviors, including emotion regulation, are a general tendency in ASD adolescent development (Seltzer et al., 2004). Nevertheless, mothers of ASD adolescents report more arguments, more attempts to avoid arguments, more childcare chores, and less leisure time, yet similar levels of positive interactions with their children, than mothers in a national sample (Smith et al., 2010). There is clear evidence of significant associations between parent behavior, stress, and emotional status and adolescents’ behavior (Baker et al., 2011; Lounds et al., 2007; Orsmond, Seltzer, Greenberg, and Krauss, 2006). However, insufficient data are currently available to understand causal paths among these associations. One study suggests that the level of ADHD symptomology may be an especially important moderator of parent–child relationships in adolescents with ASD (McStay, Dissanayake, Scheeren, Koot, and Begeer, 2014). Hartley et al. (2011) also observed that fathers’ parenting could be more affected by the behavioral characteristics of adolescents than mothers’. In adulthood, gaining and maintaining employment appear to be significant challenges for individuals with autism. In a study of 66 emerging adults that had exited high school, 61% of the adults with ASD were reported to be living with their parents. There was also variance in the distribution of these adults’ daily activities, as 14% were in post-secondary degree programs, 6% had competitive employment, 12% had supported employment, 56% were in adult day services, and 12% were engaged in no regular activities (Taylor and Seltzer, 2011b). Although many individuals with ASD pursue post-secondary education in the years after high school, an alarming 29% are described as disengaged (Wei, Wagner, Hudson, Jennifer, and Shattuck, 2014). These individuals were not employed or in school, or they withdrew from those activities in the years after high school. When these individuals become employed, the jobs may have low wages: Data from individuals accessing federal vocational rehabilitation programs indicate that emerging adults with ASD earned an average of $8.39 per hour in 2010 (Migliore, Butterworth, and Zalewska, 2012). Adults with autism, especially women, continue to show difficulties and even declines in vocational independence into middle adulthood (Taylor and Mailick, 2014). Beyond low employment and education levels, adults with autism are also at risk for a variety of physical and mental health challenges, including functional deterioration, epilepsy, increased mortality at younger ages, and affective disorders (Howlin, 2000). Many challenges faced by adults with autism prominently affect families. Relatively few institutional supports focus on increasing independence after high school (Howlin, Goode, Hutton, and Rutter, 2004), compelling parents of children with autism to retain caregiving responsibility for their whole life (Seltzer, Greenberg, Floyd, Pettee, and Hong, 2001). About 70% of young adults in their early 20s with autism have never lived outside the home (Roux, Shattuck, Rast, Rava, and Anderson, 2015), and about a third of individuals with ASD in their 30s live with their parents, who themselves are approaching retirement age (Krauss, Seltzer, and Jacobson, 2005). Because parents of adolescents and adults with autism are central sources of support and continuing care, it is vital to examine how family processes and factors can influence behavioral problems, autism symptoms, and adaptive behavior during the transition to increased independence.

Relational Factors and Young Adult Outcomes Many studies of parent–child relationships in families with children with autism use the Five-Minute Speech Sample (Magaña et al., 1986). During this task, originally designed as part of the Camberwell Family Interview (C.Vaughn and Leff, 1976), parents are given 5 minutes to speak about their 547

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child and their relationship. These speech samples are recorded, transcribed, and coded for indices of warmth (e.g., expressions of interest, empathy, and concern), praise (e.g., number of positive statements about the child), and expressed emotion, a combination of expressions of criticisms and emotional overinvolvement (e.g., expressions of self-sacrifice or emotional displays during the recording). This task yields information about parents’ perceptions of the parent–child relationship, which are then examined as predictors of child functioning. In addition to the Five-Minute Speech Sample, researchers often use questionnaires to assess parental perceptions of parent–child relationship quality in families of children with autism. For example, some studies have used the Positive Affect Index (Bengtson and Schrader, 1982), which includes items about parental perceptions of trust, fairness, affection, and understanding in the parent–child relationship. Studies have found interesting associations between these indices of family relational factors and changes in autism symptoms. Greenberg, Seltzer, Hong, Orsmond, and MacLean (2006) found bidirectional relations between increased criticism and increased internalizing, externalizing, and asocial behavioral problems over an 18-month period in families of adolescents and young adults with autism. Studies have also found evidence for bidirectional associations between higher levels of positive relational factors, such as mother-child relationship quality, warmth, and praise, and autism symptoms, namely reductions in repetitive behaviors and social reciprocity impairments (J. K. Baker, Seltzer, and Greenberg, 2011; L. E. Smith, J. S. Greenberg, et al., 2008; Woodman et al., 2015). These results illustrate how positive dyadic interactions can lead to improvements in child behavior. However, Baker et al. (2011) found that family-level adaptability was beneficial to both maternal depression and child behavior problems more so than the mother relationship for adolescents with autism. The results of this study emphasize the importance of teaching families how to generate solutions to new problems, to compromise, and to be flexible with roles within a family system perspective. Although the Five-Minute Speech Sample and questionnaires assessing the parent–child relationship provide useful and informative results, they rely on parent perceptions of relationships. It is common in studies of family relationships in typically developing youth to rely on the child’s perception of relationship quality or support. For example, typically developing adolescents who perceive high amounts of support from their parents are less likely to associate with deviant peers and engage in problem behaviors (Goldstein, Davis-Kean, and Eccles, 2005). Allowing individuals with ASD to provide their perceptions about family relationships will be an important undertaking in future family research. In addition, future research would benefit from using observational measures in parent–child dyads to better capture family processes. For example, Kim and colleagues (2001) utilized the Iowa Family Rating Scales (Melby et al., 1998) to observe hostility and angry coercion exhibited independently by parents and children with typical development during a discussion task and a problem-solving task. The results illustrated the longitudinal reciprocation of negativity between parents and adolescents and how these processes predicted similar negativity in early romantic relationships as the individuals reached adulthood. Researchers of families with autism could use similar approaches to examine the reciprocal nature of warmth and support and how those processes could lead to optimal outcomes in young adulthood.

Parenting Practices and Expectations In some of the literature on family environment predicting problem behaviors in typically developing youth, the focus has been on parenting practices. Parenting practices rated by mothers or fathers have important and wide-ranging influences on indices of successful child development, including achievement, externalizing and internalizing psychopathology, deviant behaviors, and peer relationships (Belsky and Pluess, 2009; Engels, Deković, and Meeus, 2002; Schneider, Cavell, and Hughes, 2003; Spera, 2005). The literature describing parenting behaviors or childrearing practices by parents

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of adolescents with autism is scarce. One study examined how parents of children and adolescents with autism living in Belgium and the Netherlands rated their use of positive parenting, punishment, discipline, rewards, and rules (Lambrechts, Van Leeuwen, Boonen, Maes, and Noens, 2011). Parents of youth with typical development reported higher use of harsh punishment than did parents of children with autism. Another study looked at similar parenting behaviors in over 900 mothers of children and adolescents with higher functioning autism or typical development also living in Belgium and the Netherlands (Maljaars, Boonen, Lambrechts,Van Leeuwen, and Noens, 2014). Mothers of youth with autism reported setting fewer rules and using less discipline compared to mothers of youth with typical development. There was less reported use of reinforcement and problem solving by parents of typically developing youth in adolescence compared to younger children, but there was no observed differences in the use of material reinforcement by age reported by mothers of youth with autism. These two studies suggest that parents of youth and adults with ASD may use more positive strategies for managing behaviors, such as reinforcement, and less punishment or discipline. However, much more empirical work is needed to examine how these practices influence child outcomes and whether certain parenting practices are more adaptive or developmentally appropriate in families of children with autism. Finally, parent expectations help to explain the connections between family context, child functioning, and young adult outcomes for individuals with autism. Using structural equation modeling, Kirby (2016) found that parent expectations for their children mediated prospective relations from family background and child functioning to young adult outcomes. Child functioning in social, academic, and adaptive domains was one important predictor of parental expectations that their children would live independently or attain paid work, which was a strong predictor of children achieving these outcomes. These associations illustrate how higher functioning individuals with autism may achieve independence by more readily shaping parental expectations.

Changing Relationships Studies have reported positive parent–child relationship quality and high levels of maternal affection for young adults with autism (Lounds et al., 2007; Orsmond, Seltzer, Greenberg, Krauss, and Floyd, 2006). Yet, longitudinal evidence regarding the quality of parent–child relationships as individuals with autism transition into adulthood is more troublesome. Taylor and Seltzer (2011a) examined maternal perceptions of the mother-child relationships longitudinally during and after their children’s high school exit. During high school, both positive affect toward children and expressed warmth increased with time while the subjective burden of childrearing decreased. After high school, there was significant weakening in these positive trajectories that was not explained by changes in maladaptive behavior or residential status. The reported relationship variables declined especially for mothers of individuals with autism who did not have concurrent intellectual disability and for mothers of sons with autism. The authors reasoned that worsening relationships experienced by mothers of children with autism but not intellectual disability may reflect several possibilities. First, mothers may attribute behavioral problems as being under control of their children when they are higher functioning, as seen in studies of younger children with autism (Hartley, Schaidle, and Burnson, 2013). Second, mothers of higher functioning adolescents with autism may have high expectations of their children (Kirby, 2016), which may attenuate if their children become disengaged from school or work. Third, the authors reasoned that adults with autism may be spending more time at home than adolescents who attend school for most of the day, which may strain parents’ opportunities to have time for leisure activities independent of their child. As each of these explanations has vastly differently implications for improving the quality of parent–child relationship throughout adolescence and young adulthood, more research is needed to determine the underlying mechanisms of a plateauing relationship quality.

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Care for Older Adults With Autism In any caregiving context, caregivers can experience both subjective burden for caring for the daily needs of another individual on top of their own needs and satisfaction from providing the care.These ambivalent feelings have been frequently observed in family caregivers of individuals with dementia or other terminal illnesses (Balducci et al., 2008; Shim, Barroso, and Davis, 2012). The current literature describes similar processes in families of adults with autism. These studies describe parenting experiences for adults with autism and intellectual disability as well as adults with autism who are higher functioning who may be considered disengaged from normative adult roles (Wei et al., 2014). Parents of young adults with autism living at home frequently report they enjoy their children’s company, yet also frequently report constraints due to problematic behaviors (Krauss et al., 2005). Parents of children living away from home frequently endorse that children gain more opportunities for personal growth outside the home. Individuals with autism living with family caregivers have limited access to socialization experiences outside the family, and caregivers feel that they need more support to reduce stress and plan for the future when the young adult continues to live at home (Graetz, 2010). Families of adults with autism may be acutely aware that their ability to care for their sons and daughters depends on the health and longevity of parents and that planning for the future helps to increase the positive experiences of parenting. In a study of parents of adults with autism, parent reports of increased long-term future planning, such as setting up a trust for their child, was related to increased caregiving satisfaction (Burke and Heller, 2016). In addition, community involvement led to increased caregiving reported by parents, highlighting the need for caregivers to have social and vocational activities that are distinct from caregiving activities. In a qualitative study, Hines, Balandin, and Togher (2014) interviewed 16 older parents of adults with autism.These parents described difficulties maintaining care of their children, themselves, and other family members. These parents frequently described avoidance toward changing routines to placate anticipated behavioral problems in their children. This avoidance on the part of the parents of adults with autism could potentially lead to stagnated development and lack of new opportunities for learning, despite parents’ good intentions to avoid additional stress. Currently, services for adults with autism and their families are scarce, but this evidence suggests the need for developmentally appropriate strategies for teaching parents how to provide their children new opportunities for growth while managing the mental health concerns that occur in both children and parents.

Summary The early onset of ASD has focused many of the associated research and clinical efforts on the early childhood period of development. We know less about school-aged development and less still about the adult development of affected individuals. One thing we do know, however, is that children with ASD go on to become adults with ASD (Brugha et al., 2011), and parents remain a primary if not singular source of support after secondary school.We can also expect a neurodevelopmental disorder, such as autism, to continue to develop and change not only in the preschool period, but also in the school-aged and adult periods of development. Therefore, it’s reasonable to expect that a life-span approach to intervention will most likely be needed to address the gamut of developmental needs of many people with ASD and allow them to realize their full potential. In adults, as with children, we can expect parents to play a major role in adult intervention for people with ASD. The past 30 years of research has revealed that parent intervention has a significant benefit for other adults with chronic mental health conditions such as schizophrenia (Pitschel-Walz et al., 2001). We can reasonably expect the same will hold true for adults with ASD. However, the brevity of the research reviewed in this section of the chapter indicates we have just begun to scratch the surface of this area of research. As a field, we must redouble our efforts to understand the adult development of ASD 550

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in the interactive context of the family to become much more effective in lifespan approaches to treatment and support.

Future Directions for Research on Families Affected by Autism The chief limitation in the literature on families of children with autism is that there are not enough investigations of parenting and family processes. By looking to the rich theoretical and empirical work on family processes in typical development, researchers can design studies with families of children with autism that can identify child- and family-level strengths that help promote successful adaptation. Three general ideas should be considered when designing these studies of families with children with autism. First, research on families of children with autism may be well advised to apply transactional approaches (Sameroff and Mackenzie, 2003). These approaches can help describe how varying levels of child characteristics and parent behaviors interact to predict child outcomes. One common application of this approach is to examine how positive parenting practices protect children from developing internalizing or externalizing problems when they are at high risk, often defined by genetic or temperamental characteristics (Belsky and Pluess, 2009). Children with autism have been characterized as having more negative affect than children with typical development, so it may be fruitful to examine how parenting behaviors interact with these characteristics to influence internalizing symptoms.The transactional approach may be especially important to investigations of children with autism due to the wide heterogeneity and variance of the behaviors observed, and it conforms to appeals for research to examine moderators of the phenotypical variability observed with autism (Mundy et al., 2007). Second, research on family processes in autism should strive to incorporate measures that capture the perspective or behaviors of the child. Parent perspectives can provide important information about family functioning and family factors, but they could be distorted by parents’ own psychopathology (Bitsika, Sharpley, Andronicos, and Agnew, 2015). By using child perspectives and observational approaches, we can better approximate child behaviors in the context of relationships and better acknowledge that children with ASD are active participants in the development of their relationships (Sroufe, Egeland, Carlson, and Collins, 2005). Third, more cross-cultural research is needed. To date, cross-cultural research on families of children with autism has described that parents from different cultures can experience similar parenting stressors and use similar coping mechanisms, but more research is needed on both family functioning and family interactions. Not only will this research be informative for the specific needs of families of children with autism within different communities, it also has the potential to help us understand different theories of ASD and development. For example, the biological etiology of ASD may inform hypotheses that there should be minimal differences between cultures on interactions between an individual with ASD and a family member. However, a transactional approach may generate hypotheses that cultural differences should be expected, explaining some of the heterogeneity in behaviors exhibited by individuals with ASD.

Conclusions Parents are the most proximal influence on children with ASD. This review has illustrated the various ways in which parents promote the development of their children with autism. Parent behaviors influence the development of attachment relationships (Oppenheim et al., 2012), improve child social behaviors (Meek et al., 2012) and communication skills (Siller and Sigman, 2002), and buffer children from the development of maladaptive behaviors (Woodman et al., 2015). Despite evidence for increased stress in families of children with autism (Hayes and Watson, 2013), these families can 551

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display resiliency (Bayat, 2007), and many parents demonstrate high amounts of warmth and affection for their children Smith et al., 2008). Characterizations of parents have improved drastically in accuracy and detail since the early psychogenic origins of family research in autism, but there are myriad needs and opportunities for a new generation of studies to elucidate how family processes influence the development of children with autism.The importance of additional research is emphasized by a small but growing experimental intervention literature on the malleability of parenting and how the effects of changes in parenting variables are associated with outcomes for children with ASD (Bekhet, 2017; Blackledge and Hayes, 2006; Karst and Van Hecke, 2012; Karst et al., 2015; Keen et al., 2010; Stuttard et al., 2014; Whittingham et al., 2009).

Acknowledgments Preparation for this chapter was facilitated by the National Institute for Mental Health Grant No. R01 MH106518–01A1. We thank Adrienne Nishina, Aubyn Stahmer, Ana-Maria Iosif, and Sarah Mahdavi for their comments on an earlier version of this chapter.

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17 PARENTING CHILDREN WITH INTELLECTUAL DISABILITIES Robert M. Hodapp, Ellen G. Casale, and Kelli A. Sanderson

Introduction Rearing a child with intellectual disabilities (ID) challenges any parent. Besides the child’s cognitive difficulties, children with ID often have associated motor, medical, psychopathological, and other disabilities. So too must one consider the parents’ emotional reactions and concerns. Parents of these children must cope with having produced an “atypical” child, a child who looks and acts differently from age-mates. Such parental concerns reoccur throughout the child’s life, culminating in the issue of how the adult with intellectual disabilities will live when parents can no longer provide in-home care. And yet, as difficult as such parenting issues often are, many parents cope successfully with rearing a child with intellectual disabilities. Families vary in their styles of coping; specific child characteristics influence parental and familial reactions; and many formal and informal supports protect parents from depression and hopelessness. Some parents even note how parenting their child with ID has made them more empathetic, tolerant of differences, and attuned to the truly important things in life. Before reviewing issues involved in parenting a child with intellectual disabilities, three preliminary concerns must be addressed. First, we note the area’s connections to the parenting of children without intellectual disabilities. Theories of parenting derive from those used to conceptualize parenting of typically developing children, and most studies compare parents of children with intellectual disabilities to parents of typically developing children. But many perspectives used to understand parenting typical children have only gradually been adopted within studies of parents of children with ID. In certain instances, parenting studies within intellectual disabilities have yet to be influenced by some of the newest ideas from typical parenting and development. A second issue concerns the nature of the studies themselves. Many studies—particularly those of the 1960s and 1970s—examined parents and families of children who were “disabled” or “mentally retarded.” The prevailing view was that parents react in a similar way to a child with any disability. Only gradually have studies examined parents of children with specific disability conditions, or with specific types of intellectual disabilities. As a result, parenting studies vary widely: some examine parents of children with disabilities; others children with intellectual disabilities; still others children with a specific type of intellectual disability (e.g., Down syndrome; fragile X syndrome). Third (and related), one must address issues of etiology. In the recent past, researchers have begun to appreciate the effects on behavior of many different genetic disorders of intellectual disabilities (Dykens, Hodapp, and Finucane, 2000). Such etiologies differentially affect intellectual, cognitive, and adaptive strengths and weaknesses, proneness to specific maladaptive behaviors, and trajectories

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of speeded or slowed development over the childhood years (Hodapp and Dykens, 2012). But if children are prone to exhibit particular etiology-related behaviors, might not parents and others in the child’s environment also respond in predictable ways? Studies have only begun to examine such possibilities. This chapter touches on these issues while examining both old and new work in parenting children with intellectual disabilities. We begin with the history of studies on parental reactions to rearing children with intellectual disabilities, the nature of interactions between mothers and these children, and characteristics of such families. Following this discussion, we tackle such theoretical and methodological issues as how one conceptualizes the family of a child with intellectual disabilities, between-group versus within-group studies, and the role of the child’s cause of intellectual disabilities on family functioning. Examining more recent studies, we then return to maternal and paternal reactions, mother-child interactions, and the effects of pre-existing parent and family characteristics on parent–family functioning. The chapter ends by providing more practical information and directions for future research.

History of Studies of Parenting Children With Intellectual Disabilities In studies of parents, parent–child interaction, and family characteristics, a clear history emerges. To this day, this history sets the tone for parenting studies of children with intellectual disabilities.

Parents of Children With Intellectual Disabilities Parents of children with any type of disability have traditionally been considered as prime candidates for emotional disorders. Comparing parents of children with intellectual disabilities, with emotional disorders, and with no impairments, Cummings, Bayley, and Rie (1966) found that mothers of 4- to 13-year-old children with intellectual disabilities were more depressed, more preoccupied with their children, and had greater difficulty in handling their anger toward their children than did mothers of typically developing children. Similarly, compared to fathers of typically developing children, fathers of children with intellectual disabilities were also more likely to show increased rates of depression; these fathers also scored lower in dominance, self-esteem, and enjoyment of their children with ID (Cummings, 1976; see also Erickson, 1969; Friedrich and Friedrich, 1981). The marital couple may also be adversely affected by the presence of a child with disabilities. In both Gath’s (1977) study of children with Down syndrome and Tew, Payne, and Lawrence’s (1974) study of children with cerebral palsy, families of children with disabilities were less likely to be intact than were families with sameaged typically developing children. Presumably, difficulties in dealing with the birth and increased demands of the child with disabilities lead to increased risks of parental break-up (Hagamen, 1980). A second strand more specifically examines why parents are affected and which psychological mechanisms are involved in their reactions. The orientation of most such studies involves the so-called “maternal mourning reaction.” Drawing on Freud’s work on mourning and melancholia, Solnit and Stark (1961) proposed that mothers (the main parent in psychoanalytic models) mourn the birth of any type of “defective” infant.This mourning was thought to be akin to the grieving that occurs in response to a death, with the death being the loss of the mother’s fantasy of the idealized, perfect infant. Solnit and Stark (1961) felt that maternal mourning occurs in response to the birth of a child with any cognitive, motor, social, or physical deficit. Although not perfect, the mourning model did highlight the time-bound nature of the mourning process, the idea that one works through one’s mourning reaction over the first few years of the child’s life. Influenced by Solnit and Stark’s model, later workers examined mothers of children with disabilities to determine the nature and course of maternal mourning. Most workers hypothesized that there are essentially three stages of maternal mourning (see Blacher, 1984, for a review). Directly after 566

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birth (or diagnosis), mothers experience shock, involving the dissociation of their knowledge from their feelings about having given birth to a child with disabilities. Mothers say things like “I found myself repeating ‘It’s not real’ over and over again” (Drotar, Baskiewicz, Irvin, Kennell, and Klaus, 1975, p. 712). The second stage involves “emotional disorganization,” which manifests itself as either anger toward others or depression (that is, anger toward oneself). The third and final stage involves “emotional re-organization.” Having worked through their feelings of shock and anger-depression, mothers come to appreciate and love their child with disabilities. Parents now realize that the birth of the child with disabilities was “nothing I had done” and that their child is “very special” (Drotar et al., 1975, p. 713). Parents set about to act in the child’s best interests, as they increasingly accept the child’s strengths and limitations. In contrast to this stage-model of mourning, Olshansky (1962, 1966) noted that the metaphor of working through a grief reaction is inadequate and that parents continue having strong emotional reactions as the child gets older. He noted that most parents “suffer chronic sorrow throughout their lives. . . . The intensity of this sorrow varies from time to time for the same person, from situation to situation, and from one family to the next” (1962, pp. 190–191). Olshansky asked that practitioners change their clinical practices to accommodate long-term reactions that can occur at various points over the child’s lifetime. He noted that, in contrast to the Solnit and Stark (1961) view, the problem of parenting a child with intellectual disabilities “is clearly both in and outside of the [parents’] psyche” (p. 21). Two additional themes are also implicit within the Solnit and Stark (and even the Olshansky) views of parental reactions (Hodapp and Ly, 2005). The first is that the parent in almost every case was the mother. Given an essentially Freudian perspective, Solnit and Stark, Olshansky, and most parenting researchers considered the mother as the main—almost the sole—parent of children with intellectual disabilities. In addition, both the mourning model and Olshansky’s chronic sorrow view spoke little of variations among parents of children with intellectual disabilities. Little attention was also paid to which external or internal factors might influence reactions from one mother to another.

Parent–Child Dyads Given this background of either stage-like or recurrent maternal mourning of children with intellectual disabilities, interactional researchers during the 1970s searched for differences in various parental behaviors between dyads with children who did and did not have intellectual disabilities. As a rule, the earliest studies found such differences. Buium, Rynders, and Turnure (1974) and Marshall, Hegrenes, and Goldstein (1973) found that, compared to mothers of same-aged typically developing children, mothers of children with Down syndrome provided less complex verbal input and were more controlling in their interactive styles. But not all studies found such differences in maternal input. Rondal (1977) and Buckhalt, Rutherford, and Goldberg (1978), for example, observed that mothers of children with intellectual disabilities behaved similarly to mothers of typically developing children. Rondal (1977) noted that, when children with Down syndrome and typically developing children were matched on the child’s mean length of utterance (MLU), “None of the comparisons of mothers’ speech to normal and to Down Syndrome children led to differences that were significant or close to significant” (p. 242) between the two groups. Rondal (1977, p. 242) concluded that “the maternal linguistic environment of DS children between MLU 1 and 3 is an appropriate one.” What could lead to such divergent findings from one study to another? Most differences were undoubtedly caused by methodological factors. In general, when the child with intellectual disabilities has been matched to a typically developing child on chronological age (CA), mothers of children with intellectual disabilities have been found to interact differently. But children with intellectual disabilities are, by definition, functioning below typically developing age-mates; CA matching may thus 567

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be inappropriate. A more appropriate strategy might be to match mother-child dyads on the child’s mental age (MA) or the child’s level of language (MLU).The issue of what constitutes an appropriate matching variable (and for which outcomes) continues to be debated.

Characteristics of Families of Children With Intellectual Disabilities A final area of investigation has been the characteristics of families of children with disabilities, the ways in which these families are similar to or different from families of children without intellectual disabilities. In a classic work, Farber (1959) identified several differences between families of children with and without intellectual disabilities. He noted that the child with intellectual disabilities increasingly violates the family’s rules concerning appropriate family roles. Whereas the infant with intellectual disabilities plays the “infant role,” at later ages the child with intellectual disabilities continues being “a little kid.” The rights and responsibilities typical of middle childhood or the teen years are generally not passed on to the child with intellectual disabilities. Several implications arise from this lack of movement in the roles undertaken by these children. First, typically developing siblings assume different roles than would normally be expected. Farber (1959) identified the “role tensions” experienced by typically developing siblings, particularly by the oldest daughter. As older girls are the traditional caregivers in Western society, oldest daughters more often perform household jobs and supervise younger children, thereby freeing their mothers to care for the child with intellectual disabilities (Kramer and Hamilton, 2019). Probably due to their inability to enjoy their childhood years and increased familial responsibilities, oldest daughters were thought to more often display depression and other psychopathology (Lobato, 1983). The child with intellectual disabilities’ social role stagnation also does not allow these families to move through a normal family life cycle. Like individual children, families also develop. They undergo changes in dynamics from the couple’s early years of marriage, to the 3-, 4-, or more person family rearing young children, to dealing with one or more child’s growing independence. In later years, families must cope with their child’s breaking away and parental negotiation of the “empty nest syndrome” to grandparenthood for the parents and a new family cycle for the now married children (Carter and McGoldrick, 1988; Combrinck-Graham, 1985; Duvall, 1957; Demick, 2019). But Farber (1959) noted that, when rearing children with more significant levels of intellectual disability (i.e., IQs below 50), parents are never allowed to grow up along with their children, thus forcing parents to become stuck in issues of parenting younger children. Alongside Farber’s work on family roles, early (and subsequent) studies delineated basic demographic differences between families with and without children with intellectual disabilities. The differences, while expectable, are nonetheless interesting. Families that are more affluent cope better with rearing a child with disabilities than do those making less money (Farber, 1970; Hoff and Laursen, 2019); two-parent families cope better than one-parent families (Beckman, 1983; see also Weinraub and Kaufman, 2019, in this edition; and women in better marriages cope better than those in troubled marriages (Beckman, 1983; Friedrich, 1979; Ganong and Coleman, 2019). In addition, families are less likely to use social supports when children are older (Suelzle and Keenan, 1981), even as the childcare needs of such children increase due to the child’s becoming taller, heavier, and (sometimes) more difficult to manage. As the initial work of a new field, studies of parents, interactions, and familial integration set the stage for the explosion of parenting work. These earlier studies provided basic information about how parents react emotionally and how they interact with their children, as well as how families respond to the child with intellectual disabilities. More importantly, this early work provided themes that continue to organize parenting research. 568

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Theoretical and Methodological Issues in Parenting the Child With Intellectual Disabilities Six interrelated themes cut across both earlier and later work on parents, interactions, and the larger family unit.

From Pathology to Stress-Coping: Examining the Models Used to Conceptualize Parenting The earliest work on families of children with intellectual disabilities considered parents, interactions, and families as a whole in terms of psychopathology. Parents were examined for psychiatric problems and for expressed or latent anger and other negative emotions (e.g., as on the Minnesota Multiphasic Personality Inventory [MMPI]; Erickson, 1969). Interactions between parents and children with intellectual disabilities were examined to determine how such interactions differed from interactions between mothers and typical children, and differences were considered as evidence of deficient interactions. Divorce, role tensions, stuck family cycles for families as a whole—all reflect the dominant pathology focus of parenting research during the 1960s and 1970s (Hodapp and Ly, 2005). Gradually, however, researchers shifted from considering the child as a cause of psychopathology to a stressor on the family system (Crnic, Friedrich, and Greenberg, 1983). This change in perspective is important, for although stressors can be detrimental, they are not always so. In some situations, stressors can strengthen mothers and fathers—as individuals or couples—and families as groups. Events such as moving, caring for an ill family member, or experiencing a natural disaster can thus often be hard on the family as a whole and on individual members, but such events can also draw family members closer together. In a similar way, the stress-and-coping perspective allows for a more positive, albeit realistic, orientation toward the problems and strengths of these families, setting the stage for studying the positive reactions of many families to rearing their child with disabilities (Dykens, 2006; Hastings, 2016; Taunt and Hastings, 2002). The stress-coping perspective also led to borrowing models from other areas. Specifically, to help explain potential variations among families of children with intellectual disabilities, McCubbin and Patterson’s (1983) ABCX model was adapted by family researchers into a Double ABCX model. Briefly stated, the Double ABCX model hypothesizes that the effects of the “crisis” of having a child with intellectual disabilities (“X” in the model) is due to specific characteristics of the child (the “stressor event,” or A), mediated by the family’s internal and external resources (B) and by the family’s perceptions of the child (C). But children with intellectual disabilities and their effects on families also change over time. Characteristics of the child change as the child gets older, the family’s internal and external resources may change, and so too may the family’s perceptions of the child. Hence, the “Double” in the Double ABCX model. Such stress-coping perspectives and models also led to better measurement of parenting stress. In examining the extant literature, parenting stress is most frequently measured via a parent report. Lessenberry and Rehfeldt (2004) conducted a meta-analysis to determine which tools are most often used to measure stress in parents of children with disabilities. Their search yielded seven such instruments, most notably the Parenting Stress Index (PSI; Abidin, 1997). In a broader examination of the literature, both the PSI and the Questionnaire for Resources and Stress (QRS; Holroyd, 1976) frequently appear. But a number of other parent-report measures exist, with the entire list possibly including up to 20 different parent-stress measures (Hodapp and Casale, in press). Beyond such parent-report measures, developments in technology have led to direct physiological measures of stress. Such physiological measures include ambulatory blood pressure (Foody, James, and Leader, 2014); electrodermal activity (Ruiz-Robledillo and Moya-Albiol, 2015); cortisol salivary biomarkers (Foody et al., 2015; Seltzer et al., 2010; Seltzer et al., 2009; Dykens and Lambert, 2013); 569

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and blood immune parameters (Pariante et al., 1997; Gallagher, Phillips, Drayson, and Carroll, 2009a, 2009b). Additionally, researchers have looked at other biological markers, including chromosomal telomere shortening (Epel et al., 2004). In future years, we can expect the development of additional biological or physiological measures. The Double ABCX model, with increasing theoretical and measurement specification, has served researchers well. Most importantly, the model helps explain both negative and positive consequences of rearing a child with intellectual disabilities (Minnes, 1988). For all families, children displaying fewer emotional problems and requiring less physical caregiving may help parents and families to adjust more positively. In the same way, families with few internal or external resources are more likely to be negatively affected by the child with intellectual disabilities; families with more resources should do better.

The Child’s Meaning to the Parents As scientists in many fields are discovering, human beings are “meaning-makers,” creatures obsessed with deriving meaningful understandings of human events (Bruner, 1990).Yet until recently, the role of meaning—of what the child with intellectual disabilities means to the parents—has rarely been examined. This focus on meaning can best be seen in examinations of interactions between children with intellectual disabilities and their parents. A common finding is that such interactions are both the same and different from interactions between typical child-mother dyads (see next section). Many interactive differences appear due to the different meanings of the child with intellectual disabilities to the mother. In addition to the role of meaning in mother-child interactions, families have complex meaning systems for both the family overall and for each individual member. Employing an ecological perspective on the family, Gallimore, Weisner, Kaufman, and Bernheimer (1989) described the different social constructions held by families of children with intellectual disabilities. They noted that some families feel that the child with intellectual disabilities needs intensive intervention, whereas others feel that typically developing children should receive more time and attention. Families then change their day-to-day lifestyles to accommodate their prevailing values. To Gallimore et al. (1989), the meaning of the child with intellectual disabilities—and how this child fits within the overall family’s meaning-system—is the most important influence on the family’s behaviors and how these behaviors are interpreted by each family member.

Group Versus Individual Differences Approaches to Studying Families of Children With Intellectual Disabilities No two families of children with intellectual disabilities are exactly alike. Individual mothers and fathers, siblings, families as a unit, and children with intellectual disabilities themselves all display individual characteristics that may affect parenting.Yet as a side effect of the Solnit and Stark (1961) formulation, most research has compared parents, interactions, and families of children with intellectual disabilities to parents, interactions, and families of typically developing children. Such studies have sought to determine if behaviors are the same or different relative to behaviors occurring in response to typically developing children. Although useful in many areas, such a group-difference approach needs to be complemented by studies examining intra-group variation among families of children with ID. A complementary focus on individual differences has begun to affect the parenting literature, somewhat as a result of the Double ABCX and other stress-coping models. If any one family’s reaction is due to a combination of child characteristics and the family’s internal and external resources and perceptions, then individual differences—in the child with intellectual disabilities, the parents, 570

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and the entire family system—become important foci of research and intervention. Indeed, families differ on a host of factors: in the degree to which they are warm or cold, open or closed, harmonious or unharmonious. Personal characteristics of—and relationships among—mothers, fathers, sisters, brothers, and extended family members all vary from one family to another, and all potentially influence parenting. In the same way, many characteristics of children themselves affect parental and familial reactions. The child’s chronological age, mental age, IQ, degree and types of associated disability, maladaptive behavior, personality, and interests might all be important. Most such characteristics have only begun to be investigated.

“Indirect Effects” of the Child’s Etiology on Parents and Families Another important influence on parental reactions and behaviors may be the child’s type of intellectual disability. A revolution has occurred in behavioral research in intellectual disabilities. Whereas previously most behavioral researchers studied children with intellectual disabilities who had similar degrees of impairment (e.g., mild, moderate, severe, and profound levels), contemporary studies have proliferated in such disorders as Williams syndrome, Prader-Willi syndrome, and fragile X syndrome (Hodapp and Dykens, 2012). Even in Down syndrome, the sole etiology to receive research attention over many decades, behavioral studies almost doubled from the 1980s to the 1990s and continue climbing (Hodapp and Dykens, 2012). Beyond increasing numbers of studies per se, the field is now appreciating that children with specific genetic conditions more likely demonstrate particular behavioral strengths, weaknesses, and problems. Many children with Down syndrome, for example, have special difficulties in language (especially expressive language and articulation) and difficulties in performing means-ends tasks (Fidler, 2005). Even early on, these children show a strong interest in people (vs. objects), to the extent that they use this sociability to avoid performing difficult cognitive tasks (Kasari and Freeman, 2001; Pitcairn and Wishart, 1994). Children with Prader-Willi syndrome almost always display extreme hyperphagia (i.e., overeating), along with obsessions-compulsions and tantrums (Dykens, Cassidy, and DeVries, 2011). Those with Williams syndrome, who often show relatively high linguistic abilities and an affinity for music, also show extreme empathy in many laboratory tasks, even as they have difficulties making and keeping friends (Thurman and Fisher, 2015). Although this listing of etiology-related behaviors is not complete for any of these disorders—and 750–1,000 genetic conditions have now been associated with intellectual disabilities (Ellison, Rosenfeld, and Schaffer, 2013)—they nevertheless give a sense of etiology-related behavioral effects. To date, most studies have focused on delineating behavior of the children themselves. Increasingly, however, studies also focus on genetic disorders’ “indirect effects,” or parental (and others’) reactions to etiology-related child behaviors (Hodapp, 1997, 1999). The background for indirect effects arises from R. Q. Bell’s classic notion of interaction (Bell, 1968; Bell and Harper, 1977), the idea that, just as parents affect children, so too do children affect their parents. In the case of intellectual disabilities, children with a particular syndrome are predisposed to exhibit certain etiologyrelated behaviors, which in turn may elicit specific behaviors from parents. If parents of typically developing children react in certain ways to their children’s hyperactivity, then might not parents of children with either 5p- or fragile X syndromes—two disorders with high rates of hyperactivity— respond similarly (Hodapp, 2004)? Such analyses hold great promise for better understanding parenting behaviors in children with intellectual disabilities. Two final issues concern the indirect effects of genetic disorders. The first involves direction of causality. Are children affecting parents or are parents affecting children? Although traditional socialization theory holds that parents affect their children, most studies of parents of children with different syndromes—and of parents of children with intellectual disabilities in general—assume the opposite. Moreover, longitudinal studies show that the direction of effects often goes from the child’s 571

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behavior to the parents’ or family’s functioning (Keogh, Garnier, Bernheimer, and Gallimore, 2000). Yet still to be addressed are complicated questions such as how ongoing parent–child transactions or interventions develop over time; to what extent, for example, do parental behaviors during interactions foster, buffer, or negate children’s already existing tendencies across a variety of behavioral domains (Fidler, 2011)? Conversely, to what extent do the child’s behaviors influence adults, and when (or under which circumstances) do such parental responses occur? Even if children do affect parents, what is the “active ingredient”? So far, the idea has been that those behaviors that elicit specific reactions in parents of typically developing children should bring about similar responses when exhibited by a child with a particular type of intellectual disability. The particular genetic disorder, then, becomes a proxy for one or a small number of that disorder’s characteristic behaviors. But etiologies also differ in terms of other characteristics. To give the most well-known example, to this day births of infants with Down syndrome more often occur to mothers who are older (Congenital Anomaly Statistics, 2010; Martin, Hamilton, Osterman, Curtin, and Mathews, 2015). In most industrialized societies, however, older mothers are also more likely to be married and more educated (McLanahan, 2004; McLanahan and Jacobsen, 2015); these older mothers also more often enjoy higher levels of social support and better understand child development and caregiving practices (Bornstein, Putnick, Suwalsky, and Gini, 2006). As seen in initial studies, the correlates of advanced maternal age might also be at work in families of children with Down syndrome. Related to more often having older mothers, then, children with Down syndrome more often have mothers who are married and better educated (Hodapp and Urbano, 2008). Although the focus of few studies, these mothers would seem likely to be more savvy in terms of child development and learning about their child’s disability and available services (Hodapp, Burke, and Urbano, 2012). These issues are complicated and, to date, little studied, but suffice to say here that the specific aspects and operation of indirect effects remain under-examined.

Focus on Parenting and Care Over the Lifespan of Persons With Intellectual Disabilities From Farber (1959) on, family researchers have appreciated that children with ID do not always follow the usual age-appropriate roles of children within a family. This realization becomes especially prominent at the end of the childhood years, when most offspring leave home for work or college. Researchers have long discussed the ways in which offspring with disabilities often continue to live in the family home into the adult years, a phenomenon called “delayed launching” (Seltzer and Ryff, 1994). This issue becomes especially salient given the increasingly long lifespans of persons with ID, along with a scarcity of state-run adult-disability services (Hodapp, Burke, Finley, and Urbano, 2016). As a result, our views of parenting offspring with intellectual disabilities increasingly reach beyond the childhood years. As noted below, when considering adults with intellectual disabilities, there are many twists on caregiving. Such twists relate both to the intergenerational nature of care—including the health and functional abilities of aging parents—as well as the possibility that one or more of the other (i.e., typical) offspring in the family—the adult siblings—might assume care of their brother or sister with disabilities. Such long-term, intergenerational family care may become even more complicated when offspring have specific types of disabilities.

Methodological Issues in Studying Parents and Families of Children With Intellectual Disabilities Since the late 1960s, researchers have debated how best to conceptualize behavior in children with intellectual disabilities. One side has included the many defect theorists, researchers who believe that intellectual disabilities are caused by one or another specific defect (for a review, see Zigler and Balla, 572

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1982). On the other have been developmental workers who propose that children with certain types of intellectual disabilities—particularly those demonstrating no specific organic cause—show more general delays across many domains of functioning (Zigler and Hodapp, 1986). One key aspect of this debate concerns CA- versus MA-matching, whether it is better to compare children with intellectual disabilities to typically developing children of the same chronological age (CA-matching) or mental age (MA-matching). Defect theorists have long advocated CAmatching, arguing that CA-matching directly demonstrates a child’s deficiencies in a particular area (Baumeister, 1967). Developmentalists respond that, to show that a child is “deficient” in a particular area, performance that is delayed beyond overall mental age must be established. Performance that is deficient to CA-matches shows only that a particular task is one of many performed poorly by the child with intellectual disabilities (Cicchetti and Pogge-Hesse, 1982). In addition, with recent debates about the degree to which functioning is spared in several genetic disorders (e.g., is language spared in Williams syndrome?), both MA- and CA-matches may be necessary (Hodapp and Dykens, 2001). In addition to studying the child’s own behavior, how should one study parental reactions, maternal behaviors within interactions, or the family systems of children with intellectual disabilities? It would seem that research strategies need to be tailored to the question of interest. For example, studies of maternal language input should employ children with and without intellectual disabilities who are of the same language-age (Conti-Ramsden, 1989). In contrast, CA-matching might be more appropriate for studies of family functioning. As Stoneman (1989) notes, families with 10-year-old children are in a particular family stage, even if the child functions at a 5-year-old level.To examine issues such as divorce rates, quality of marriage, sibling reactions, and other family dynamics, CA-matching may be the most appropriate strategy. In line with this reasoning, most studies have compared families of children with and without intellectual disabilities when the children are matched on CA. At the same time, however, not every family question may be best addressed with a CA-match. Specifically, many of the changes of family dynamics involve reactions based on the child’s immaturity, on the idea that the child with intellectual disabilities—while she or he may be a 10-year-old— in fact acts like a much younger child. If families of a child with intellectual disabilities are indeed stuck in their development (Farber and Rowitz, 1986), then a match to a group of families of typical children of the same MA might be indicated. Better yet, both CA- and MA-matching might be useful to address many questions, as only this combination can differentiate how long the child has lived (CA) from the child’s present level of functioning (MA, or age-equivalent score). An additional methodological issue relates to individual differences, the idea that there are wide individual differences from one family to another. Here, too, many important variables have not yet been examined. We know little, for example, about the family dynamics of families who are more versus less successful in parenting the child with intellectual disabilities, and only generally why some marriages break up whereas others become stronger. It may also be that couples who parent children with different conditions—for example, Down syndrome as opposed to autism spectrum disorder—have different amounts and timings of divorce (Hartley et al., 2010; Urbano and Hodapp, 2007). How familial adaptation might differ based on the family’s SES, ethnicity, and parental education levels also remains underexplored. Even those variables that have been studied are usually examined in a piecemeal fashion, making more difficult the determination of each variable’s contribution to individual differences among families. Change may be occurring, however, as more researchers use larger, family systems frameworks to conceptualize their findings (Kerig, 2019). More attention is needed on how to do research from the group-difference versus the individual-difference perspective and what each implies.

Modern Research on Parenting the Child With Intellectual Disabilities The six issues discussed above can be found within much of the modern research in maternal and paternal reactions, mother-child interactions, and the reactions of the family as a whole to rearing the 573

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child with intellectual disabilities. Much of this research combines recent theories and methodologies with the perspectives and findings of the 1960s and early 1970s.

Factors Affecting Maternal and Paternal Reactions to Parenting Children With Intellectual Disabilities Much modern research has examined both the Solnit and Stark and the Olshansky perspectives to delineate further when and how parents react to the child with intellectual disabilities. When closer, more fine-grained examinations have been performed, researchers have found that several factors affect parental emotional reactions.

Factors Intrinsic to Parents Themselves To date, maternal coping styles have been implicated as a major factor influencing parental reactions to their children with intellectual disabilities. Following from Folkman, Schaefer, and Lazarus’s (1979) work, mothers can be identified as predominantly using either problem-focused or emotion-focused coping strategies (for a review, see Turnbull et al., 1993). In the first, mothers approach their child’s intellectual disabilities as a practical, concrete problem to be addressed. These mothers make plans to cope with everyday problems, work hard to alleviate those problems, and feel that they have learned from their experiences. In contrast, another group of mothers either totally denies their feelings about their child and the disability, or instead becomes over-concerned, almost obsessed, with their own feelings of depression and grief. Across a range of studies, active, problem-focused copers seem much better adjusted than emotion-based copers (Essex, Seltzer, and Krauss, 1999). Although in some sense obvious, a mother’s style of social problem solving seems important for successful adaptation to rearing a child with intellectual disabilities. Such parent characteristics and coping styles can impact the degree to which parents respond with resilience to the stress of parenting a child with, or at-risk for, a disability (Ellingsen, Baker, Blacher, and Crnic, 2014). So too may differences in the mothers’ genetic status sometimes lead to different maternal reactions. For example, mothers who carry the fragile X gene have been found to more often be shy, anxious, and withdrawn compared to mothers of children with other types of disabilities (Lachiewicz et al., 2010; Mailick et al., 2017). In many ways similar to the broader autism phenotype among parents of children with autism (see also Chapter 16 in this volume), such personality characteristics—which appear specific to female carriers of the fragile X gene—contribute to the problems these women have in making use of clinical, educational, and other supportive services. An additional difference involves the ethnicity of the mother. Although an under-researched area, mothers of different ethnicities seem to react differently to rearing a child with intellectual disabilities. One area of interest has concerned Latina mothers, especially related to their health and depression (Magaña, Li, Miranda, and de Sayu, 2015; Magaña, Schwartz, Rubert, and Szapocznik, 2006). For example, Latina mothers report more problems than non-Hispanic mothers in finding out information about their child and in participating in parent programs (Heller, Markwardt, Rowitz, and Farber, 1994). Other studies find that many Latina mothers are depressed, with levels of depression best predicted by the absence of a spouse or partner, low family cohesion, and poor maternal health (Blacher, Lopez, Shapiro, and Fusco, 1997; see also Magaña, Seltzer, and Krauss, 2004). For at least certain ethnic groups, one important—and often overlooked—variable involves religiosity. Although a topic in disability family research for many years (Zuk, Miller, Bertram, and Kling, 1961), the degree to which mothers consider themselves religious may be especially important among Latino and African American populations. In Heller et al. (1994), Latina (versus non-Latina) mothers considered rearing a child with intellectual disabilities as a religious duty. In the African American community, mothers benefited both from their personal religious feelings and from the 574

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support they received from other church members (Rogers-Dulan, 1998). Mothers thus mentioned how church members “are especially good in helping my daughter’s self-confidence,” “prayed for Tim the whole time he was in the hospital,” and “brought us groceries and things for Kevin like clothes and diapers” (p. 98). Just as the reactions of mothers may differ due to several factors, so too may reactions differ in mothers versus fathers. Few studies have examined paternal compared to maternal reactions, but mothers and fathers appear to vary. Damrosch and Perry (1989) asked mothers and fathers to describe retrospectively their emotional reactions since the birth of their children with Down syndrome. Two graphs were provided.The first graph, consistent with Solnit and Stark’s mourning model, showed strong emotional reactions early and then gradual acceptance of the child with disabilities. The second graph featured a series of wide emotional swings that was more consistent with the repeated up-and-down pattern of Olshansky’s recurrent reactions model. Mothers and fathers differed in their reactions. Mothers more often described their feelings as repeatedly up and down (i.e., the recurrent reactions pattern), whereas fathers reported early emotional reactions then later acceptance (i.e., the maternal mourning model). Mothers and fathers may also differ in how they conceptualize the child and the child’s problems. Many studies have found that mothers experience more stress and feel themselves less in control of the situation than fathers (Bristol, Gallagher, and Shopler, 1988; Damrosch and Perry, 1989; Goldberg, Marcovitch, MacGregor, and Lojkasek, 1986). Mothers much more than fathers express needs for more social and familial support, information to explain the child’s disability to others, and help with childcare (Bailey, Blasco, and Simeonsson, 1992). In contrast, fathers seem particularly concerned about the costs of caring for a child with disabilities and what the child will mean to the family as a whole (Price-Bonham and Addison, 1978; see MacDonald and Hastings, 2010). Given these differences, factors that support mothers may not support fathers. Frey, Greenberg, and Fewell (1989) found that the presence of supportive social networks promotes better coping on the part of mothers of children with intellectual disabilities, whereas fathers cope better when there is a minimal amount of criticism from extended families. Both mothers and fathers cope best if the other spouse is coping well and if each feels a strong measure of personal control in rearing the child with intellectual disabilities.

Factors Related to Child Characteristics In addition to variables related to parents, several characteristics of the children themselves seem to influence parental reactions. The first of these factors concerns the age of the offspring with intellectual disabilities. Several researchers have attempted to determine when emotional reactions and concerns are most likely to occur for mothers of children with disabilities. For example, Emde and Brown (1978) noted that parents of children with Down syndrome undergo several waves of depression over the child’s first year of life (Suchman, DeCoste, and David, 2019). After experiencing strong feelings of depression at the baby’s birth and diagnosis, parents generally do better until approximately 4 months of age, when feelings of sadness reappear. This second wave of depression occurs as parents realize the behavioral implications of Down syndrome, as their infants show more dampened affect and less consistent social smiles than do same-aged typically developing children. Such recurrent emotional reactions continue throughout the childhood years.Wikler (1986) noted that parents experience stress during puberty (ages 11–15) and during the onset of adulthood (ages 20–21). Compared to responses from these same mothers 2 years before or after these periods, lesser amounts of stress were reported (Wikler, 1986). In a more general sense, Minnes (1988) described a “pile-up” of stressors on mothers as the child gets older, even as mothers less often use formal and informal social supports (Suelzle and Keenan, 1981). In evaluating Solnit and Stark’s formulation, it seems that, although parental emotions may be most intense directly after birth, later events and milestones also evoke strong reactions. As Wikler (1981, p. 284) noted, “The accepted view that a crisis 575

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occurs following the diagnosis because of the general disruption of expectancies is probably correct; but the conclusion that the gradually gained equilibrium is permanent is probably incorrect.” Researchers have also examined parental reactions to their children during a different period of life, when the child with intellectual disabilities becomes an adult. Two contrasting viewpoints have been featured in this work. In the first, wear-and-tear hypothesis, parents of adults with intellectual disabilities are thought, over time, to be beaten down by the day-to-day struggle to parent their now adult offspring. In the second, adaptational hypothesis, parents and their adult offspring come to coexist peacefully, with the caregiver developing new coping strategies and growing psychologically (Townsend, Noelker, Deimling, and Bass, 1989). For the most part, studies support the second, more hopeful perspective for mothers of adults with intellectual disabilities. In a study of 450 mothers aged 55–85 years, Seltzer and Krauss (1989) found that most (78%) reported that their health was good or excellent; compared to other samples of family caregivers, these mothers were substantially more satisfied with their lives and reported slightly less caregiving stress and feelings of burden. A high level of involvement by the other (non-disabled) siblings was also helpful, as were the mothers’ own constructive coping strategies (Seltzer and Ryff, 1994; Sanderson, Burke, Urbano, Arnold, and Hodapp, 2017). Before painting too rosy a picture, however, it should be noted that these families have their problems. Specifically, about half of older mothers reported experiencing a stressful life event (death of family member or close friend, illness, or the like) over the prior 18 months, and individual mothers showed higher levels of depressive symptoms after experiencing such events (Krauss and Seltzer, 1998). As during their offspring’s childhood years, mothers who employed more constructive coping styles did better. On balance, though, these mothers and their families were doing relatively well. In some studies, parents even reported that they themselves received support from their adult offspring with intellectual disabilities and that such support was important in mothers reporting greater satisfaction and less caregiving burden (Heller, Miller, and Factor, 1997). A second factor concerns the etiology of the child’s intellectual disabilities. Across all but a very few studies, families of children with Down syndrome appear to do better than families of children with other forms of intellectual disabilities, autism spectrum disorders, or psychiatric disorders. When compared to children with autism and to children with unidentified intellectual disabilities, parents of children with Down syndrome exhibit significantly lower amounts of stress (see Hodapp, 2007). Compared to mothers of children with other disabilities, mothers of children with Down syndrome even report experiencing greater support from friends and the greater community (Erikson and Upshure, 1989). Compared to parents of children with other conditions, then, parents of children with Down syndrome may experience what has been called a “Down syndrome advantage” (Hodapp, Ly, Fidler, and Ricci, 2001; Seltzer and Ryff, 1994). Several potential explanations have been ascribed for the existence of a Down syndrome advantage. First, Down syndrome is a common and widely known disorder that is understandable to parents and families and others. The syndrome also has many parent groups, often with active local chapters. Unlike many other conditions (e.g., Prader-Willi syndrome, Williams syndrome), parents and family members generally do not need to explain the syndrome to extended family, friends, coworkers, and the child’s schoolmates. Second, because of the higher prevalence rates of Down syndrome to mothers of more advanced age, mothers may be more mature and more experienced in the parenting role. Reviewing census data from several industrialized countries, the median maternal age at the birth of newborns with Down syndrome is approximately 32 years, roughly 5 years older than maternal age for births in the general population or in other disability groups (see Hodapp et al., 2016, for a review). As noted earlier, the mother’s age when giving birth also correlates with higher levels of formal education, more often being (and staying) married, having fathers who are more involved in childrearing, and more generally providing greater amounts of financial and cultural resources (McLanahan and Jacobsen, 576

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2015). Although only a few such variables have been examined among mothers of children with Down syndrome (Hodapp and Urbano, 2008), most correlates likely occur in this group as well. Indeed, the few studies not finding this Down syndrome advantage have suggested that these parents’ age (Corrice and Glidden, 2009) and socioeconomic status may account for differences earlier attributed to the etiology itself (Cahill and Glidden, 1996). Along with these associated characteristics, children with Down syndrome also possess several personal characteristics that may differ from others with intellectual disabilities (Hodapp, 1999). Children with Down syndrome may have more upbeat, sociable personalities, particularly during the early years. Such personalities have now been found using both questionnaire measures (Hodapp et al., 2001) and in parents’ descriptions of their children’s personalities (Carr, 1995; Hornby, 1995). Such sociable personalities are evident from the toddler years, when, compared to other children with intellectual disabilities, toddlers with Down syndrome more often look to their mothers than to surrounding objects (Kasari, Freeman, Mundy, and Sigman, 1995). Such looking to adults continues into the middle-childhood years, sometimes even interfering with these children’s completion of difficult cognitive or academic tasks (Fidler and Nadel, 2007; Kasari and Freeman, 2001). A second behavioral difference concerns the relative lack of psychopathology—especially severe psychopathology—in the Down syndrome population. Granted, estimates of children with Down syndrome who have significant behavior problems range from 15% to 38% (Hodapp, 1996), with studies noting the presence of severe psychopathology-maladaptive behavior in subsets of children and adolescents with the syndrome (Dykens et al., 2015;Tasse et al., 2016). Still, such percentages are generally lower than those found in same-aged children with mixed etiologies (Dykens and Kasari, 1997; Meyers and Pueschel, 1991). In addition to the child’s behaviors per se, other, more physical, characteristics may also elicit parental reactions. Specifically, children with Down syndrome generally have more infantile or baby-like faces, that is faces that are rounder and with smaller, lower-set features (Allanson, O’Hara, Farkas, and Nair, 1993). When seeing such faces, adults display a strong tendency to attribute to these individuals infantile personality characteristics (Berry and McArthur, 1985), to rate photographs of more versus less baby-faced individuals (children or adults) as being warmer, friendlier, and more honest, compliant, and sociable (Zebrowitz, 1997). Such findings also extend to children with Down syndrome. Examining pictures of 8-, 10-, and 12-year-old children with Down syndrome, another genetic intellectual disabilities disorder (5p- syndrome), and same-aged typically developing children, naïve respondents rated children with Down syndrome as more honest, warm, compliant, and sociable (Fidler and Hodapp, 1999). In a second, within-group part of the study, those children with Down syndrome who objectively possessed more versus less baby-faced faces were rated higher on these personality characteristics. Recent studies have even extended such findings to other aspects of human infants, especially “cute” vocal sounds (e.g., babbling, laughter) and smells, with facial, vocal, and olfactory cues all found to elicit parental reactions both behaviorally and neurologically (Kringelbach, Stark, Alexander, Bornstein, and Stein, 2016). As with parents of typical children, then, the face (and, possibly, other aspects) of the child with Down syndrome may ultimately join behavior as a child characteristic to which adults respond. In considering the research on parental emotional reactions, much progress has occurred since the original Solnit-Stark and Olshansky formulations. Increasingly, researchers are developing a taxonomy of parent and child characteristics that affect parental reactions, a taxonomy that should promote more effective parental coping strategies throughout the childhood years.

Interactions Between Mothers and Their Children With Intellectual Disabilities Starting with Rondal’s (1977) study showing that mothers of children with Down syndrome provide similar levels of language input as mothers of typically developing children of the same level of 577

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language (i.e., MLU), many studies have examined interactions between mothers and children with a variety of disability conditions.These studies converge on a basic theme: Maternal interactive (mainly linguistic) behaviors with their children with disabilities appear both the same as and different from maternal behaviors with typically developing children of the same level of language. Overall, the similarities have occurred when one examines what might be called the structural properties of input language. Mothers of young children with intellectual disabilities provide language that is of the same grammatical complexity, has the same amount of information per sentence, and appears much like the language provided by mothers of typically developing children of the same language or mental age. Yet at the same time, mothers of children with intellectual disabilities appear very different in their styles of interaction. Even when children with versus without intellectual disabilities are equated on overall mental or linguistic age, mothers of children with Down syndrome and other types of intellectual disabilities are often more didactic, directive, and intrusive compared to mothers of typically developing children (Marfo, 1990). Such stylistic differences between mothers of children with and without intellectual disabilities are seen on a number of levels.Tannock (1988) found that, compared to mothers of typical children, mothers of children with Down syndrome took interactive turns that were longer and more frequent; in addition, these mothers more often clashed—or spoke at the same time as—their children (Vietze, Abernathy, Ashe, and Faulstich, 1978). Mothers of children with Down syndrome also switched the topic of conversation more often and less often silently responded to the child’s utterance. But why mothers in the two groups differ remains unclear.The most common explanation is that mothers of children with intellectual disabilities inject into mother-child interactions their own parenting concerns. They more often treat mother-child interactions as teaching sessions, as moments not to be squandered in the non-stop effort to intervene effectively (Cardoso-Martins and Mervis, 1984; Jones, 1980). In contrast, mothers of typically developing children display fewer fears and concerns; they may simply desire to play—in a more spontaneous and less directive manner—with their typically developing children. In line with most work in this area, the above review focuses on studies examining differences between maternal behaviors of children with and without intellectual disabilities. But several studies have now examined variation in maternal behaviors within samples with intellectual disabilities (usually Down syndrome). The main findings are that not all mothers behave identically and that certain maternal styles of interaction may be more helpful than others are for language development in children with Down syndrome. In a direct examination of this issue, Crawley and Spiker (1983) rated maternal sensitivity and directiveness of mothers in their interactions with their 2-year-old children with Down syndrome. They found wide individual differences from one mother to another. Some mothers were highly directive, whereas others followed the child’s lead; similarly, mothers varied widely in self-rated degrees of sensitivity to their children. Because the two dimensions of sensitivity and directiveness were somewhat orthogonal, mothers could be high or low on either sensitivity or directiveness. All four combinations were demonstrated in this study. Just as mothers of typically developing children vary widely on both directiveness and sensitivity, so too do mothers of children with Down syndrome. A final issue concerns the effects of different maternal behaviors on children’s development. In the sole study of this issue, Harris, Kasari, and Sigman (1996) examined the effects of maternal interactive behaviors on children with Down syndrome’s expressive and receptive language behaviors. Examining children when they were 2 and again at 3 years of age, Harris et al. (1996) found that the mean length of time in which mothers and children were engaged in joint attention (i.e., focusing on the same object) was correlated to the child’s degree of receptive language gain over the 1-year interval. In addition, the child’s receptive language gains were also correlated with the amount of time that 578

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mothers maintained the child’s attention to child-selected toys, and (negatively) to instances of redirecting the child’s focus of attention and of engaging in greater numbers of separate joint attention episodes. Such findings parallel those found for interactions between mothers and typically developing infants, where maternal sensitivity (Baumwell, Tamis-LeMonda, and Bornstein, 1997) and joint attention episodes (Tomasello and Farrar, 1986; Kasari, Freeman, and Paparella, 2006) also promote young children’s early language abilities. Some researchers have extended such investigations beyond language outcomes to more global positive parenting outcomes. Home environment factors such as lower income and maternal sensitivity have been associated with needing special education or remedial services for children identified as developmentally delayed or in need of early intervention services (La Paro, Olsen, and Pianta, 2002; Mann, McCartney, and Park, 2007). To this end, Ellingsen and colleagues (2014) examined the protective and prohibitive factors that influence positive parenting in 232 parent–child dyads in the context of the ABCX model. In this model, researchers investigated to what extent risk factors (e.g., child behavior problems, maternal education, and presence of developmental disability) predicted positive parenting outcomes, and to what extent positive parenting outcomes were influenced by maternal education, health, and optimism.When mothers had higher levels of education, they showed higher levels of positive parenting— even when the child was reported to engage in difficult behaviors. Ellingsen and colleagues (2014) also confirmed previous hypotheses that higher levels of maternal optimism were associated with higher levels of positive parenting outcomes.These authors found no evidence of a relation between maternal health and positive parenting. This study provides evidence of the influence of maternal factors on positive parenting of children with developmental disabilities at age 3. Mother-child interactions, then, are interesting from the perspective of both group differences and intra-group variation. As a group, mothers of children with intellectual disabilities are the same but different in their interactions from mothers of typically developing children at similar mental ages. They are the same in the structural aspects of their input—such as MLU, type-token ratio, and other measures of communicative complexity. At the same time, these mothers appear more intrusive, didactic, and “pushy.” It remains unclear whether such stylistic differences are due to maternal emotional reactions or to child factors. Preliminary evidence, however, indicates that such motherdirected, intrusive interactions are less effective than when mothers comment on or extend their child’s ongoing interactive topics and allow enough time for the child to respond. In essence, then, this pattern of mothers following the child’s lead is more effective in fostering the child’s communicative skills, an insight that has now been used in a variety of mother-child interventions (see below).

Characteristics of Families of Children With Intellectual Disabilities Modern research on families continues the historic tradition of delineating the characteristics of families of children with intellectual disabilities. However, conceptual frameworks have shifted from family pathology to family stress and coping. As with parents and mother-child interaction, research emphasizes both differences of these families from families with typically developing children and intra-group variation across families with a member with intellectual disabilities. A good example of the change to a stress-coping perspective comes from work on family support. Earlier research noted that families of children with intellectual disabilities were often isolated, with few formal and informal supports.Wikler,Wasow, and Hatfield (1981) noted a divergence of perception on the part of families themselves and the social service workers who aid them.Whereas parents were concerned about child milestones occurring both earlier and later during the child’s life (e.g., when the child reaches adulthood), social service personnel identified the early years as the period of most difficulty for parents and other family members. Such professional perspectives may exacerbate the front-loading of services for families of children with intellectual disabilities, the tendency of 579

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services to more often be provided during the earliest years, even as these families may require more help—and become less connected to formal support services—as the child gets older (Suelzle and Keenan, 1981; Sanderson et al., 2017). Although these families may receive lesser amounts of formal support later on, they are not quite as isolated as earlier hypothesized. In work with families of children with intellectual disabilities and with chronic illness, Kazak and Marvin (1984; also Kazak, 1987) noted that families of children with both conditions possess strong informal social networks, but that these networks differ from those of families without a member with a disability. Specifically, Kazak and Marvin (1984) found that parents of children with disabilities have smaller social networks, but networks that are more dense. These mothers thus receive a fair amount of informal support, but the support comes from the mother’s own mother, sister, or a few close family friends. Such networks are denser in that each member of the network interacts with every other. As Byrne and Cunningham (1985) noted, the presence of smaller but denser social networks is both good and bad.These families are not isolated, in that they often receive support, encouragement, and respite from day-to-day responsibilities from a small circle of loving friends and relatives (see also Krauss, Seltzer, and Goodman, 1992). But as the networks are smaller, parents of children with disabilities have fewer contacts with a wider, more diffuse network of friends and associates. Families are often enmeshed in a tightly organized, intimate circle of social support that can at times feel suffocating. In addition to such group-differences research, sporadic research has also appeared on how families of children with intellectual disabilities differ one from another. Through cluster analysis, Mink, Nihira, and Meyers (1983) identified five types of families of children with severe intellectual disability: (1) cohesive, harmonious families, (2) control-oriented, somewhat unharmonious families, (3) low disclosure, unharmonious families, (4) child-oriented, expressive families, and (5) disadvantaged, low morale families. Similar, although not identical, family clusters have been found for families of children with mild and borderline intellectual disabilities (Mink, Nihira, and Meyers, 1984). More and more, then, variation among different families is being characterized. Such work helps to explain which child, individual member, or family variables lead to different family styles. As with parental reactions, the child’s type of intellectual disabilities may contribute to different family styles. In Mink et al. (1983), almost two-thirds of “cohesive harmonious” families were of children with Down syndrome, a much higher percentage than might be expected by chance. In another study as well, Beavers, Hampson, Hulgus, and Beavers (1986) noted that 7 of the 11 families considered to be functioning “optimally” were families of children with Down syndrome (although it is unclear how many of their 40 study families had children with this syndrome). As noted above, we do not yet know why families of children with Down syndrome seem to be doing better than families of children with other types of disabilities. Seltzer et al. (1993) emphasize that, although the reasons for such differences remain unknown, Down syndrome features readily accessible support groups and a more researched, more understood clinical syndrome. Or it may be that, as Mink et al. (1983, p. 495) noted, “Taking into consideration the effects of children on their caretakers, we may speculate that Down syndrome children [or adults] will have a positive effect on the climate of the home.” Family work shows a change in emphasis from pathology to stress and coping. Such research also shows the complexity of familial reactions and the strong influences of factors associated with both the child (age, type of intellectual disabilities) and the family (size and nature of family network).

Practical Information for Parents, Families, Service Providers, and Policymakers Like the larger field of child development (Sears, 1975), the field of parenting children with intellectual disabilities is not purely a scientific enterprise. Instead, the field has strong and enduring practical 580

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concerns. Many family researchers consult with or direct intervention services, others write practical books and manuals for parents of children with various types of intellectual disabilities. This chapter therefore discusses the practical implications of classical and modern research for parents, interactions, and families overall.

Mothers and Fathers Compared to the past, parents of children with intellectual disabilities are now much more visible, playing the role of active decision-makers in their children’s services. These parents are simultaneously members of parent organizations, advocates for their individual children and for children with disabilities in general, and recipients of professional services (Turnbull and Turnbull, 1986). Professional services themselves have also increased dramatically. Up through the 1960s, many children with intellectual disabilities were institutionalized; nowadays, children and families are served through a variety of services, ranging all the way from services supporting parents in performing in-home care or performing respite care for children with the most severe and multiple disabilities. This “continuum of services” for individuals with intellectual disabilities gives parents both more rights and more responsibilities. Many of these expanded rights and responsibilities concern schools, the most important service provided throughout the childhood years. Federal laws such as Public Law 94–142 (the Education for All Handicapped Children Act of 1975) and the Individuals with Disabilities Education Act, or IDEA (first passed in 1990), now provide as a right a free, appropriate public school education for all children with intellectual disabilities (Yell and Drasgow, 2000). The hallmark of this legislation is that all children be educated in the “least restrictive environment” (LRE). This term, often equated with education within an integrated classroom, actually entails a host of alternatives. LRE allows for full-time integration with non-disabled children, integration for part of the day (the remainder with a resource room or specialist), special classes within a public school, and even special classes or special residential schools when necessary to meet the child’s educational needs. Integral to decisions concerning the best educational alternative are the child’s Individualized Educational Plan (IEP) and the series of legal hearings and appeals that are the right of all parents of children with disabilities. Unfortunately, even though parents are now guaranteed that their children have a right to a free and appropriate public education, much of this information remains unknown or unclear to many parents of children with ID. In response, several trainings have been developed to provide to parents and advocates information about IEPs, IDEA and 504 laws, parent rights, and how to advocate effectively for special education services within the schools (Burke, 2012). One such program, the Volunteer Advocacy Project (VAP), is a 12-week, 40-hour workshop series.VAP graduates increased in their special education and IEP knowledge and advocacy skills (Burke, Goldman, Hart, and Hodapp, 2016);VAP training has recently been expanded via webcast to diverse distance sites in both Tennessee and Illinois. Residential services have also changed enormously. As recently as the 1960s, parents had two choices: to provide in-home care or to institutionalize their child with intellectual disabilities. In contrast, families now enjoy a continuum of residential alternatives. Granted, in most industrialized countries, in-home care remains the option of most parents and their offspring (Fujiura, 2014), although increasing numbers of adults live outside of the family home as they get older (Stancliffe et al., 2012). Such out-of-home living options range from individual apartments or houses, to supervised apartments, to group home and residential care services (particularly for offspring with profound intellectual disabilities, multiple disabilities, or severe behavior problems). Although the range of educational and adult-disability services has expanded tremendously, more services are needed. The greatest difficulties in accessing services occur during the transition from the educational services provided during the school years (i.e., until 21 years in most states) to 581

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the adulthood years. Called the “second shock” (Hanley-Maxwell, Whitney-Thomas, and Pogoloff, 1995) and often referred to by families as “falling off a cliff,” adult services are difficult to know about, qualify for, and attain; even when attained, they are often provided in a piecemeal fashion. Given that young adults are beyond the age of federally mandated special education services, the provision of such adult-disability services is optional. Indeed, faced with scarce resources, most states have long waiting lists for services; although numbers vary; across the United States it is estimated that only 1 in 4 adults with intellectual disabilities receives state-run adult-disability services (Hewitt, 2014). As many as 2.4 million adults are on waiting lists for such services (Braddock et al., 2014). In addition to formal educational and adult-disability services, parents also benefit from the many parent support groups.These run the gamut from large to small, from emphases on all disabilities to a focus on a single disability, and from national organizations (often with local chapters) to local groups. The largest and best-known national organization is The Arc (originally, the National Association of Retarded Children), founded in 1950 (Castles, 2004). In addition to providing supportive and informational services, The Arc was instrumental in passing PL 94–142, IDEA, the Americans with Disabilities Act (ADA), and other federal disability legislation (Jones, 2004). Besides organizations concerned with all children with intellectual disabilities, groups also exist for parents of offspring with specific types of intellectual disabilities. The National Down Syndrome Society, National Down Syndrome Congress, National Fragile X Foundation, Prader-Willi Syndrome Association, and other organizations are particularly good sources of support and information for parents of children with each type of intellectual disabilities (for a listing, see Dykens et al., 2000). Most groups organize national conferences annually. Parents, researchers, and service providers all attend these conferences, providing interchanges of needs, experiences, and information rarely available in other contexts. Parents, individuals themselves, professionals, and researchers also benefit enormously from a federal infrastructure that fosters research, training, and service-outreach. Growing out of the Kennedy Administration in the 1960s (Shorter, 2000), researchers are aided by Eunice Kennedy ShriverIntellectual and Developmental Disabilities Research Centers, or EKS-IDDRCs, which provide core research support for everything from grant budgets to participant recruitment to MRI, animal model, or statistics help. Interdisciplinary training is provided by 52 Leadership Education in Neurodevelopmental Disorder, or LEND, programs throughout the United States (AUCD, 2012a). Most prominent for most families, however, are University Centers for Excellence in Developmental Disability (UCEDD) programs. With at least one in each U.S. state and territory and 67 overall, UCEDD programs provide services, outreach, and information for parents and families throughout the country (AUCD, 2012b). Working together, the EKS-IDDRCs, LENDs, and UCEDDs provide families an infrastructure to learn about and access local programs and supports (Hodapp, Fidler, and Depta, 2016). Finally, one can ask about the research-based programs to address parental stress and coping with parenting a child with a disability. Unfortunately, only a small number of outcome studies exist. In one review of the 173 articles investigating distress in families of children with intellectual and developmental disabilities published between 2012 and 2014, only 11% of published articles focused on parents (Dykens, 2015). Still, some published intervention studies target how parents cope with the stressors. Such interventions employ a variety of techniques, including mindfulness-based stress reduction (MBSR; Dykens et al., 2014); group counseling with focus on familial communication, problem solving, decision-making, or conflict resolution strategies; and parent-to-parent support models (i.e., parent mentors are trained and partnered with other parents as a source of coaching and support; Hastings and Beck, 2004). Many of these interventions use cognitive-based therapeutic techniques coupled with a psychoeducational approach to build coping skills and strategies within the family unit. Over recent years, evidence is building to support the efficacy of practices such as mindfulness-based stress reduction and multi-modal group models using a combination of therapeutic techniques (Dykens et al., 2014; Hastings and Beck, 2004; Lindo et al., 2016). 582

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Mother-Child Interactions In addition to the many behavior modification and training programs available to help caregivers to parent their children with intellectual disabilities (Baker et al., 1989; Hastings and Beck, 2004), several programs have focused on mother-child interactions. A good example is the parent–infant interaction model, first developed by Bromwich (1976, 1990) in the late 1970s. Designed for mothers of children with a variety of disabilities, this program involves 10 general steps that are individualized to the specific needs of each child, caregiver, and family. Preliminary steps focus on enhancing the quality of parent–infant interaction by improving the caregiver’s (usually the mother’s) self-esteem, making her feel more comfortable with the child, and teaching her to become a sensitive observer of and interactor with her baby. Later steps involve strategies to understand each family’s stresses and supports and to help each member of the family cope with rearing a child with intellectual disabilities. Although not specific to mothers of children with intellectual disabilities, Bromwich’s program provides a good general model for mother-child interactions. The hope is that such programs will foster productive mother-child interactions, maternal perceptions, and familial responses—all of which can be started, enhanced, and then continued as the child with intellectual disabilities grows older. Bromwich and similar programs are also good examples of intervention programs concerned with parent behavioral training. Such training can be conceptualized as interventions that present parents with psychoeducational content to intervene directly with their child (Matson, Mahan, and LoVullo, 2009). By using parents as interventionists, such programs strive to ameliorate children’s behavioral, cognitive, linguistic, or developmental deficits. As a byproduct, parent implementation of prescribed interventions or strategies targets those skill deficits of the child that may be a source of parental stress (Lindo, Kliemann, Combes, and Frank, 2016). In recent years, such parent-intervention approaches have also become widely disseminated through web-based technology, under the general rubric of telepractice or telehealth. Using such telepractice approaches, practitioners can more easily reach parents in more remote areas. Although such approaches are only now being tested in various centers, they appear to be feasible and costeffective. In some conditions, parents or early interventionists are the recipients of coaching from a distance therapist at a university or medical center (McDuffie et al., 2013; Wright and Kaiser, 2016). Other approaches use telemedicine to diagnose conditions (e.g., to perform ADOS or ADI-Rs to diagnose autism spectrum disorders) or to provide medical care. All of these uses of technology will most likely increase over the coming decades (Casale et al., 2017).

Families As service-delivery systems change and the prevalence of in-home care increases, families of children with intellectual disabilities are increasingly the object of attention. This attention has even begun to infiltrate federal legislation. Specifically, federal law PL 99–457 expands educational and support services to the 0- to 3-year-old group, allowing a bridging of services from birth until adulthood. A major component of PL 99–457 is its provision of an individualized family service plan (IFSP), thereby recognizing that the family, more than the child alone, needs services during these early years (Krauss and Hauser-Kram, 1992). But even as some federal laws are including families, many unresolved issues remain. For example, families of children with severe-profound intellectual disabilities or who have multiple disabilities face severe financial hardships. In addition to documenting the medical costs of caring for such children, Barenbaum and Cohen (1993) noted how simple changes in health care coverage could benefit these families enormously. They suggested that changes could be as easy as considering the costs of babysitting a child with a shunt or of remodeling a home to make it wheelchair accessible as a medical-habilitation service. Such health-habilitation issues have become even more complicated, 583

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as most children and adults with disabilities have started to receive their health care services through health management organizations (HMOs) often paid for by Medicaid waivers (Braddock et al., 2015; Kastner, Walsh, and Criscione, 1997). Debates about Medicaid expansion also feature families of offspring with intellectual disabilities (Bachman et al., 2012). Other concerns relate to when and how services are provided. As noted by Suelzle and Keenan (1981), families of children with intellectual disabilities receive most services early on, even as they often need more services as the child gets older. Other difficult issues revolve around how care is provided for children with multiple impairments, or for those who are “dually diagnosed”—that is, for those who have both intellectual disabilities and psychiatric impairments (Dykens, 2016). How fathers are reached is another major issue, as is the question of how the needs of mothers and fathers can be addressed as families change (to the extent that they do) as the child with disabilities gets older.

Future Directions in Studies of Parents of Children With Intellectual Disabilities With both a research and interventionist bent, research on parenting children with intellectual disabilities has advanced rapidly over the past decades.Yet a few major areas and problems remain to be addressed in future research.

Research With Better Theoretical Grounding The three sub-areas of parenting children with intellectual disabilities feature a wide (some might say bewildering) array of theoretical orientations. Studies of maternal and paternal emotional reactions often show a psychoanalytic—or at least a clinical—perspective, focusing on the loss of the idealized child and maternal and paternal depression and psychopathology. Mother-child interaction studies employ Bell’s (1968) interactional theory, and comparisons of dyads of children with and without intellectual disabilities usually focus on MA or other level-of-functioning matching (e.g., MLU) as used in the developmental approach to intellectual disabilities (Zigler and Hodapp, 1986). Family work has used sociological role theory (Farber and Rowitz, 1986), models such as the Double ABCX (Minnes, 1988), and, at times, little or no theories, as when delineating basic family characteristics of families of a child with intellectual disabilities. To this day, few studies have joined these different perspectives and different bodies of knowledge. Part of the problem involves the “ownership” of different research questions by researchers in different disciplines or research traditions. For the most part, maternal and paternal reactions have been the province of child psychiatry and child clinical psychology; mother-child interactions the focus of developmental scientists and special educators; and families the work of family researchers and social workers. Each research community works in relative isolation, with little attempt to join these different, but mutually influential, levels. An additional, related problem concerns difficulties inherent in joining different levels of analyses in behavioral work. For example, researchers in Down syndrome, families, gerontology, and lifespan health have begun to appreciate the many issues related to family caregiving for aging adults with Down syndrome (Hodapp et al., 2016). Specifically, adults with Down syndrome, who even compared to 40 years ago enjoy increased lifespans (Zigman, 2013), nevertheless often experience Alzheimer’s dementia and other “old-age” health problems beginning in their late 40s and throughout their 50s (van Schrojenstein Lanman-deValk et al., 1997).Their parents are, on average, 30 years older, and experience their own aging issues as parents proceed through their 70s and 80s. Complicating things further is increasing evidence that, compared to other adults with intellectual disabilities, those adult children with Down syndrome are more likely to remain longer in the parent home (Stancliffe et al., 2012; Hodapp, Sanderson, and Mello, in press).When considering family caregiving during the 584

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older adult years, then, one is faced with issues related to the adult with Down syndrome’s health, the parents’ health and caregiving abilities, and even the potential roles of siblings (Hodapp, Perkins, Finley, and Urbano, 2015).Yet, to date, most research concerning lifespan parenting fails to connect these disparate dots to achieve a more useful, integrated picture of offspring, parental, and familial functioning. In addition to the gaps and lack of coordination in the areas of parental reactions, interactions, and familial adaptation, other areas also require attention. Five areas in particular deserve note.

Etiology The child’s particular type of intellectual disabilities—and the behaviors generally caused by that etiology—affect parents and families. Although more studies now appear on parent and family functioning of children with specific intellectual disability conditions (Dykens, 2015; Hayes and Watson, 2012), many more such studies are needed. In addition, we need to study parenting of children with conditions other than Down syndrome or autism, the two conditions that—at present—comprise the large majority of parenting studies that examine particular ID conditions. In addition to considering various parenting issues among children with other ID conditions, we also need to progress beyond behavior. In this sense, the babyface studies of children with Down syndrome (Filder and Hodapp, 1999) begin this process, but the wider child development field now also includes aspects of young children’s “cuteness” that include as well the baby’s babbling, laughter, and smells (Kringelbach et al., 2016). Beyond these perceptual characteristics, children with disabilities may provide additional elicitors of parental behaviors and feelings. To give a few examples, differential responses from parents may come about based on the timing of diagnosis for children with different conditions; parents may react differently when their child is diagnosed at birth (e.g., Down syndrome), during early childhood (e.g., autism, some cases of fragile X syndrome), or during the teen years (e.g., schizophrenia; Seltzer et al., 2004). Many genetic conditions also show associated medical problems that would seem to impact parent and family reactions. In addition to their intellectual disabilities, then, children with Down syndrome (during their first few years of life) are especially prone to experiencing in-patient hospitalizations for heart surgeries, pneumonia, and bronchitis (So, Urbano, and Hodapp, 2007).The child characteristics that influence parenting may go beyond behavior in ways that remain mostly unexamined.

Ethnicity and Cross-Cultural Issues Although sporadic studies exist on parents of certain ethnicities, we generally know little about family functioning in most ethnic groups. As Sue (1999) noted, the issue may relate to psychology’s emphasis—some might even say over-emphasis—on issues of internal validity, often to the exclusion of external validity or generalization. More ethnically informed work may be occurring as the United States population itself changes (Magaña et al., 2015), but such progress is occurring only gradually. A related issue concerns studies of parenting in different countries and cultures. While families of children with intellectual disabilities share certain similarities in every society, variations arise in how different cultures respond to individuals with ID, particularly in regard to social beliefs (Groce, 1999). Specifically, cultures hold divergent beliefs related to (1) the reason individuals have disabilities, (2) the treatment of persons with disabilities, and (3) the societal roles and the rights of these individuals. Acknowledging that few studies exist of parenting children with intellectual disabilities in nonindustrialized countries, a few themes nevertheless emerge. A first relates to stigma and blame. In many Asian countries, mothers blame themselves for their child’s disability (Holroyd, 2003; Lam and Mackenzie, 2003). In China, the birth of a child with intellectual disability is associated with 585

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loss of face or an end to the bloodline (Ghosh and Magaña, 2009), with parents hesitant to reveal their child’s disability to others (Holroyd, 2003; Lam and Mackenzie, 2003). Chinese parents are also thought to be more likely to seek alternative treatments to cure the child of his/her disability (Wang, 2009). In Korea, especially, Ryu (2009) finds that the stigma of having a child with intellectual disabilities extends to the entire family. A second, related theme involves religion. Muslim parents believe that all things in life, including having a child with a disability, is the will of Allah (Al Khateeb, Al Hadidi, and Al Khatib, 2015). In a similar way, for those Asian families who believe in the Hindu concept of reincarnation, children with intellectual disabilities constitute a partial retribution for parents’ sins committed in a previous life (Gabel, 2004; D’Antonio and Shin, 2009). Beyond these more general statements, however, we know little about parenting children with intellectual disabilities in most countries of the world.We have few studies about the everyday experiences and practices of parents of children with intellectual disabilities in different countries; about how such experiences-practices relate to parental thoughts and feelings; about mother-child interactions or the connections of parents to their child’s schools or other service institutions; or about the roles of fathers, siblings, grandparents, and friends. And, while service systems are often inadequate in many non-industrialized countries (Ghosh and Magaña, 2009; Wang, 2009), we have only rudimentary senses of parent-service system connections.

Lifespan Apart from the work of a few research groups (Seltzer, Krauss, and Tsunematsu, 1993), few researchers have systematically examined the family functioning of older individuals with intellectual disabilities. Indeed, the large majority of studies on parental emotional reactions, mother-child interaction, and family reactions focus on children, often during the preschool years (Singer, Biegel, and Conway, 2012; Stoneman, 1989). One could almost argue that, until recently, there has been a “child-centric” view toward parenting—and families—of offspring with intellectual disabilities. This state of affairs may, however, be changing. A first impetus toward this change has been the increasing lifespans of individuals with intellectual disabilities; like adults in the general population, adults with intellectual disabilities are living increasingly long lives (Ouellette-Kunz, Martin, and McKenzie, 2015). Equally important, however, have been the acknowledgments that many adults with intellectual disabilities live in their family homes into adulthood (Stancliffe et al., 2012) and that adult-disability service systems are inadequate (Hewitt, 2014). Increasingly, we are also appreciating the lifelong roles, including often caring or overseeing care for their adult brother or sister with disabilities, of the family’s other children, the adult siblings (Hodapp, Sanderson, Meskis, and Casale, 2017). All of these forces are coalescing to make more prominent lifelong parenting concerns for adults with intellectual disabilities.

Measurement Future research also needs to consider how to better measure stress, coping, and other constructs in parents of offspring with disabilities. At present, the field lacks good measures that are specifically focused on parents whose children have disabilities. Consider parental stress, one of the parenting field’s most important constructs. For the most part, the most common stress measures are either not standardized or do not include families of children with disabilities in their norming samples. Some researchers then argue that such reasonably normed measures such as the PSI can be used to measure stress in parents of children with intellectual disabilities (Sexton, Burrell, Thompson, and Sharpton, 1992), whereas others feel that the manner in which such measures attempt to capture parental stress may not actually do so (Glidden, 1993). 586

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With no clear guidelines and confronted with numerous parent-family measures that are only partially applicable, researchers vary widely in their choices and uses of available measures. Different researchers select different individual measures, with many often shortening or adapting measures as they see fit. As a result, it becomes difficult to aggregate data across studies (Glidden, 1993); especially when examining parental stress or other parent or family outcome within and between specific disability types or conditions, findings are often not consistent from one study to another (Glidden and Schoolcraft, 2007).

Methodologies In addition to informational and measurement gaps, more attention needs to be paid to how one performs parenting research in intellectual disabilities. The issue of matching—of whether MA- or CAmatches are best (described above)—is one unresolved methodological issue, but there are many others. For example, it remains unresolved whether parenting studies should examine parents of children with disabilities (including, for example, deafness, blindness, or speech-language impairment), with intellectual disabilities (including all known and unknown etiologies), or with a particular condition of intellectual disabilities (e.g., Down syndrome).There are also issues involved in even finding appropriate matches: Given, for example, that approximately 10%–12% of mothers of newborns with Down syndrome give birth at age 40 years and above, it is often difficult to find a single “match” on maternal chronological age. Given this type of problem, Blackford (2009) suggests the use of propensity scores to match individuals across the two groups. Similarly, Bornstein et al. (2006) find that women who are older when giving birth possess greater childrearing knowledge and supports, but this linear relation holds only until the later 20s or early 30s. Similar patterns of “linear-then-plateauing” relations occur in many areas of disability as well. Note, for example, the connections between maternal age at birth and education levels; when examining both typical (McLanahan, 2004) and Down syndrome (Hodapp, Burke, and Urbano, 2012) births, increasing percentages of college-educated women are found to give birth at older ages, but only until the early to mid-30s. In both cases, researchers benefit from spline analyses that are able to characterize such plateauing relations between two variables.

Ties to the Practice of Intervention and to Policy Even though many family researchers are interested in practical issues, research on parenting in intellectual disabilities connects only marginally with the common practice of intervention or policy. Only a few research findings have been integrated within the majority of intervention programs, and even some obvious concepts rarely become incorporated in intervention work. For example, Olshansky’s (1962, 1966;Wikler, 1986) recurrent maternal reactions model continues to be ignored in most service systems; to this day, many services continue to be front-loaded, with fewer services for parents and families of older individuals with intellectual disabilities. To take but a single example, consider the Family Medical Leave Act (FMLA) in the United States. Signed into law in 1993, the FMLA allows family members to take up to 12 work weeks of unpaid leave to attend to the health conditions of themselves or their parents, spouses, or children. But only as of July 2015 did the U.S. Department of Labor expand the FMLA’s protections to allow adult siblings to care for their aging adult brothers or sisters with disabilities. As of that time, there are now statements that a “child” can refer to an individual older than 18, who is “incapable of self-care because of a mental or physical disability,” and that anyone who “acts in the place of a parent” could access FMLA protections (U.S. Department of Labor, 2015).

Conclusions In summarizing the work on parenting children with Down syndrome and other forms of intellectual disabilities, one can envision the glass as either half empty or half full. If judged by the amount 587

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of unknown information, the glass is half empty. Even after two decades of intense work, we still do not know how parents, interactions, and families “go together,” how each level changes over time, how each is affected by many child characteristics, and other interesting issues. The parenting field also continues to be dominated by research on white, middle-class families, leaving under-studied essential questions relating to SES and ethnicity. And yet, compared to what was known only 50 years ago, the glass is more than half full. From the early days of Farber, of Solnit and Stark, and of Olshansky, we now know much more about these families, their interactions with their children, and the child’s effects on siblings and the family as a whole. More importantly, what we know has been fit into more interesting and less detrimental frameworks, as parents, interactions, and families are now seen as coping under stressful circumstances. Such stress may help or hinder adaptation, but these stress-coping perspectives seem both more accurate and more humane. Ultimately, research on parenting children with intellectual disabilities seems a discipline that is beginning to reach its stride. Indeed, probably more has been learned about parenting children with intellectual disabilities in the recent past than was known in all the years up until this time. The coming years promise continued, near exponential growth. With an increased joining of different perspectives and more fully considered research paradigms, such work will hopefully become increasingly useful to service providers and policymakers. This knowledge should also help parents face the many challenges and rewards inherent in parenting the child with intellectual disabilities.

Acknowledgments We thank Marc H. Bornstein and Elisabeth Dykens for comments on earlier versions of this chapter.

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18 PARENTING CHILDREN WITH A CHRONIC HEALTH CONDITION Thomas G. Power, Lynnda M. Dahlquist, and Wendy Pinder

Introduction Parenting is a complex, challenging, and rewarding task. This is particularly true for parents of children with a chronic health condition. For many chronic health conditions (e.g., asthma, cancer, cystic fibrosis, diabetes, epilepsy, food allergy, juvenile rheumatoid arthritis, kidney disease), the diagnosis of the condition places tremendous emotional, financial, and physical demands on parents, requiring substantial adaptation to the “new normal.” On top of addressing the normative tasks of parenting, these parents, depending on the nature of the condition, must deal with considerable uncertainty and confusion as they come to learn about an illness and its treatment; make major changes to their daily routine to adapt to the illness; endure increased caregiving burdens; attempt to “normalize” family life for healthy siblings; endure considerable strain on their marriage; cope with strong feelings of anxiety, hopeless, and depression; closely monitor their child’s behavior and symptoms; perform complex in-home treatments; teach their children involved self-care routines and monitor their implementation; witness considerable discomfort and pain in their child; and cope with relapses, disease progression, and even the death of their child. Success in adaptation varies widely across families and across conditions. Despite the considerable stress and change, the process of adapting to their child’s chronic condition can be an opportunity for many families for growth and increased family cohesion. Over the last 40 years, the growth of the field of pediatric psychology has led to a considerable amount of research on children with chronic health conditions and their families. Because we cannot present a comprehensive review of this literature in the current chapter, our review is selective— focusing on the major issues that parents of children with a chronic health condition must face and on those issues that have received the most research attention. Because there is a wide range of chronic health conditions, we have narrowed our primary focus to illnesses or health conditions that are typically diagnosed in the toddler years or later, involve continuing medical treatment, and normally last for several years or for the child’s entire life. We will restrict our review of the literature on parenting children with congenital birth defects to children with spina bifida, as this patient population has been the focus of extensive study of parenting and autonomy development, which has implications for other health conditions.We also do not review the literature on parenting a child with a cognitive, sensory, or physical disability (e.g., intellectual disability, autism, blindness; Hodapp and Sanderson, 2019; McCauley, Mundy, and Solomon, 2019). Because chronic health conditions vary widely in their severity, symptoms, prognoses, age of onset, and so forth, we focus more on

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similarities across illnesses than differences. Finally, because some conditions have been researched more than others, our review necessarily focuses on the most studied illnesses (e.g., asthma, cancer, diabetes) compared to illnesses that have received considerably less attention (e.g., epilepsy, cardiovascular disease, kidney disease).

Historical Considerations in Parenting Children With a Health Condition Although collaborations between pediatricians and psychologists date back to the late 1890s (Aylward and Lee, 2017), the field of pediatric psychology did not actually emerge until the late 1960s, when Logan Wright, in his seminal American Psychologist article, first coined the term “pediatric psychologist” to describe psychologists who primarily work with children with health conditions in nonpsychiatric medical settings (Wright, 1967). The leading journal in this relatively new field, the Journal of Pediatric Psychology, was established in 1976, and the Society of Pediatric Psychology became an independent Division of APA (Division 54) in 1980. Since then, the field has witnessed a rapid expansion of the number of professionals specializing in pediatric psychology as well as tremendous growth in the breadth and depth of research in the field. Today, pediatric psychologists can be found in virtually all major medical centers and many primary care settings, providing clinical services and conducting interdisciplinary research with children and families representing a wide range of medical conditions. The fifth edition of the Handbook of Pediatric Psychology (Roberts and Steele, 2017) provides an excellent overview of the breadth of current research in the field.

Central Issues in Parenting Children With a Health Condition A wide range of issues has been addressed in research on parenting children with chronic health conditions. The issues considered here are those that have been examined most extensively in the research literature. Because parents of children with chronic health conditions must manage their own emotional reaction to the diagnosis, as well as manage the significant caregiving burden that the condition can require, we first consider the impact of parental emotional distress and caregiving burden on parenting practices. We then explore the role of parents in helping their children cope with the many challenges of their health condition, including how parents help their children handle illness-related stressors (including acute pain) and how they help their children adhere to the complex medical regimens that their condition may require. Finally, given the many challenges that parents face in rearing a child with a chronic health condition, we address issues that arise in helping these children maintain age-appropriate development and functioning.

Theory in Parenting Children With a Health Condition A variety of theoretical approaches has been applied to understanding some of the challenges of rearing a child with a chronic health condition. Although some researchers have approached these issues through some of the mainstream developmental theories, for example, attachment (Williamson, Walters, and Shaffer, 2002), social learning (Osborne, Hatcher, and Richtsmeier, 1989; Walker and Zeman, 1992), and ecological theories (Kazak, 1989), other work has been informed by narrow, more focused theories specific to this area. Examples that are discussed in more detail in the following sections include Kazak et al.’s traumatic stress model (Kazak et al., 2006; Price, Kassam-Adams, Alderfer, Christofferson, and Kazak, 2016), the Health Beliefs Model (Armstrong, Duncan, Stokes, and Pereira, 2014; DiMatteo, Haskard, and Williams, 2007), Green and Solnit’s (1964) vulnerable child syndrome, and Thomasgard and Metz’s (1993) overprotection model.

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Classical and Modern Research in Parenting Children With a Health Condition Most of the early research on parenting children with a chronic health condition was applied in nature, conducted by scientist-practitioners who work directly with such parents, often in medical settings (e.g., nurses, pediatricians, pediatric psychologists). Because the research usually has been conducted to inform the treatment and care of children and their families, at least for several illnesses (e.g., asthma, cancer, diabetes), we know a great deal about the challenges that parents face as well as their needs and how to address them. Laboratory studies have also been utilized to test assumptions about the role of parenting in children’s adjustment to acute and chronic pain. These findings are reviewed as we discuss the research on the central issues outlined above.

Parents’ Emotional Reactions to Their Child’s Illness and Impact on Parenting Parents show a wide range of emotional reactions to the diagnosis of a health condition in their child, and research shows that these reactions often follow a predictable course over time. These emotional reactions appear to have a systematic influence on parenting practices, and researchers have identified several factors that predict individual differences in the nature of these responses.

Time of Diagnosis When a child is diagnosed with a chronic illness, parents must assimilate a large amount of information about a disease that they may have never heard of or know very little about. Numerous qualitative studies of parents with children with a chronic health condition show that such diagnoses often lead to high levels of parental uncertainty (see Aldridge, 2008; Fisher, 2001; Kerr, Harrison, Medves, and Tranmer, 2004; Smith, Cheater, and Bekker, 2013; Tong, Lowe, Sainsbury, and Craig, 2008, for reviews). Although the diagnosis might reduce some uncertainty resulting from trying to make sense of pre-diagnosis symptoms (Cashin, Small, and Solberg, 2008), the diagnosis increases uncertainty in multiple areas, including uncertainty about the long-term prognosis for the child, the appropriate treatment options, and who to tell about the condition (Melnyk, Moldenhouer, Feinstein, and Small, 2001), as well as uncertainty created by the way that the information is presented (overuse of medical jargon, insufficient information, information provided too quickly, and so on; Smith et al., 2013). A review by Kerr and colleagues (2004) showed that, depending on the illness, the diagnosis can also elicit a range of negative emotions in the parent, such as “fear, powerlessness, denial, stress, guilt, sadness, terror, anticipatory loss, anger, devastation, shock and confusion” as well as “anxiety regarding their child’s diagnosis, palliative care, and death” (p. E124). Smith and colleagues (2013), in a review article, identified many of these same emotions, in addition to “confusion, disbelief, anxiety, turmoil, and a loss of identity” (pp. 458–459). Kazak and colleagues (2006) argued that some parents of children with a chronic health condition experience symptoms of posttraumatic stress disorder (PTSD—e.g., arousal, avoidance, and intrusive “re-experiencing” thoughts) in response to experiences they appraise as traumatic. This is particularly true for parents of children with life-threatening diseases. For example, in one study of 119 mothers and 52 fathers of children in treatment for cancer (Kazak, Boeving, Alderfer, Hwang, and Reilly, 2005), all except one parent reported posttraumatic stress symptoms, and nearly 80% of children had at least one parent showing moderate to severe symptom levels. The diagnosis of PTSD is more common in parents of children with cancer than parents of healthy children. In their meta-analysis of 16 studies of children with chronic diseases (13 were studies of parents of children with cancer), Cabizuca and colleagues (2009) found that

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the PTSD prevalence (i.e., a PTSD diagnosis) was 19.6% for mothers, 11.6% for fathers, and 4.2% among mothers of healthy children (only one study examined PTSD separately for fathers of healthy children and it revealed no cases). Similar PTSD prevalence estimates have been reported for the small number of studies of other chronic diseases (i.e., asthma, diabetes, epilepsy, kidney disease, and meningococcal disease) included in the Cabizuca et al. (2009) review and in separate reviews by Price and colleagues (2016) and Woolf and colleagues (2016). Empirical studies comparing levels of emotional distress between parents of children with chronic illness and healthy controls confirm the conclusions of the qualitative and PTSD studies reviewed above. For example, in a meta-analysis of studies of parents of children with cancer, Pai and colleagues (2007) found significantly higher maternal and paternal distress (i.e., depression, anxiety, posttraumatic stress symptoms, or global distress) in parents of children with cancer compared to parents of healthy children. Similar results were found in a narrative review by Vrijmoet-Wiersma and colleagues (2008). Easter and colleagues (2015), in a meta-analysis of studies of asthma, found that caregivers of children with asthma reported higher levels of depressive and anxiety symptoms than did caregivers of healthy children. Finally, in their review of parents of children with epilepsy, Jones and Reilly (2016) found that two of the three studies comparing parental anxiety levels between parents of children with epilepsy and healthy controls found higher levels among parents of children with epilepsy (the other study found no significant difference). Although both mothers and fathers of children with chronic illnesses tend to show higher levels of emotional distress than parents of healthy children, for parents of children with a chronic condition mothers tend to report higher levels of emotional distress than fathers (Clarke, McCarthy, Downie, Ashley, and Anderson, 2009; da Silva, Jacob, and Nascimento, 2010; Pai et al., 2007; Vrijmoet-Wiersma et al., 2008). This result is consistent with the results of numerous studies of gender differences in depression in the general population (Salk, Hyde, and Abramson, 2017), although it may be related to the observation that in most families mothers are the primary caregivers of the child with a chronic disease (Goldstein, Akre, Belanger, and Suris, 2013; Pai et al., 2007; VijmoetWiersma et al., 2008) and, therefore, are the parents who experience the most childcare-related stress.

Beyond the Initial Diagnosis Once a child is diagnosed with a chronic disease, family life changes radically for many parents. Qualitative studies have identified a range of changes, including increased contact with medical professionals through out-patient visits, hospitalizations, and surgeries; increased financial stress; changes in parental responsibilities and routines (to provide in-home treatment for the child as well as for one parent to spend more time away from home in the case of frequent hospitalizations); disruptions in the child’s schooling and education; increases in parents’ social isolation; increases in monitoring child behavior and well-being; and decreases in parental social life, personal freedom, and leisure time (Aldridge, 2008; Goldstein et al., 2013; Kerr et al., 2004; Melnyk et al., 2001; Smith et al., 2013;Tong et al., 2008;Whittemore, Jaser, Chao, Jang, and Grey, 2012). Changes in the marital relationship occur as well, including changes in spousal roles, difficulties in communication, less attention devoted to the partner due to an increased focus on the child, and less time for intimacy, sexuality, and leisure activities with the partner (da Silva et al., 2010; Dahlquist, Czyzewski, and Jones, 1996;Van Schoors, Caes, Alderfer, Goubert, and Verhofstadt, 2016). Depending on the nature of the illness, parental distress might decrease as the parent and child develop a long-term treatment regimen (such as managing the child’s diabetes) or parental distress might increase as uncertainty about the effectiveness of a treatment option may arise (such as chemotherapy for childhood cancer). In her literature review, Fisher (2001) argued that families adapt by creating a new normalcy “through the control of issues over which they had a jurisdiction: management of time; management of illness; reorganization of family life; management of information, awareness; and the environment” (p. 604). She argued, however, that 600

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this sense of control is fragile and can be disrupted by several triggers:“routine medical appointments; minor symptoms or variations from the child’s norm; specific medical words and phrases; changes in the therapeutic regime; evidence of negative outcomes for other children; changes in developmental stages; and night-time absence” (p. 604). In each of these situations, something unexpected happens and can lead to increases in parental uncertainty, concern, and anxiety. Relapses are particularly problematic in this regard, leading to increased concerns about the child’s future and well-being (Aldridge, 2008; Melnyk et al., 2001; Vrijmoet-Wiersma et al., 2008). Normative, developmental changes can be challenging as well, for example when the child goes to school for the first time or the child transitions into adolescence and spends more time away from home (Melnyk et al., 2001). Longitudinal studies that have examined levels of parental distress over time confirm the observation that parental distress appears to decrease with adaptation to the condition. For example, in their meta-analysis, Pai and colleagues (2007) found that, although mothers and fathers of children with cancer showed greater distress than did controls at the time of diagnosis, at 12 months post-diagnosis, this difference had become nonsignificant. In contrast, Vrijmoet-Wiersma and colleague’s (2008) narrative review described decreases in parental depression and anxiety over time, but concluded that parents of children with cancer still showed higher levels of depression and anxiety than comparison families at long-term follow-up, although they decreased to near normal levels. Insight on the reasons for this inconsistency comes from a systematic review of studies of parents of childhood cancer survivors at least 5 years post-diagnosis and/or 2 years after the child’s treatment has ended (Ljungman et al., 2014). Although most parents were in the normal range for general psychological distress, coping, and family functioning at this long-term follow-up, a significant minority of parents showed clinical levels of general psychological distress and reported a severe level of posttraumatic stress symptoms.

Predictors of Individual Differences in Adjustment Clearly, these results point to considerable variation in how parents adapt emotionally to a chronic condition in their child. Qualitative studies have uncovered a range of parental strategies that minimize the negative impact of the child’s condition. These include educating oneself about the child’s disease and treatment; mastering new childcare tasks; engaging in effective partnerships with the spouse and health care workers; developing consistent, effective routines; focusing on the child’s accomplishments; seeking and depending on social support outside of the family; and engaging spiritually (Fisher, 2001; Goldstein et al., 2013; Kerr et al., 2004; Smith et al., 2013). Quantitative studies have examined the correlates of emotional distress as well and have identified a range of positive and negative correlates (see reviews in Aldridge, 2008; Clarke et al., 2009; Ferro and Speechley, 2009; Jones and Reilly, 2016; Kerr et al., 2004; Ljungman et al., 2014; Melnyk et al., 2001; Price et al., 2016;Vrijmoet-Wiersma et al., 2008; Wallander and Varni, 1998; Woolf et al., 2016). Parents of children with a chronic health condition who are at greater risk for emotional distress include those who have lower levels of education; are of lower socioeconomic status; are unemployed or experiencing work strain; are younger; are experiencing financial difficulties; have had prior psychopathology and/or more negative life events in their past; are high on neuroticism or trait anxiety; perceive the child’s condition and treatment more negatively; and are experiencing marital or family conflict. Parents who show lower levels of distress are those who have a healthier lifestyle (e.g., exercise, nutrition, sleep, leisure); are more optimistic and resilient; have higher levels of social support; have good spousal communication patterns; have high levels of spirituality; and have high levels of family cohesion and adaptability. Parental coping strategies are important as well. The use of problem-solving strategies is associated negatively with distress, whereas avoidant coping, passive coping, self-blame, and substance use are positively related. Surprisingly, in most studies, few disease-related characteristics (e.g., medically rated severity, time since diagnosis) are consistently 601

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related to parental emotional distress—parent perceived severity is a much more consistent predictor. This finding is consistent with Kazak and colleagues’ (2006) model that proposes that subjective appraisals of threat are more important than objective illness factors in predicting a parent’s response to a diagnosis. Several studies, however, have shown that children with poorly controlled conditions (such as poorly controlled asthma or diabetes) have parents showing more distress (see discussion of adherence below).

Parenting Stress So how does the emotional distress of having a child with a chronic health condition influence parenting cognitions and practices? One possibility is that it may contribute to high levels of parenting stress. Numerous studies confirm that parenting stress is higher in parents of children with a chronic health condition. For example, in a meta-analysis of 13 studies, Cousino and Hazen (2013) found that parenting stress was higher in parents of children with a chronic health condition than in parents of healthy children. Moreover, as part of a larger, accompanying systematic review, they found that general and disease-related parenting stresses were positively associated with symptoms of depression or anxiety in parents of children with arthritis, cystic fibrosis, diabetes, and cancer. Because parents vary widely in the amount of parenting stress reported, Cousino and Hazen (2013) examined the positive and negative correlates of parenting stress separately for different chronic conditions. As was the case for the studies of parental emotional distress reviewed above, one of the most consistent predictors of parenting stress was the parents’ perceived vulnerability of the child. Although their review showed that most objectively measured illness characteristics did not predict parenting stress, a few factors particular to specific conditions did. Parenting stress, for example was positively associated with sleep disordered breathing in children with asthma; invasive, painful medical procedures and activity limitations due to treatment for children with cancer; low levels of child self-care behaviors in children with cystic fibrosis and children with diabetes; nocturnal glucose checks for children with diabetes; disease-related child behavior problems (e.g., refusing glucose checks) for children with diabetes or epilepsy; intractable seizures for children with epilepsy; and pain intensity for children with juvenile rheumatoid arthritis or sickle cell disease. Summarizing these findings, parenting stress appears to be higher when children experience high levels of pain or discomfort; resist routine medical procedures; cannot perform many self-care skills on their own; or must be constantly monitored when sleeping. The resulting parenting stress in these situations likely results from some combination of parental concern about the child’s well-being and excessive caregiver burden (see section on caregiver burden below).

Parent Emotional Distress and Parenting Practices Given the high levels of emotional distress and parenting stress that many parents of children with a chronic health condition experience, does this affect their parenting cognitions and practices? Because depressed mothers of healthy children hold more negative and critical perceptions of their children and show more negative, more disengaged, and less positive parenting behaviors than nondepressed mothers (Goodman, 2007; Lovejoy, Graczyk, O’Hare, and Neuman, 2000), one would expect similar differences for parents of children with a chronic condition. A significant amount of research has been conducted on differences between the parenting practices of parents of children with a chronic health condition and parents of healthy children. For example, Pinquart (2013) conducted a meta-analysis of 325 studies on this question. Although the effect sizes in his analysis were small, the analysis yielded differences in every parenting dimension studied. Parents of children with a chronic health condition had less positive relationships with their children, showed lower levels of responsiveness, and showed higher levels of demandingness and overprotection. Although only a 602

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small number of studies examined parenting styles, analyses of these data also showed differences, with parents of children with a chronic health condition more likely to show authoritarian and neglectful parenting styles and less likely to show an authoritative style. Many of the effect sizes in Pinquart’s (2013) meta-analysis, however, were heterogeneous, indicating that moderating variables likely were operating. Sufficient sample sizes were available to examine moderation for three of the parenting dimensions studied—quality of the parent–child relationship, parental responsiveness, and parental demandingness. Although small sample sizes for some conditions may have worked against yielding significant effects, only four conditions showed significant differences in his analysis: asthma (all three parenting dimensions), diabetes (quality of parent–child relationship only), epilepsy (all three dimensions), and HIV infection (quality of parent–child relationship only, although this was the only dimension examined for this group). Significant effects also were found for parents of hearing-impaired children, but this finding is not relevant to the current review. Finally, significant effects were found for parental responsiveness and demandingness for the “other” category, a combination of studies of understudied populations or studies combining children with multiple conditions. Does parental emotional distress or parenting stress account for some of these differences in parenting? Studies of parents of children with asthma (Mullins et al., 2007; Weil et al., 1999), cancer (Link and Fortier, 2016), chronic pain (Sieberg, Williams, and Simons, 2011), diabetes (Eckshtain, Ellis, Kolmodin, and Naar-King, 2010; Monaghan, Horn, Alvarez, Cogen, and Streisand, 2012; Mullins et al., 2004; Sweenie, Mackey, and Streisand, 2014), epilepsy (Rodenburg, Meijer, Dekovic, and Aldenkamp, 2007), and sickle cell anemia (Logan, Radcliffe, and Smith-Whitley, 2002) show significant associations in the expected direction between parental emotional distress or parenting stress and measures of parenting including warmth/nurturance, criticism, behavioral control, psychological control, inconsistent discipline, monitoring, overprotection, and authoritative parenting. No study, however, was located that tested whether parental differences in emotional distress or parenting stress accounted for, in a mediational analysis, differences in the parenting practices of parents of healthy children and parents of children with a chronic health condition.

Posttraumatic Growth The experience of adapting to a child’s chronic disease can have positive benefits for the family. In a narrative review of 35 qualitative or quantitative studies of posttraumatic growth in the families of childhood cancer survivors, Duran (2013) identified five themes that captured the types of growth often seen in these families: meaning-making (i.e., coming to terms with the experience through a new understanding); a deeper sense of appreciation of life; greater self-knowledge; a greater sense of closeness and family togetherness; and a desire to pay back society. In a review of 19 studies of posttraumatic growth in parents of children with a chronic illness, Picoraro, Womer, Kazak and Fedutner (2014) argued that both cognitive (e.g., sense making and benefit finding) and affective processes (moderate levels of posttraumatic stress) contribute to posttraumatic growth and that individuals who are optimistic and have high levels of social support from family, friends, and peers are most likely to experience such growth.

Summary and Conclusions The diagnosis of a child with chronic disease often leads to major changes in family routines and functioning and to a wide range of parent emotional responses. These initial emotional reactions can be compounded by increases in parenting stress that results from taking on additional and challenging new roles. With this negative affect come predictable changes in parenting cognitions and practices, leading to increases in parental control, demandingness, criticism, overprotectiveness, and inconsistency 603

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and decreases in parental warmth and nurturance.These negative reactions usually decrease over time, but they can reemerge in response to changes in the child’s situation or health status. Despite the difficulties that most parents initially experience, with the passage of time most parents adapt to the increased stresses associated with a chronic disease in their child by developing and implementing new family routines. However, a significant minority of parents continues to show high levels of negative responses that do not decrease over time. Researchers have identified multiple factors that increase or decrease the likelihood of negative emotional responses, and these partially account for this wide range of individual differences in adaptation. Finally, for many parents, the experience of rearing a child with a chronic health condition can lead to opportunities for development and personal growth as well.

Caregiver Burden and Impact on Parenting Another factor that might account for differences in the parenting practices of parents of children with a chronic health condition is the significant caregiver burden that accompanies many illnesses. As described earlier, the diagnosis of a childhood chronic condition often leads to major changes in family routines and processes (Crespo et al., 2013). Many of these changes are in response to an increased burden on the family to help manage the child’s condition and symptoms. Researchers have documented the nature of these burdens and many of the factors that contribute to them. The increased parenting demands that result from rearing a child with a chronic health conduction cover a range of areas, including but not limited to increased monitoring of the child’s symptoms and behavior; helping the child perform daily self-care tasks; providing regular in-home treatments; dealing with the child’s resistance to routines and treatments; working with health care systems (scheduling, transporting, and accompanying the child to visits to the doctor, physical therapist, and so on); frequent contact with insurance companies and health care providers to manage costs; spending time away from home during child hospitalizations; and increased workload both at home and at work. Chronic conditions vary widely in the caregiving demands required of parents. For example, increased monitoring is particularly demanding for parents of children with type 1 diabetes who need to perform (or to ensure that their child performs) multiple glucose checks during the day as well as the need to carefully monitor the child’s behavior and diet (Sullivan-Bolyai, Deatrick, Gruppusa, Tamborlane, and Grey, 2003). Similarly, parents of children with food allergy need to closely monitor what the child eats, monitor how and where the food is prepared, and carefully examine food labels to reduce risk of exposure to potentially fatal allergens (Bollinger et al., 2006). Assistance with self-care routines, in contrast, is particularly challenging for parents of children with severe juvenile rheumatoid arthritis who often must help their child with daily tasks (e.g., getting dressed) and other motor tasks (Power, Dahlquist, Thompson, and Warren, 2003). Parents of children with cystic fibrosis, in contrast, must spend a considerable amount of time managing their child’s disease by providing breathing treatments and chest physical therapy and by managing the child’s diet and administering pancreatic enzymes (Drotar and Ievers, 1994). The highest level of caregiver burden is likely found for parents of “technology-dependent children” who must perform multiple medical procedures for children living at home “who need both a medical device to compensate for the loss of a vital body function and substantial and ongoing nursing care to avert death or further disability” (Wagner, Power, and Fox, 1988, p. 3).These are children, for example, on mechanical ventilation, who receive parenteral nutrition, or who are on dialysis (Kirk, 1998; Kirk, Glendinning, and Callery, 2005). A number of questionnaires have been developed to assess caregiver burden for parents of children with chronic diseases, some of which are tailored to the caregiving burden of specific diseases. Across a range of chronic conditions (i.e., asthma, cancer, and diabetes), parent reports of caregiver burden are associated with parental anxiety, depression, or low reported quality of life (Canning and Harris, 1996; Crespo, Carona, Silva, Canavarro, and Dattilio, 2011; Cunningham, Vesco, Dolan, and 604

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Hood, 2011; Litzelman, Catrine, Gangnon, and Witt, 2011; Salvador, Crespo, Martins, Santos, and Canavarro, 2015; Silva, Carona, Crespo, and Canavarro, 2015). Neri and colleagues (2016), in a study of parents of adolescents with cystic fibrosis, examined a wider range of correlates. Not only did they find that parents who report high levels of caregiver burden reported a greater number of depressive symptoms and lower life satisfaction, these parents also report poorer sleep quality, less happiness, and poorer self-rated health. Such parents also reported more work-life balance interference, more jobrelated stress, and more missed days at work. Finally, caregiver burden was greatest for parents who reported a lack of services in their community and no aid from relatives. With the exception of the study by Neri and colleagues (2016), all of the studies of caregiver burden cited above involved distributing questionnaires to the primary caregiver of the child, who in over 80% of the cases was the mother. Therefore, mothers apparently experience the greatest caregiver burden. Neri and colleagues (2016) distributed their questionnaires to all parents visiting the clinic with their child, so only 59% of their sample was female (75% of the primary caregivers in this sample were mothers). This allowed for a direct comparison of mothers versus fathers in the level of caregiver burden, and in their study mothers reported higher levels than fathers. Only one study was located that examined the relation between caregiver burden and parenting practices. In a study of mothers of children with asthma, Fiese and colleagues (2008) found that mothers who reported higher levels of asthma-related caregiver burden were more rejecting of their children during a 15-minute observation of family interaction. In summary, researchers have done a thorough job of documenting the increased caregiver burden for parents rearing a child with a chronic health condition and in identifying some of the determinants of that burden. They have also shown that caregiving burden is associated with a range of negative psychological outcomes for parents. However, with the exception of the study conducted by Fiese and colleagues (2008) described above, the impact of caregiver burden on specific parenting cognitions and practices has yet to be examined.

Role of Parenting in Helping Children Handle Acute Pain and Other Condition-Related Stressors Children with chronic medical conditions often undergo repeated medical procedures that can be both frightening and painful. Children with cancer, for example, undergo repeated blood tests (finger sticks), intravenous access to draw blood or administer chemotherapy, painful intramuscular injections, and needle sticks to access indwelling subcutaneous ports. Treatment can last years, and, despite the availability of topical anesthetics, can be an ongoing significant source of stress for the child as well as for the parent (Dahlquist, 1992, 1999). Other chronic conditions, such as sickle cell disease, arthritis, and diabetes, also require repeated frequent needle procedures. Coping with the fear and pain associated with these procedures presents a significant challenge to many children, especially younger children, who have less well-developed emotion regulation abilities (Dahlquist, 1992; Racine et al., 2015). Even non-painful experiences, such as anesthesia induction, having an MRI, or being hospitalized, can be frightening (Cohen et al., 2017; Dahlquist, 1992; Slifer, Tucker, and Dahlquist, 2002). Parents play an important role in facilitating the child’s adjustment to medical stressors by preparing the child for impending procedures and by the way that they interact with the child during the medical procedures. The sections that follow briefly review the empirical literature in these two domains.

Parent Roles in Preparing Children for Medical Procedures Children with accurate, specific information about an upcoming medical procedure tend to show less distress during the procedure and better adjustment after the procedure (Dahlquist, 1992, 1999; Jaaniste, Hayes, and von Baeyer, 2007). Providing accurate information about what will be done and 605

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the sensations the child can expect to experience, as well as suggesting strategies for coping with the event, can help to establish trust between the child and medical staff, alleviate any misconceptions the child might have about the procedure, make the medical procedure more predictable, and facilitate child coping (Dahlquist, 1992, 1999; Jaaniste et al., 2007; Spafford, von Bayer, and Hicks, 2002). Involving parents in the process can facilitate positive outcomes. Parents often report elevated stress and dissatisfaction with their child’s medical care when they have received what they perceive to be inadequate information about their child’s medical procedure (Jaaniste et al., 2007).When parents are involved in the preparation process, either by being present when the child is prepared, or by conducting the preparation itself, not only do their children display less anxiety prior to or during the procedure (Kain et al., 2007; Spafford, von Baeyer, and Hicks, 2002), but the parents themselves also report less anticipatory anxiety (Kain et al., 2007) and are less likely to seek information from other potentially less reliable sources, such as the Internet (Jaaniste et al., 2007).

Parent Influences on Child Behavior During Medical Procedures Although parents typically prefer to be present during their child’s medical procedures (Piira, Sugiura, Champion, Donnelly, and Cole, 2005), the helpfulness of parental presence depends on whether the parent can manage his/her own distress and behave in a manner that facilitates child coping (Kain, Caldwell-Andrews, Maranets, Nelson, and Mayes, 2006; Piira et al., 2005; Wright, Steward, Finley, and Raazi, 2014). A number of studies have documented a strong positive relation between parental anxiety and child distress during medical procedures (Caes et al., 2014; Dahlquist, Power, Cox, and Fernbach, 1994; Racine et al., 2015) as well as between parent and child pain expectancies (Liossi, White, Franck, and Hatira, 2007). In fact, in a study of the effects of parental presence during anesthesia induction, children who were calm prior to anesthesia induction did worse during the actual induction if accompanied by an anxious parent (Kain et al., 2006). Microanalyses of parent–child interactions during medical procedures reveal that child distress tends to be greater when parents demonstrate behaviors that appear to communicate anxiety, such as agitation (Bush and Cockrell, 1987; Dahlquist et al., 1994) and apology (Blount et al., 1989). Parental reassurance (e.g., “It’s going to be ok,”) also has been shown to be positively associated with child distress (Blount et al., 1989; Campbell, DiLorenzo, Atkinson, and Pillai Riddell, 2017; Martin, Chorney, Cohen, and Kain, 2013). The relations between parent behaviors and child distress likely are bidirectional, with the child’s temperament and the child’s expressions of distress during the procedure playing a role in eliciting parental responses, which subsequently hinder or foster child coping (Campbell et al., 2017; Wright et al., 2014). Parent anxiety may play a role in this process by heightening parental attention to “threat” (i.e., distress/pain) cues in the child and thereby increasing the probability of responding to child distress in less effective ways (Caes et al., 2014; Caes, Vervoort, Trost, and Goubert, 2012; Martin et al., 2013) or by altering the manner in which the parent communicates (via voice tone or facial expression), such that, even though the parent is attempting to provide “reassurance,” the child senses the parent’s fear (McMurtry, Chambers, McGrath, and Asp, 2010; McMurtry, McGrath, Asp, and Chambers, 2007). In contrast, parent behaviors that encourage child coping, such as distracting conversation or prompts to use coping strategies, are associated with reductions in child distress (Campbell et al., 2017; Chorney et al., 2009). However, parent anxiety may also interfere with the parent’s ability to effectively coach their child in the use of potential coping strategies. For example, in a post hoc analysis of a parent-administered distraction program for preschoolers undergoing chemotherapy injections, Dahlquist and Pendley (2005) found that the children who appeared to be treatment failures—i.e., did not evidence reduced distress during intervention—had parents who were significantly more anxious than the parents of the children for whom the intervention was successful. 606

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Dahlquist and Pendley (2005) speculated that anxious parents may have less confidence in their ability to help their child during the procedure (Harper et al., 2013), may inadvertently behave in ways that increase the child’s sense of threat associated with the procedure (e.g., via negative comments or displays of agitation), or may demonstrate more criticism or less sensitivity in their efforts to assist their child, similar to the less optimal patterns of parenting interactions that have been observed in anxious parents in other contexts (Ollendick and Benoit, 2012). Although critical parent–child interactions are less common than supportive interactions during medical procedures (Cline et al., 2006), when they occur, they tend to be associated with greater child-reported and behavioral indicators of pain and distress (Cline et al., 2006; Cohen et al., 2017). In summary, stressful medical procedures can be upsetting for the parent as well as the child. In order for parents to effectively prepare their child for an impending procedure or foster coping during the procedure, they must first manage their own anxiety; otherwise, their subsequent interactions with the child regarding the medical procedure may be less effective or even deleterious. Future research should continue to focus on integrating interventions specifically targeting parental anxiety into procedural distress-management programs for children.

Parenting and Children’s Adherence to Medical Regimens Adherence refers to the extent to which a person’s behavior corresponds with a medical treatment plan developed with a health care provider (Rapoff, 2010). Adherence specifically focuses on engagement in health behaviors, distinct from resulting health outcomes. This is important—a patient can be highly adherent to their medical regimen but still have non-optimal health outcomes depending on their disease, the severity, and the appropriateness of the treatment prescribed (DiMatteo, HaskardZolnierek, and Martin, 2012). Despite this distinction, higher levels of adherence are associated with better physical and psychological health and quality of life outcomes (Hood, Peterson, Rohan, and Drotar, 2009). The consequences of non-adherence include drug resistance, increased morbidity and mortality, and reduced quality of life (Rapoff, 2010). To illustrate the dangers of poor adherence, in pediatric asthma the consequences of not taking prescribed inhaled steroids or emergency inhalers vary from wheezing to frequent hospitalizations to death.Yet research shows that many children do not receive their medications as prescribed for a variety of reasons, including failure to administer medications properly or failure to administer medications at all (McQuaid, Kopel, Klein, and Fritz, 2003). Parents of children with chronic health conditions play a central role in promoting children’s adherence to medical regimens.The role of parents in adherence is widely studied. Given the heterogeneity of chronic conditions, treatment, parental and child traits, and many other contextual factors, however, it remains a complicated topic that requires ongoing research. A number of key parenting roles and behaviors are shown to have significant effects on children’s adherence and thus overall health and well-being. Developmental considerations are the forefront of this issue, as parenting a child with a chronic health condition requires ongoing adjustment according to children’s developmental tasks and abilities. As such, in this section we first describe key developmental considerations delineated in the literature, and then we present various parenting behaviors that impact children’s adherence.

Developmental Considerations Research consistently shows that child development is a key mediator of children’s adherence and is intimately connected to parenting behaviors. In general, child age is negatively associated with adherence in many chronic conditions, such that adherence is higher among younger children than adolescents (McQuaid et al., 2003; Pai and Ostendorf, 2011). However, age arguably provides a very rough estimate of a child’s development in terms of cognitive, emotional, behavioral, and physical 607

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abilities, and therefore can be misleading. Much of the extant literature on child development and adherence is organized into two broad developmental periods, namely childhood and adolescence, as important patterns emerge in relation to parenting a child with a chronic health condition during each of these broad developmental stages. Adherence in very young children with chronic conditions requires that parents and caregivers assume complete responsibility for medical tasks. As children begin to develop motor and cognitive abilities throughout early childhood, they become increasingly equipped to assist with tasks associated with their medical treatment. However, development of skills does not occur spontaneously in such a way that children can one day simply conduct a task independently without error. With the use of scaffolding, a teaching strategy through which parents control the components of the medical task that are initially beyond the child’s ability, the child can conduct the components of the task that are within his or her abilities, leading to successful completion of medical tasks (Wood, Bruner, and Ross, 1976). In this iterative process, children can master components of the tasks until they are able to perform them accurately with little parental assistance. This teaching strategy provides support to the child and gradually withdraws parental support at a pace that matches the child’s development of skills in conducting the task. During adolescence, parental responsibility for medical tasks typically decreases due to marked increases in adolescents’ skills and desire for independence (Holmbeck et al., 2002). However, considerable evidence also suggests that adherence to medical regimens shows a steep decline from childhood to adolescence, as adolescents’ beliefs about adherence, risk-taking behaviors, and still-developing executive functioning skills play a greater role in health behaviors and choices (Shaw, 2001). Physical changes during adolescence, specifically during the pubertal stage, can affect adherence. In the case of diabetes management, pubertal maturation changes the metabolic system, making it more difficult to achieve good glycemic control (Wiebe et al., 2014). A decline in glycemic control during this period can create additional stress and conflict in families. As such, it is important for parents to actively collaborate and monitor daily medical tasks to limit adolescent and parent frustration. One strategy that can serve to limit parent–child conflict during adolescence is to implement a scheduled daily or weekly (depending on the child’s need for monitoring) meeting during which parents and children communicate about medical tasks and problem-solve together. Parent–child meetings serve to create a “team-like” atmosphere and also reduce the likelihood of conflict at times during the day or week that may occur during heightened stress of frustration, leading to less effective communication. However, this strategy has not been empirically examined as an individual intervention and requires empirical support to verify its effectiveness for reducing parent–child conflict. Across chronic conditions, parental involvement is considered necessary throughout childhood and adolescence. Psihogios, Kolbuck, and Holmbeck (2015) followed adolescents with spina bifida across 2 years, finding that adolescents gained more responsibility and independence skills, although adherence rates did not show equivalent improvement. Similarly, in a sample of adolescents with type 1 diabetes, caregivers who actively provided autonomy support to adolescents encouraged more frequent blood glucose monitoring (Wu et al., 2014). Overall, although adolescents are developing self-care skills and independence, ongoing parental involvement in medical regimens may promote optimal health outcomes during adolescence.

Parental Health Beliefs Following the health belief model (HBM), parental health beliefs and perceptions are associated with children’s adherence to medical regimens (Armstrong et al., 2014; DiMatteo et al., 2007). A metaanalysis of 11 studies with children with chronic conditions found that parental perceptions of their child’s disease severity were related to their child’s adherence (DiMatteo et al., 2007). Specifically, in studies with samples that had less serious chronic conditions, including asthma, children judged 608

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by their parents to be in poorer health had better adherence. In samples of more serious conditions, including end stage renal disease and diabetes, the opposite pattern emerged: children judged by their parents to be in poorer health had worse adherence. These findings suggest that parents’ beliefs and ensuing behaviors are important factors in supporting children’s adherence.

Parenting Behaviors That Promote Adherence Parents can effectively promote their child’s competence in adhering to their medical regimen in a way that matches the child’s developmental abilities. Parents also can facilitate the development of critical skills that will allow children to independently care for their chronic condition. Encouraging the development of self-care skills is linked to successful transition to adult care and a variety of other positive health and well-being outcomes.Various parenting behaviors that promote adherence are discussed below. One way that parents can promote the development of child adherence is through sharing selfcare responsibilities with the child. A burgeoning literature has examined the allocation and transfer of responsibility from parents to children and the associated impacts on adherence. It is generally accepted that the allocation and transfer of responsibilities does not follow a linear pathway for all families, and that the process is affected by multiple factors (Reed-Knight, Blount, and Gilleland, 2014; Williams, Mukhopadhyay, Dowell, and Coyle, 2007). Williams and colleagues (2007) presented a visual model that consists of two parallel continua to depict the level and nature of involvement of parents and children in completing medical tasks that illustrates the complex process of shifting responsibilities from parents to children, or from children to parents. In this model, the parental role in any given medical task can range from “complete direction,” through the stages of “passive supervisor” and “directed assisting,” to “non-involvement.” In parallel, children’s roles in conducting a medical task can range from the “overwhelming recipient” to “independent administrator.” Parent and child level of responsibility for a single medical task may vary according to maturity as well as changes in internal (e.g., performance uncertainty), external (e.g., illness episodes), and environmental (e.g., weekly family routines) factors which may influence the level of responsibility of the parent and child at any given time. Added complexity arises when the chronic condition of the child involves multiple medical tasks that vary in degree of difficulty and nature, and therefore require varying levels of parent and child responsibility for overall adherence to a medical regimen at any given time. As children mature, they become increasingly capable of successfully managing certain medical tasks independently. Drotar and Ievers (1994) found that the percentage of treatment-related responsibilities shared among parents and children with cystic fibrosis and type 1 diabetes increased from younger children (ages 4–7) (19% for cystic fibrosis and 18% for type 1 diabetes) and older children (ages 8–10) (32% and 42%, respectively), but did not significantly increase thereafter, as treatment-related responsibility sharing at 11 and 14 years remained at a similar level (34% and 37%, respectively). Similarly, the percentage of tasks that parents performed exclusively decreased across childhood. However, sharing responsibility for some specific medical tasks may be associated with poorer adherence. Marhefka and colleagues (2008) examined the odds of adherence to antiretroviral therapy (ART) for pediatric HIV at different levels of responsibility sharing between parents and children and found that, in families with caregivers who are solely responsible for calling the doctor or pharmacy to refill prescriptions, children were more adherent compared to families that shared this responsibility with children. These results suggest that some tasks may be particularly important for parents to complete to promote better adherence. Another way that parents can promote adherence is by encouraging daily routines and, more specifically, by integrating medical treatment tasks into children’s daily routines. Research support for this approach has been found in samples of children with diabetes (Greening, Stoppelbein, Konishi, 609

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Jordan, and Moll, 2007), sickle-cell anemia (Klitzman, Carmody, Belkin, and Janicke, 2017), inflammatory bowel disease (Hommel, Odell, Sander, Baldassano, and Barg, 2011), and asthma (Fiese and Wamboldt, 2000). Routines may encourage better adherence by incorporating treatment tasks into daily scheduled activities, creating less sense of treatment burden, and minimizing barriers, such as forgetting, children’s task avoidance, or oppositional behavior and clarity of who is responsible for conducting the task (Hommel et al., 2011). Flexibility in routines may be most favorable (Fiese, Wamboldt, and Anbar, 2005), although this area remains largely understudied. High collaboration between caregivers and children in conducting daily diabetes tasks is associated with better diabetes control (Wysocki et al., 2008). The best health outcomes for this population are associated with having two caregivers who both collaborate effectively with the child on diabetes tasks. However, having only one parent who is high on collaboration is consistently linked to more favorable outcomes if that parent is the caregiver who is most involved in diabetes care tasks. This pattern may be uniquely true for diabetes, as the complexity and necessity of frequent monitoring of daily diabetes management may require one caregiver to be highly in tune with the child’s diabetes management. Parental monitoring is a critical feature of pediatric medical regimens (Ellis et al., 2007). Monitoring refers to the direct oversight and supervision of activities related to the child’s medical regimens. Depending on the regimen and various other factors related to the child’s self-care abilities, monitoring may include watching a child take medication and/or establishing a daily or weekly time to seek information about the child’s activities.The optimal level of parental monitoring is not always easy to determine and can change according to multiple factors. Complex treatment regimens that require multifaceted behaviors, such as with diabetes, spina bifida, or cystic fibrosis, may require higher levels of parental monitoring, whereas other tasks may require less monitoring after adherence habits have been formed and tasks are performed with high accuracy (Babler and Strickland, 2015; Eakin, Bilderback, Boyle, Mogayzel, and Riekert, 2011; Psihogios et al., 2015). Various parenting dimensions have been found to be associated with adherence in adolescents. Goethals and colleagues (2017) showed that parental responsiveness and psychological control were particularly predictive of adherence in adolescents and young adults with type 1 diabetes. This finding suggests that there may be value in educating parents on appropriate responsive and nonintrusive parenting practices to promote adherence, particularly during adolescence. The content and quality of parent–child interactions during performance of treatment activities affect adherence. In one study, direct observation of school-age children with cystic fibrosis and their parents during home respiratory treatments revealed that parental positive attention, instructions, and avoidance of negative statements were highly related to higher rates of adherence to respiratory treatments (Butcher and Nasr, 2014). Parents also promote adherence by successfully transferring medical knowledge to their child. Adhering to a medical regimen requires a significant base of knowledge on the part of the parent, and secondarily on the part of the child. Lee and colleagues (2017) showed that parents who had greater medication knowledge led to better medication adherence for their child. This effect was moderated by level of conscientiousness, which represents the capacities to be attentive, organized, and planful, such that parents who had the highest level of knowledge and were more conscientious had the highest levels of adherence. Furthermore, parents play a critical role in ensuring that their children understand aspects of their medical regimen that are necessary for them to accurately complete tasks. For children, information about their medical regimen may need to be explained and modeled in various formats outside of the medical provider visits, and on a frequent basis for the information to be adequately learned.

Transition to Self-Care Parents play a critical role in successful transitions from parent to adolescent responsibility and from pediatric to adult providers. Although it is necessary to transition responsibility for medical tasks as 610

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adolescents and young adults become increasingly skilled in their illness care and otherwise more self-sufficient, the process can occur at varying speeds and with varying degrees of success. To date, much of the extant literature in the area of transition of care consists of qualitative studies that capture families’ coping and experiences (Heath, Farre, and Shaw, 2016).To our knowledge, no empirical studies have examined specific parenting practices that predict successful transition to self-care or to adult health care providers. However, qualitative and theoretical research highlights critical trends regarding parenting behaviors and successful medical regimen transition. Reed-Knight and colleagues (2014) provided examples of how responsibilities can be shared between parents and adolescents to transfer responsibilities using a developmental systems perspective. One of their examples suggests that, in facilitating adolescent learning about prescriptions refills, parents may function as an observer as the adolescent stands in line at the pharmacy or makes calls for refills. Allowing the adolescent to take responsibility for these tasks, but at the same time monitoring adolescent performance, encourages skill development and simultaneously assures that the medical task is completed properly. Additionally, parents can encourage their adolescents to participate in medical visits by answering providers’ questions directly in parental presence (Buford, 2004). Encouraging the adolescent to take primary responsibility for answering questions functions similarly to scaffolding, as the parent is able to assist if the child requires additional support, but also encourages a sense of autonomy on the part of the adolescent. Furthermore, modeling engagement in medical visits (e.g., asking questions) is likely beneficial for adolescents in learning how to navigate medical visits independently following transition of that responsibility, although this parental strategy has not been studied directly. Although disease knowledge is an important component of adherence, research has not found evidence to suggest that adolescents who demonstrate greater knowledge of their disease and medical regimen necessarily exhibit more health responsibility or greater adherence rates, suggesting that although knowledge may facilitate transition of care to adolescents, it may not function as an exclusive predictor of transition success (Reed-Knight et al., 2014). Therefore, parents should encourage adolescents to be knowledgeable about their disease and medical regimen, but should still provide additional behavioral support. Overall, caregivers play a substantial role in fostering optimal adherence to children’s medical regimens throughout child development. Of note, rates of adherence show a steep decline during adolescence, highlighting the importance of parental support during this period. Medical regimens are often composed of various health behaviors, each of which require parental monitoring and support tailored to the individual child’s abilities. Additionally, parent- and family-level factors, including parent health beliefs and communication skills, are associated with adherence rates and health outcomes in children and youth. Future research should begin to explore the effectiveness of specific parenting behaviors in promoting child and adolescent adherence rates, in the context of complex and diverse social systems and developmental processes.

Role of Parenting in Maintaining Age-Appropriate Functioning Childhood illness has the potential to interfere with interactions between the child and the environment that are crucial to successful mastery of important socioemotional tasks of development as well as optimal progression to more advanced stages of development (Perrin and Gerrity, 1984). As a result, it may be particularly challenging for parents to create opportunities for children to exercise control over their environments and develop autonomy, self-confidence, and social competence. In the following sections, we review the research linking parental emotional responses and parenting behaviors to autonomy development and adaptive school functioning in children with chronic health conditions. 611

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Parental Perceptions of Child Vulnerability In 1964, Green and Solnit coined the phrase “vulnerable child syndrome” to describe a disrupted pattern of parent–child interactions they observed in children who had recovered from a life-threatening illness but whose parents continued to view them as unrealistically vulnerable to future serious illness, injury, or even death (Wright, Mullen, West, and Wyatt, 1993). Green (1986) and Levy (1995) expanded the construct to include children who were perceived by their parents to be particularly vulnerable to illness, regardless of the objective medical basis for such perceptions. Heightened parental perceptions of child vulnerability have been shown to be associated with elevated parental fears about the child’s health, hypervigilance for signs of illness (Thomasgard, 1998), and excessive utilization of medical services (Levy, 1995). Greater perceived vulnerability has also been shown to relate to child-reported depressive symptoms (Mullins et al., 2004) and social anxiety (Anthony, Gil, and Schanberg, 2003). Although Green and Solnit (1964) originally proposed that perceived vulnerability also was associated with overprotective, overindulgent, and overcontrolling parenting, subsequent research by Thomasgard and colleagues (Thomasgard, 1998;Thomasgard and Metz, 1995;Thomasgard, Shonkoff, Metz, and Edelbrock, 1995) found only modest overlap between parental self-report measures of perceived vulnerability (i.e., the Child Vulnerability Scale; Forsyth, Horwitz, Leventhal, Burger, and Leaf, 1996) and overprotective parenting behaviors (i.e., the Parent Protection Scale; Thomasgard, Metz, Edelbrock, and Shonkoff, 1995). Thus, perceived vulnerability and overprotection appear to be best conceptualized as related but distinct constructs (Mullins et al., 2004).

Parental Overprotection In the context of child health conditions, “overprotection” has been defined as protective parental behavior that is excessive for the child’s developmental level (Pinquart, 2013;Thomasgard et al., 1995), although scholars have differed with respect to the degree to which indulgent parenting, overly controlling parenting, and parental anxiety should be considered components of overprotection. Holmbeck et al. (2002) argued that overprotection includes both excessive parental control and intrusiveness or prevention of independent behavior as well as an anxious component involving excessive concern about the child’s welfare, infantalization, and excessive social or physical contact. Although most health professionals could easily identify parents in their practices who appear overprotective, the empirical study of overprotection in children with health conditions is challenging. Much of the literature demonstrating more overprotection in parents of children with health conditions is based on adults’ retrospective recall of how they were reared (Herbert and Dahlquist, 2008; Thomasgard, 1998), which is subject to the biases and distortions inherent in any retrospective report. Efforts to obtain ongoing assessments of overprotective parenting have generated mixed findings (Pinquart, 2013). For example, 10- to 17-year-old children with cancer did not differ from healthy peers in their ratings of parental care and overprotection on the Parental Bonding Instrument (Parker,Tupling, and Brown, 1979;Tillery, Long, and Phipps, 2014). Similarly, parents of children with cancer did not report more overprotective parenting on the Child-Rearing Practices Report (Noll et al., 1999) than did parents of healthy comparison children (Long et al., 2013). In contrast, parents of 8- and 9-year-old children with spina bifida both reported and were observed to be more overprotective than parents of age-matched able-bodied peers (Holmbeck et al., 2002). Some of the challenges inherent in identifying the prevalence of and contributors to parental overprotection in the context of chronic childhood health conditions may simply reflect the realities of parenting a child with a significant medical condition. That is, the management of many childhood health conditions requires a greater level of parental oversight and involvement than would otherwise be necessary for the child’s level of development (see discussion on caregiver burden 612

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above). As such, high levels of parental involvement may simply be adaptive responses to the child’s physical limitations or crucial to maintaining the child’s health. Nonetheless, these behaviors also may conflict with the equally important parental role of facilitating the development of autonomy (Holmbeck et al., 2002). Anderson and Coyne (1991) referred to this conflict as “misguided helping,” in which tension develops between parents and children as the parent’s efforts to keep the child healthy interfere with the child’s emerging autonomy (Holmbeck et al., 2002). Although research findings are mixed (Pinquart, 2013), lower levels of autonomy support have been documented in observational studies of parents of children with spina bifida (Holmbeck et al., 2002; Lennon, Murray, Bechtel, and Holmbeck, 2015; Murray et al., 2015) and children born prematurely (Potharst, Schuengel, van Wassenaer, Kok, and Houtzager, 2012). Parents who are highly anxious may be particularly at risk for excessive levels of control and involvement to manage their own fears about potential catastrophic consequences for their child (i.e., avoid a dreaded outcome; Ollendick and Benoit, 2012). As has been demonstrated in childhood anxiety research, anxious parents are more likely to perceive threat in innocuous scenarios, demonstrate greater parental control, involvement, restriction, or avoidance of “threatening” settings, and transmit threat interpretation biases to their children (Ollendick and Benoit, 2012). Thus, the highly anxious parent may be particularly prone to encourage avoidance of threatening situations rather than teach ways to cope and master such threats. A similar pattern of parental encouragement of avoidance also could emerge in response to child anxiety. For example, children with asthma who also had significant anxiety symptoms made more avoidant responses to hypothetical asthma-related threat scenarios after discussions with their parents than did non-anxious children with asthma, suggesting that their parents played a role in encouraging avoidant coping (Sicouri et al., 2016). Alternatively, excessive control and involvement may simply serve to reduce the stress associated with day-to-day management of their child’s health in families where parents are already experiencing high levels of stress (Holmbeck et al., 2002). For example, by keeping their children out of preschool or daycare, parents of children with food allergy can limit the number of situations in which accidental exposures to food allergens might occur, thus making the children’s disease management easier. Indeed, Bollinger et al. (2006) reported that 10% of parents of youth with food allergy did not enroll their children in school because of the child’s food allergy. An emerging body of literature also suggests that overly involved parenting may reflect a generalized response style or a failure to differentiate setting conditions in which their high level of involvement in their child’s life is medically necessary from contexts that are unrelated to the child’s health status, resulting in unnecessary or excessive levels of parental involvement in aspects of children’s lives that are not relevant to a health condition. For example, in an observational study of parent–child interactions during easy and challenging visual motor tasks, Dahlquist, Power, et al. (2015) found that parents of 3- to 4-year-old children with food allergy were more likely to provide unnecessary help on a simple puzzle (i.e., telling the child where to place a piece) than were parents of healthy children, despite the fact that the food allergic and healthy children did not differ in basic visual motor skills. In this example, food allergy has no impact on puzzle solving, and exposure to puzzles arguably has no impact on food allergy, yet the parents of food allergic children demonstrated both intrusiveness and a tendency to shield their children from stress (i.e., frustration or failure). In a study of older children (aged 6–13 years) with juvenile rheumatoid arthritis, Power, Dahlquist, Thompson, and Warren (2003) also documented subtle indications of parental overinvolvement. Rather than providing the correct answer, mothers of children with more severe arthritis were more directive during a visual memory task than the mothers of children with less severe arthritis or healthy children. Although the groups of children did not differ with respect to visual motor skills or performance on the memory task, mothers of children with more severe disease more frequently prompted the child for an answer, reiterated more rules, and made more structuring statements than comparison mothers did. Greater perceived disease severity has been shown to relate to less 613

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autonomy support in other health conditions as well, such as atopic disease (Im, Park, Oh, and Suk, 2014) and congenital heart disease (Rassart, Luyckx, Goosens, Apers, and Moons, 2014). When parents take over problem-solving by telling the child what to do or providing the solution themselves, as illustrated in these examples, they interfere with the child’s independent problemsolving. This phenomenon may be less blatant than the overprotection evidenced when parents significantly restrict the child’s access to physical and social environments, but may nonetheless also serve to undermine the child’s sense of competence and self-efficacy (Colman and Thompson, 2002; Dahlquist et al., 2015; Grolnick, Price, Beiswenger, and Sauck, 2007) and ultimately disrupt autonomy development (Deci, Driver, Hotchkiss, Robbins, and Wilson, 1993; Grolnick and Ryan, 1989; Power, 2004; Power and Hill, 2008). Such parenting behaviors also have been linked to the development of anxiety in healthy children (Hudson and Rapee, 2001, 2002; Kiel and Buss, 2009; Ollendick and Benoit, 2012). In summary, the level of parental involvement needed to manage many chronic childhood health conditions, although necessary and adaptive in many respects, can also pose challenges to the child’s autonomy development. Given the emerging evidence that parental control and involvement may overgeneralize to aspects of the child’s life that are unrelated to health, more research is needed to identify the parent and child variables that influence these subtler manifestations of protective parenting and determine the long-term consequences of these patterns of parent–child interaction.

Parenting and Chronic Pain and Disability Knowing the “correct” way to parent when a child is experiencing chronic or recurrent pain can be particularly challenging. Many parents provide special attention, sympathy, and comfort when their child is in pain and often allow the child to avoid strenuous activities, chores, or even attending school. Some authors refer to this pattern of parental behavior as “protective,” in the sense that the parent strives to “protect” the child from physical pain and emotional distress (Chow, Otis, and Simons, 2016; Simons, Claar, and Logan, 2008; Walker and Zeman, 1992). Although well meaning, these parent behaviors may function to positively reinforce child expressions of pain as well as negatively reinforce avoidance behaviors. At the same time, parents may fail to reinforce adaptive coping (i.e., performing tasks of daily living despite experiencing pain). Over time this pattern of parent reinforcement may serve to increase children’s report of pain symptoms and exacerbate pain-related disability (Palermo,Valrie and Karlson, 2014; Peterson and Palermo, 2004; Simons et al., 2008;Walker and Zeman, 1992; Welkom, Hwang, and Guite, 2013). Indeed, overly solicitous parental behavior is associated with longer duration of symptoms, impaired school performance in adolescents with chronic headache, social withdrawal, depression, and more severe pain-related disability (Chow et al., 2016; Kaczynski, Claar, and LeBel, 2013; Peterson and Palermo, 2004; Welkom et al., 2013). Experimental studies provide further support for the operant role of parental responses to child pain. Children’s pain complaints in response to an uncomfortable water load test doubled when parents were instructed to deliberately attend to symptom complaints and were reduced substantially when parents were instructed to use distraction instead of attention (Walker et al., 2006). Parents who are high in personal distress and who tend to catastrophize about their child’s pain appear to be particularly likely to attend to signs of pain and to allow the child to avoid uncomfortable situations (Caes,Vervoort, Eccleston,Vanderhende, and Goubert, 2011). For example, in a study of 8- to 17-year-old youth with chronic pain, Logan, Simons, and Carpino (2012) found that both parental catastrophizing and parental protective responses (i.e., providing special attention or allowing the child to avoid demands) independently predicted poorer child school attendance and greater general reports of school-related problems, over and above the child’s pain intensity or depressive symptoms. Moreover, parental protective behaviors mediated the relation between catastrophizing and negative school outcomes. Logan et al. (2012, p. 440) argued that parents who have strong 614

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negative emotional reactions to their child’s pain may be particularly “quick to sympathize with pain complaints and to acquiesce to requests to stay home from school,” especially if they perceive the child’s teacher or school to be unsympathetic or unreasonable. To minimize parental threat appraisals associated with child pain symptoms and concomitant parental emotional distress, recent clinical interventions have targeted the development of more accepting, psychologically flexible parental attitudes toward pain symptoms through Acceptance and Commitment Therapy (ACT). Preliminary findings suggest that ACT-based intervention may help minimize parent pain-related distress and ultimately foster less parental monitoring of pain and reinforcement of pain avoidance behaviors (Wallace,Woodford, and Connelly, 2016). Similarly, providing parents of children with chronic pain four to six sessions of individual training in problem-solving skills through modeling and behavioral rehearsal appears to result in less parental catastrophizing and reductions in maladaptive protective parenting behaviors (Law et al., 2017). In summary, parents play a crucial role in reinforcing children’s efforts to engage in age-appropriate activities despite being in pain. Inhibiting the urge to protect the child from distress and discomfort and instead fostering adaptive coping is difficult, especially for parents who are themselves more emotionally upset by their child’s pain. Intervention programs that target parent’s emotional reactions to pain as well as teach operant strategies appear to have considerable promise for minimizing disability and fostering adaptive outcomes in children with chronic pain.

Future Directions in Parenting Children With a Health Condition Despite the diversity of chronic conditions that have been studied and the differences in symptom severity within conditions, researchers have identified similarities in the issues that parents of children with chronic conditions often face. These include predictable emotional and behavioral reactions to uncertainty about their child’s health and future; changes in family routines and responsibilities; caregiver burden from the daily challenges that parents face in addressing the consequences of their child’s condition; and predictable changes in parenting styles and practices. Although this research provides an excellent starting point for understanding parenting within such families, we still have much to learn. Some suggestions for future research follow. First, because the majority of research studies in this area rely almost exclusively on parent verbal reports to assess parenting practices (e.g., interviews, focus groups, questionnaires), it is important that future research employ multiple methods to assess parenting styles and practices. Qualitative studies of parenting children with a chronic health condition have identified numerous issues worthy of future study. However, these studies give us limited insight into the proportion of parents who experience various emotional and behavioral reactions to specific conditions; the factors that predict individual differences in parental responses to these conditions; and the short- and long-term consequences of children’s conditions on parenting and child development. Quantitative studies using standardized self-report measures of parenting address some of these issues, but such measures have their limitations (Wysocki, 2015). For example, questions may be confusing, participants may respond to what they think the researchers want to hear, and parents may try to make a positive impression. Additionally, parents may not accurately remember how often they engaged in specific behaviors, may not accurately average across multiple occurrences of a behavior, or may not be consciously aware of the behavior being assessed (Power et al., 2013). The use of multiple methods (e.g., interviews, questionnaires, diaries, observations, and ecological momentary assessments), along with statistical analyses that examine convergence across measures (e.g., structural equation modeling with latent constructs) would increase our understanding of the specific parental practices that are influenced by children’s chronic conditions, as well as how different practices promote or interfere with child development. A second general issue is how many of the processes and/or experiences described earlier are typical of parents and children across a range of chronic health conditions and how many are 615

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condition-specific? One might expect, for example, that parents who have experienced a situation where their child’s life was in danger (e.g., aggressive cancer or an anaphylactic reaction to the child ingesting peanuts) likely experience more PTSD symptoms than parents of children with less lifethreatening conditions. In contrast, parents whose children require daily care (e.g., cystic fibrosis) likely experience greater caregiver burden. Although the debate regarding the pros and cons of diseasespecific versus cross-diagnosis research in pediatric psychology is far from new (Drotar, 1994; Holden, Chmielewski, Nelson, and Kager, 1997), as this review highlights, there is benefit to be gained from both approaches. Future research should continue to examine differences and commonalities between the various health conditions in the nature of the processes discussed in this chapter as well as identify which aspects of these conditions (e.g., threat, unpredictability, course, age of onset) and which child and parent characteristics account for differences between conditions in parent and child outcomes. Third, to date, many studies that have examined the impact of chronic health conditions on children’s and parents’ well-being have focused primarily on whether children with a chronic health condition (or their parents) show clinical levels of psychopathology. Even though most children or parents do not exhibit clinical levels of symptoms, this finding does that not mean that the condition had little effect. There are likely many short-term and long-term consequences of these conditions that reflect subtle differences in the nature of development (for example, the differences in autonomy development discussed earlier). Future longitudinal studies need to examine trajectories of parent and child development over time and examine a wide range of child and parent reactions (both subtle and obvious). Moreover, as demonstrated in the studies of posttraumatic growth, both positive and negative consequences need to be explored, as well as the factors that predict different developmental trajectories over time. Fourth, we have very little understanding at this point of how the impact of parenting in chronic health conditions varies as a function of the child’s developmental level or the larger culture in which the child was reared. As argued by Bornstein (1995), cross-cultural comparisons are difficult because the same activity may function differently across cultures, or conversely, very different-looking activities may serve the same function in different cultures. Moreover, parents with different cultural backgrounds may respond differently in the presence of medical professionals. Mougianis, Cohen, and Shih (2017), for example, in interpreting the results of their observations of Latino parents during pediatric immunizations, argued that the Latino cultural value of respecto may have led to deferential behavioral toward medical authorities and lower levels of interaction with their children during the medical procedures. Cultural and social class differences in parenting children with a health condition has received limited research attention—it is an extremely important area for future research. Finally, future research should continue to study the psychological and behavioral processes that account for the impact of children on their parents and parents on their children. Through the use of multiple methods and measures, researchers can continue to make significant progress in understanding, for example, how parental anxiety is communicated to children during stressful medical procedures, how cognitive and emotional processes interact in accounting for parents’ responses to a particular child diagnosis, or how parenting practices impact the development of children’s autonomy. A greater use of longitudinal and experimental designs will continue to move the field forward. Addressing some of the directions outlined above will give us greater insights into the impact of children with a chronic health condition on parenting (and vice versa), and will help to provide directions for the development of effective interventions to minimize child and parent risk and promote positive developmental and family outcomes.

Conclusions Parenting a child with a chronic health condition presents parents with numerous challenges and opportunities for growth. Challenges include the high degree of uncertainty they must face; the unexpected, negative emotional reactions they must manage; and adjustments they must make in their daily 616

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lives to support their child’s condition. Parents clearly differ in how they adapt to these challenges, and researchers have identified some of the factors associated with the most positive outcomes. Parents who adapt well are those who create new, shared family routines that manage family stress and facilitate the development of the child’s autonomous self-care skills; who develop effective partnerships with their spouse and health care workers; who successfully utilize support outside of the family; and who flexibly adapt to the new challenges that arise. Moreover, these parents support their child’s ageappropriate functioning by maintaining age-appropriate expectations and by focusing on their child’s achievements and accomplishments in a way that avoids the development of patterns of parental overinvolvement and overprotection. For parents who successfully manage these challenges, rearing a child with a chronic health condition can lead to positive changes, including a deeper sense of appreciation of life and a greater sense of family closeness and togetherness. Given the importance of parents for the development of children with a chronic health condition, it is important that health care providers and health care systems create programs and policies that support these parents and their children.

Acknowledgments The authors thank Jackelyn Hidalgo-Mendez, Sara Gliese, Emily Wolfe, Masoud Montazeri Jouybari, Christina Saba, Daniel Gordon, Pavan Konanur, Natalie Konig, Sneha Saggurthi, Christina Paul, Laura Arvin, Gunner Sudol, Gloria Gutierrez, and Jenna Guglielmini for their assistance in the literature review of this chapter.

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INDEX

Note: Italicized page numbers indicate a figure on the corresponding page. Page numbers in bold indicate a table on the corresponding page. ABCX stress-coping model 569 – 570, 579 academics and gender differences 269 – 270 Acceptance and Commitment Therapy (ACT) 540, 615 active information management 148 – 149 active sleep and preterm births 428 activities of daily living (ADL) 199 – 200 acute pain conditions 605 – 607 adapting control processes 89 – 91 adaptive behaviors 474 – 478 Adler, Stella 409 adolescent crisis phenomenon 415 adolescents: active information management 148 – 149; adoption and 333 – 334; agency in socialization process 142 – 152; aggressive children 497, 504; autonomy 122 – 123, 131, 132, 138 – 140; basic psychological needs 131 – 133; boundary conditions and independence 121 – 123; brothersister intimacy in 231; conflict management styles 149 – 151; developmental changes 120 – 121; distance taking and independence 120 – 123; emotional development during 113 – 116; heightened orientation toward peers 117 – 120; introduction to 111 – 112; legitimate parental authority and 145 – 148; parent-adolescent bidirectional influence 144 – 145; parent-adolescent conflict 116 – 117; parent-adolescent relationships 112 – 124; psychosocial development 124 – 130; puberty 112 – 113, 116; self-determination theory of parenting 67, 122, 131 – 142, 133, 141; sibling parenting during 230 – 238; summary of 140 – 142, 141, 152; troublesome children and 329 – 330, 344 – 345

adoption/adoptive families: adolescents 333 – 334; communicative openness in 335 – 336; competency training programs 353; external stressors and support structure 347 – 348; forming attachment and grief process 344–; infants 16, 329 – 330; introduction to 322; late-placed children/specialneeds children 341 – 343; maintaining pre-existing relationships 346 – 347; maintaining realistic expectations 345 – 346; middle childhood 83; new contextual realities 323 – 325; openness in 334 – 336; post-adoptive services 328; pre-adoptive adversity 350 – 351; as protection 350 – 352; racial and ethnic considerations 323, 336 – 341; as risk 349 – 350; school-age children 331 – 333; sexual minorities 324 – 325, 349; socialization process 328 – 334; structural openness in 334 – 335; summary of 354; temperament and 296; toddlers/preschoolers 330 – 331; in twenty-first century 322 – 323; unique processes and challenges 336 – 349; variations and patterns 326 – 328 Adoption and Safe Families Act (1997) 369 Adoption Assistance and Child Welfare Act 323 – 324 adoption entrance narratives 330 – 331 Adult Attachment Interview (AAI) 373 – 374, 375 adult children see aging parents and adult children adult day services (ADS) 207 – 208 adversity and aggressive children 507 adversity and talent 402 – 404 affective expression in middle childhood 87 affective-motivational impulses 114 African Americans: adult children as parental caregivers 202; aptitude testing 404; foster care discrimination 389; infant parenting 36 – 37;

625

Index loneliness of 174; middle childhood school experiences 98; permissive parenting 144; sibling relationships 240, 242 after-school care 100 – 101 aggressive children: adoption and 344; attachment theory of parenting 499 – 500; bidirectional interactions and 504; childhood and adolescence 497, 504; child-level characteristics as moderating medium 504 – 506; cultural differences 507 – 509; defining key terms 497 – 498; developing trajectories 497; future parenting directions 512 – 513; gender differences in parenting 263 – 265; introduction to 496; meta-level theories 498; methodological considerations 511 – 512; negative emotions and 503; parental control 500 – 502; parenting as mediating mechanism 506 – 507; parenting interventions 509 – 511; parenting of 498 – 509; social learning theory 498 – 499; summary of 513; temperament and 505 aging parents and adult children: conflict strategies 196; critical issues 193 – 194; death and bereavement 206; demographics and social changes 192 – 193; family systems interventions 207; future trends in intergenerational ties 208 – 209; intergenerational relationship qualities 195 – 196; introduction to 191 – 192; managing burden of caregiving 206 – 208; offspring support of parents 197 – 198; parental support of grown children 196 – 197; parents with disabilities 191 – 192, 199 – 206; relationship measures 198 – 199; summary of 209; talented children and 406; theoretical approaches to 194, 194 – 195 Ainsworth, Mary 373 Allen, Steve 408 alpha-amylase enzyme 21 Alzheimer’s disease 203 American Academy of Pediatrics (AAP) 70 American College Test (ACT) 410 American Psychologist 598 Americans with Disabilities Act (ADA) 582 American Time Youth Survey 8 anabolic steroid 23 Anglo culture and sibling relationships 240 angry temperament 291, 292 antenatal attachment expectancy 12 antiretroviral therapy (ART) for pediatric HIV 609 antisocial behavior 92 – 93, 238, 496 anxiety: adoption and 345; during free play in school 480 – 481; over medical procedures 605 – 607; in parents with preterm infants 436; social anxiety disorder 483; talented children 404 anxiety-driven social withdrawal 472 appearance-based pressure 267 aptitude testing 404 Arc, The 582 assisted living for aging parents 205 Attachment and Biobehavioral Catch-Up (ABC) 352, 376, 383 – 384

attachment relationships 169, 344, 472 – 474 attachment states of mind 376 – 377 attachment theory of parenting: adolescent parenting 128 – 129; aggressive children 499 – 500; autism spectrum disorder 541 – 543; foster children 372, 373 – 377; introduction to 10, 19; siblings 225 attention deficit disorders (ADD) 404, 405 attention deficit hyperactivity disorder (ADHD) 297, 404, 547 attention-regulation 64, 523 Austrian parental leave policy 262 authoritarian parenting 124 – 125, 146, 171 – 172, 233, 292, 297, 301, 478 authoritative parenting 124 – 126, 128, 171 – 173, 478 Autism Diagnostic Interview-Revised (ADI-R) 526 Autism Diagnostic Observation Schedule(ADOS-2) 526 Autism Speaks 528 autism spectrum disorder (ASD): attachment theory of parenting 541 – 543; changing relationships 549; coping with 529, 535 – 540, 536 – 538; economic impact of 531 – 532; family processes and 546 – 551; future research directions 551; historical views on 527 – 529; impact of diagnosis 529 – 531; infants 29; introduction to 523 – 527, 524, 525; marital satisfaction impact of 532; older adults with 550; parent-child interactive processes 540 – 546; parentimplemented interventions 545 – 546; parenting practices and expectations 548 – 549; relational factors and outcomes 547 – 548; resilience and 529, 539 – 540; sibling interactions 242; stigma of 531; stress and 526, 529, 533 – 535; summary of 551 – 552; talented children and 404, 405 autonomic arousal 480 autonomic functioning 309 autonomic nervous systems 23 autonomy: adolescence 122 – 123, 131, 132, 138 – 140; cultural differences in 260; emerging adults 173 – 174; emotional autonomy 176; middle childhood 91 – 92; psychological autonomy 176; sibling parenting 233; toddlers 58 – 60 autonomy-supportive parenting 138 – 141, 176 baby biographies 6 babyishness 26 Bayley Scales of Infant Development 447 behavioral inhibition and social withdrawal: adaptive vs. maladaptive behaviors 474 – 478; age-related 476 – 477; buffering effect 473 – 474; causal parenting effects 482 – 483; cultural differences 473, 477 – 478; defined 468; emotional competence theory 470, 472 – 474; father parenting 484; future research directions 486 – 487; internalizing problems and disorders 481; intrapersonal factors 485; introduction to 467 – 468; measurement and design in 469 – 470; overly protective childrearing strategies 476, 479 – 480, 484 – 486; parenting behaviors 478 – 484; positive parenting 481 – 482; psychological control 479 – 481; relationship

626

Index and contextual factors 485 – 486; as risk factors 468 – 469; social competence theory 470 – 471, 475 – 476; social withdrawal 475 – 476; summary of 487 – 489 behavior/behavioral states: adherence-promoting behaviors 609 – 610; antisocial behavior 92 – 93, 238, 496; control by parents 177; dieting behaviors and self-esteem 267; externalizing behaviors problems 293 – 294; gender differences in play behavior 270 – 272; hostile-reactive behaviors 9; infancy 27; maladaptive behaviors 144, 178, 179, 474 – 478, 480, 565; maternal intrusive behavior 69; negative behaviors 226; overcontrolled behaviors 471, 481; positive behaviors 226; predictability in infant behavior 33; prosocial behavior of emerging adults 182; risk behavior/ risk management 84 – 86, 180; rule-breaking behavior 181 – 182; self-endorsement of 122 behavior genetic (BG) research 222 – 223 behavior-modification techniques 62 – 63 Bell’s classic notion of interaction 571 bereavement 206 bicultural socialization 340 – 341 bidirectional interactions 144 – 145, 504 binge drinking 21 biological determinants of parents 22 – 25 birth order 116 – 117, 241 birth parents vs. foster parenting 371 Birtwell, Charles 369 Boston Children’s Aid Society 369 Bowlby, John 373 brain impact on parenting 23 Brando, Marlon 409 brother-sister intimacy in adolescence 231 Bucharest Early Intervention Project 375 buffering effect 473 – 474 callous-unemotional (CU) characteristics 295, 506 Canada, social withdrawal in children 477 canalization 8 caregivers/caregiving: adoption and 332 – 333; aggressive children and 507; autism spectrum disorder and 543 – 545; chronic health conditions and 604 – 605; enactment of role 202 – 205; expressions 22; managing burden of 206 – 208; older adults with autism spectrum disorder 550; parents with disabilities 191 – 192, 199 – 206; preterm births 448; psychoeducational programs for 206 – 207; sensitive caregiving 352, 439 – 442, 447 – 450; social caregiving 14; stressors 202 – 205; transitions and disengagement from role 205 – 206 Care Index data 441 care settings for aging parents 205 – 206 case planners 369 – 370 Casey Foster Parent Inventory 378 central nervous systems 23 cerebral cortex 170 chaos parenting 133

characteristic development of gifts and talents 401 Child Abuse Prevention and Treatment Act (1974) 369 child development see developmental changes/ outcomes child effortful control in 297 – 300, 302 – 303 child-focused social-skills intervention 526 childhood psychiatric disorder 430 child neglect 370, 388 Child-Parent Psychotherapy (CPP) 387 child prodigies 411 – 412 Child-Rearing Practices Report 612 children, defined 4 Child Report of Parent Behavior (CRPBI) 130 child welfare caseworkers 371 – 372 Child Welfare Gateway 353 child welfare system 368, 369 – 373 China, social withdrawal in children 477 – 478 chronic health conditions: adherence-promoting behaviors 609 – 610; age-appropriate functioning 611 – 615; beyond initial diagnosis 600 – 601; caregiver burden 604 – 605; central parenting issues 598; child vulnerability and 612; developmental considerations 607 – 608; emotional reactions of parents 599 – 604; future research directions 615 – 616; health beliefs of parents 608 – 609; historical considerations in parenting 598; introduction to 597 – 598; pain and 605 – 607, 614 – 615; parental overprotection 612 – 614; parenting research 599 – 615; parenting stress 602; parenting theory 598; predictors of adjustment differences 601 – 602; summary of 616 – 617; time of diagnosis factors 599 – 600; transition to self-care 610 – 611 chronological age (CA) 116, 425, 430, 510, 567 – 568, 573, 587 clinical modification of positive parenting 305 – 306 Code of Hammurabi 6 coercion theory 499 coercive processes 226 cognition evaluation studies 16 cognitive behavioral therapy 540, 582 cognitive development: middle childhood 82 – 83; parent differential treatment 234 – 235; preterm infants 448 – 449; temperament and 288; toddlers 57, 60, 65 – 66 cognitive disciplinary techniques 61 cognitive readiness in parents 24 – 25 co-incidence model 402 collective well-being in middle childhood 93 – 94 collectivism 142, 508 communication: adoptions and 328; foster caregivers and birth parents 383; openness in adoptive families 335 – 336; in parent-adolescent relationships 115; social communication deficits 533; toddler skills 60 competence needs of adolescents 131 compliance problem solving 150

627

Index Comprehensive Early Childhood Parenting Questionnaire (CECPAQ) 67 compulsory education 260 conduct disorder 295 configurational approach to parenting 124 – 126 conflict management styles 149 – 151 conflict strategies for aging parents and adult children 196 conformity in toddlers 60 conformity orientation 335 Confucianism 477 consistency in parenting cognitions and practices 14 – 15 consulting strategies of parental peer management 119 content features of infant-directed speech 24 contingent responding 440 – 441 controlling parenting 134 – 135, 142, 144 control processes 89 – 91 conversation orientation 335 Cool Little Kids program 482 – 483 co-parenting infants 11, 16 coping strategies: ABCX stress-coping model 569 – 570, 579; autism spectrum disorder 529, 535 – 540, 536 – 538; Double ABCX stress-coping model 569 – 570; emotion-focused (EF) styles 539; emotions and 97; middle childhood 84 – 86, 87, 97; problem-focused (PF) coping 539, 574; stress-coping models 569 – 570 coregulation principle 20 – 21, 90 cortisol hormone 370, 384 couple/marital relationships 227 Croatian college students 174 Croatian parental leave policy 262 cross-gender interactions in middle childhood 96 crying in preterm infants 429 cultural beliefs/differences: in adopted children 326; adult sibling relationships 239, 240 – 242; aggressive children 507 – 509; behavioral inhibition and social withdrawal 473, 474 – 478; gender differences and 258; infant expression 30; infant parenting 13, 35 – 37; introduction to 6; middle childhood schooling 98 – 99; psychological needs of adolescents 131; see also diversity Cure Autism Now 528 D’Amboise, Jacques 415 Darwin, Charles 6 daughters as parental caregivers 201 – 202, 203, 205 death and bereavement 206 de-identification of siblings 226 delayed launching 572 demand-withdraw pattern of conflict resolution 150 dementia 203, 206 demographics of aging parents and adult children 192 – 193, 199 depression: in adolescence 114; adoption and 345; aging parents 196; in caregivers 202, 205; childhood maltreatment and 375; with Down

syndrome 575; motherhood and 25; parenting aggressive children 507; in parents of children with ASD 533; in parents with preterm infants 436 – 437; postpartum depression 330 developmental changes/outcomes: adolescents 112; chronic health conditions 607 – 608; coercive family interaction patterns 226; emerging adults 171; infancy 31 – 33, 32; parental knowledge of 12; peer interaction 469, 472, 474; preterm birth 424 – 426, 430 – 431, 445 – 450, 454 – 455 developmental perspective of intelligence 401 developmental plasticity factors 409 developmental systems theory 289 – 293 deviance training 238 diathesis-stress interactions 304 didactic caregiving 14 dieting behaviors and self-esteem 267 dimensional approach to parenting 126 – 128, 129 – 130 direct commands in parenting 544 disability services for adults 581 – 582 disabled parents 191 – 192, 199 – 206 discipline: aggressive children 501 – 502; cognitive disciplinary techniques 61; inductive discipline 61; middle childhood 89; toddlers 60, 61; see also harsh discipline discrimination in foster parenting 388 – 389 disease-related parenting stresses 602 disorganized attachment 370 dispositional vulnerability 480 distance taking and adolescents 120 – 121 divergence perspective in preterm births 425 – 426 diversity: of adopted children 326; cultural diversity 260 – 261; gender diverse/nonconforming children 258; individual diversity 259 – 262; parental diversity 260; parenting emerging adults 181; talent and 402 – 404; toddler parenting 65 – 67; see also cultural beliefs/differences divorce 193 dizygotic (DZ) twin research 222 – 223 domain-dependent effects of parenting 145 – 148 domain-general perspective of intelligence 400 domain-specific perspective of intelligence 400 – 401 domestic violence 370 – 371 Double ABCX stress-coping model 569 – 570 Down syndrome 566, 567, 571 – 580 DRD4 polymorphism 484 drug use/abuse: infant parenting 21; mood disorders and 25; nonmedical prescription opioid use 175; parent risk of 371 dynamic belief systems 474 dynamic networks approach 403 dynamic systems theory 170 dyscalculia 404 dyslexia 404, 405 dyspraxia 404

628

Index Early Childhood Longitudinal Study-Birth cohort 24 Early Infancy Temperament Questionnaire 431 early infantile autism 527 East Asia, social withdrawal in children 477 ecological systems framework 227 economic stress 485 – 486 Edinburgh Postnatal Depression Scale (EPDS) 435 Education for All Handicapped Children Act (1975) 581 effortful control 297 – 300, 302 – 303, 307 – 308 Einstein, Albert 408, 412 emerging adults: autonomy-supportive parenting 176; bidirectionality in parent-child relationships 181 – 182; future directions in parenting 180 – 184; helicopter parenting 179 – 180; introduction to 168 – 169; need for diversity 181; parental control 176 – 180; parental support 174 – 176; parenting styles 171 – 173; as parents 24, 183; parents of 183 – 184; specificity and multidimensionality 192 – 183; summary of 184 – 185; theories of parenting 169 – 171 emotional abuse 370 emotional autonomy 176 Emotional Autonomy Scale (EAS) 121 emotional competence theory 115, 470, 472 – 474 emotional contagion 114 emotional cues and infants 19 emotional disorganization stage 567 emotional expressivity in infancy 29 – 30 emotional re-organization stage 567 emotional support 197, 501 emotion-based copers 574 emotion-focused (EF) styles of coping 539 Emotion Regulation Checklist 431 emotions: callous-unemotional (CU) characteristics 295, 506; coping styles 97; development/regulation during adolescence 113 – 116; gender differences in parenting 263 – 265; impact of diagnoses on 530; impairments 405; negative emotionality 291, 293, 295 – 297, 299, 303 – 306; positive emotionality 297, 299 – 300; reactions of parents to child chronic health conditions 599 – 604; self-regulation of toddlers 59 Empty Fortress,The (Bettelheim) 527 Erasmus, William 6 ethnic differences 179, 327, 336 – 341 ethnic-racial socialization 337 – 338 ethological adaptations 471 Eunice Kennedy Shriver-Intellectual and Developmental Disabilities Research Centers (EKS-IDDRCs) 582 European American families: adoption by 323, 340; emerging adults 168, 175, 181; middle childhood relationships 98, 99; sibling relationships 230 – 231, 240; socializing gender roles 260; social withdrawal in children 477 Even the Rat Was White: A Historical View of Psychology (Guthrie) 404

evidence-based interventions 390, 547 evoked response potentials (ERP) 23 evolutionary theory 6 executive functioning 170, 220, 370, 404, 431 experience models of infant parenting 17 exploration in play 471 externalizing behaviors 293 – 294, 340 extra-familial experiences 98 – 101 extrauterine life 8 eye-to-eye contact of infants 28 face-to-face interactions 9, 90 Face-to-Face Still-Face procedure 446 families/family characteristics: autism spectrum disorder 546 – 551; coercive family interaction patterns 226; extra-familial experiences 98 – 101; intellectual disabilities 568, 571 – 572, 583 – 584, 585; Mexican American families 239, 245, 261; ‘patchwork’ families 70; triadic family relationships 229 – 230; see also adoption/adoptive families; European American families family configurations 34, 69 – 70 Family Life Project Investigators, The 436 – 437 Family Nurture Intervention 453 family systems theory 227, 234 – 235, 406 – 409 Far From the Tree (Solomon) 416 Farrell, Suzanne 408 Fast Track social skills training 245 fathers/fathering: adolescence and 114; authoritative fathering 172; behavioral inhibition and social withdrawal 484; infant parenting 8 – 9; middle childhood parenting 87 – 88; oxytocin (OT) hormone 23; parental leave policies for 262; preterm births and 433, 435, 453 – 454; at siblinghood transition 228; toddler parenting 68 – 69 feedback by parents 137 feeding beliefs 12 felt security 471 Finnish emerging adults 175 first births 24 Five-Minute Speech Sample 547 – 548 Foster Parent Attitudes Questionnaire 378 foster parenting: abuse and neglect 388; attachment states of mind 376 – 377; attachment theory 372, 373 – 377; birth parents 371; brief history 369 – 370; child welfare caseworkers 371 – 372; child welfare system 368, 369 – 373; commitment to 378 – 382; controversies in 387 – 389; discrimination in 388 – 389; foster children 370 – 371, 380; foster parents 372 – 373; future directions 389 – 390; interventions for 382 – 387; introduction to 368; lack of biological relatedness 379 – 380; nature of temporary care 378 – 379; parenting programs 386 – 387; quality of 381; structure of 379; summary of 390; support needs 383 fragile X gene 574 Freud, Sigmund 6, 7

629

Index Garland, Judy 408 gender bias 274 – 275 gender differences: academic concepts 269 – 270; aggressive children 505 – 506; cross-gender interactions 96; emotions and aggression 263 – 265; future research directions 275 – 276; gender as a category 263; household expectations 272 – 273; individual diversity 259 – 262; infants 9; introduction to 258; language learning 268 – 269; parental diversity 260; parental leave policies 261 – 262; parent differential treatment 235; play behavior 270 – 272; self-esteem and 266 – 268; socialization differences 263 – 274; summary of 276 – 277; support for talented children 413; survivorship and 193; theoretical frameworks 262 – 263 gender diverse/nonconforming children 258 gender gap 192 – 193, 264 gender identity 259 gender stereotypes 262 – 263, 271 gender-typed toys 271 – 272 gene–environment associations 143 general intelligence 400 Genes, Brains, and Human Potential:The Science and Ideology of Intelligence (Richardson) 404 genetics: behavioral withdrawal 483; infant development 16, 22; intellectual disabilities 574; monoamine oxidase-A (MAOA) gene variation 505; negative emotionality and 304 – 305; talented children 409; temperament and 296, 309 genius 400 German parental leave policy 262 gestational age and preterm births 431 – 432, 452 gifted children 400, 405 goodness-of-fit models 19 Graffman, Gary 408 grandparents and infant parenting 10 Greene, Graham 408 grief process and adoption 344 group-based parent-training programs 510 group-differences research 580 group homes 372 guilt and autism spectrum disorder 531 Hague Convention on the Protection of Children and Cooperation in Respect of Intercountry Adoption 324 Handbook of Pediatric Psychology (Roberts, Steele) 598 harsh discipline: aggressive children 500; behaviormodification techniques 62 – 63; developmental systems theory 289; temperament and 292, 301 Head Start students 413 health belief model (HBM) 608 – 609 helicopter parenting 179 – 180 Henry IV, King 6 heritability factors see genetics Heroard, Jean 6

high achievement after childhood trauma 407 high negative parenting 292 Home Before Dark (Cheever) 406 homework attitudes 100 hormones 22 – 23, 113, 370, 384 hospitalization of preterm births 428, 435 – 436 hostile-reactive behaviors 9 household expectations and gender differences 272 – 273 HPA-axis functioning 309 hyperactivity 295, 344, 571 hyperarousability 488 hypersensitivity of adolescents 118 hypervigilance 500 hypothalamic-pituitary-adrenocortical (HPA) activity 472 hypothesis-driven research 246 immunization lack 22 impulsiveness of adolescents 143 Incredible Years program 306, 386 – 387 independence in adolescents 120 – 123 independence of parenting cognitions and practices 15 indirect commands in parenting 544 individualism 60, 508 Individualized Educational Plan (IEP) 581 infancy: behavioral states 27; developmental changes 31 – 33, 32; effects on parenting 26 – 33; emotional expressivity and temperament 29 – 30; mothers’ responses and 442 – 445; perception and thinking 28 – 29; physical stature/psychomotor abilities 27 – 28; social life 30 – 31; speaking and understanding 29; structural characteristics 26 – 27 infant, defined 4 infant abuse/neglect 21 – 22 Infant Behavior Questionnaire-Revised 431 infant-caregiver dyad 374 infant-directed speech 23 – 24 infant mortality 13 – 14, 21 infant parenting: abuse/neglect 21 – 22; adoption and 16, 329 – 330; biological/psychological determinants of parents 22 – 25; brief history 5 – 6; contexts of 33 – 38; cultural beliefs 13, 35 – 37; direct and indirect effects 16 – 17; family configuration 34; fathers 8 – 9; infant effects on 26 – 33; introduction to 3 – 5, 4; mechanisms of 18 – 21, 20; models of 17 – 18; parenting cognitions 11 – 13; practices 13 – 14; primary responsibilities for 8 – 11; principles of 14 – 21; psychometrics 14 – 15, 15; siblings 9 – 10; situational variables 33 – 34; social support 34; socioeconomic status 14, 24, 35; summary of 38 – 39; theoretical significance 7 – 8 infertility and adoption 329 inflammatory bowel disease 610 information-processing skills of infants 28

630

Index inhibitory control 370 in-home helpers 207 – 208 insecure-resistant/ambivalent attachment classification 373 insecurity and social withdrawal 473 Institutional Abuse Investigation Unit (IAIU) 388 institutional settings for foster children 372 intangible support 197 intellectual disabilities (ID): child factors and 575 – 577; children as meaning-makers 570; ethnicity and 585 – 586; etiology and effects on parents and families 571 – 572, 585; family characteristics 568, 579 – 580, 583 – 584; future research directions 584 – 587; group vs. individual approaches to studying 570 – 571; history of parenting children with 566 – 568; introduction to 565 – 566; lifetime care 572, 586; maternal and paternal parenting reactions 574 – 577; measurement 586 – 586; methodological study issues 572 – 573, 587; modern research on parenting 573 – 580; mother-child interactions 577 – 579, 583; parent-child dyads 567 – 568; parenting factors and 574 – 575; pathology and stress-coping models 569 – 570; practical information about 580 – 584; summary of 587 – 588 intelligence assessment metrics 400 intelligence quotient (IQ) 401, 409, 410, 413 Intercountry Adoption Act 324 Interethnic Placement Act 323 intergenerational relationship qualities 195 – 196 internalizing problems and disorders 481 internal-state discourse 232 Internet-facilitated adoptions 325 interparental conflict 236 – 237 intervention strategies: aggressive children 509 – 511; aging parents and adult children 207; autism spectrum disorder 545 – 546; for behavioral withdrawal 475 – 476; Bucharest Early Intervention Project 375; child-focused social-skills intervention 526; development of 535; evidencebased interventions 390, 547; Family Nurture Intervention 453; foster parenting 382 – 387; parenting aggressive children 509 – 511; parentpsychoeducational intervention 544; Playing and Learning Strategies intervention 452 – 453; preterm birth 450 – 453 intuitive parenting 23 involvement by parents 132 Islamic cultures 260 Israeli college students 174 Italy, social withdrawal in children 477 Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER) 544 joint attention symptom 543 – 544, 546 Journal of Pediatric Psychology 598

Kaufman Assessment Battery for Children 452 Keeping Foster Parents Trained and Supported (KEEP) 385 knowledge growth in middle childhood 82 – 83 laissez-faire parenting style 408 language development: evaluation studies 16; gender differences in 268 – 269; infants 16, 18; toddlers 57, 65 – 66 late-placed adoptive children 341 – 343 Latino immigrant college students 176 Leadership Education in Neurodevelopmental Disorder (LEND) 582 least restrictive environment (LRE) 581 legitimate parental authority 145 – 148 lexical features of infant-directed speech 24 LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer) individuals: adoption and 324 – 325, 349; gender bias and 274, 275; gender diverse/nonconforming children 258; toddler parenting 70 life expectancy at birth 192 limbic activation during adolescence 114 logical thinking 332 loneliness 85, 174 low positive parenting 292 maladaptive behaviors 144, 178, 179, 474 – 478, 480, 565 maladjustment 121, 134 – 135 maltreatment: African American foster children 389; child welfare system and 370, 371, 374; in outof-home placements 388; as threat to attachment 374 – 375 marriage: adoption challenges 346 – 347; impact of autism spectrum disorder 532; infant parenting 16 – 17; parent-adolescent relationship and 113; siblinghood transition and 229; social learning theory and 169 material caregiving: inductive discipline 61; introduction to 14; psychological control 178 maternal behavior see mothers/mothering maternal mourning stages 566 – 567 Maternal Post-Natal Attachment Scale 446 maternal scaffolding 59 mathematical ability 410 maturation perspective in preterm births 425, 429 maximal development of gifts and talents 401 mean length of utterance (MLU) 567 – 568, 579 mediating strategies of parental peer management 119 media use by toddlers 70 – 71 medical procedures and parent-child interactions 605 – 607 mental age (MA) 568, 571, 573, 578 – 579 Mental Development Index 63 mental health 220, 353, 534 – 535 Mental Processing Composite of the Kaufman Assessment Battery for Children 452

631

Index Mexican American families 239, 245, 261 middle childhood: adapting control processes 89 – 91; adoption and 331 – 333; after-school care 100 – 101; aggressive children 497, 504; cognitive competence 82 – 83; coping strategies 84 – 86, 87; coregulation 90; disciplinary practices 89; effective control 90 – 81; exposure to violence 85 – 86; extra-familial experiences 98 – 101; historical considerations 81 – 82; introduction to 81; moral values 93; mutual cognitions 88; normative changes 82 – 87; parental interaction 87 – 88; parenting issues 89 – 101; peer interaction 84, 94 – 95; positive relationships 94 – 98; prosocial and antisocial behavior 92 – 93; responsibility and collective well-being 93 – 94; risks and coping 84 – 86; school experiences 98 – 100; selfmanagement and social responsibility 91 – 94; selfregulation 82, 86 – 87; siblings 94; social groups/ networks 83 – 84; summary of 101 – 102 Middle School Success (MSS) 385 – 386 mindfulness-based cognitive behavioral therapy 540 mindfulness-based stress reduction (MBSR) 582 Minnesota Multiphasic Personality Inventory (MMPI) 569 – 570 minority groups and toddler parenting 66 – 67 Mismeasure of Man,The (Gould) 404 mobility development in toddlers 57 monoamine oxidase-A (MAOA) gene variation 505 monozygotic (MZ) twin research 222 – 223 mood disorders 25, 404 – 405 moral-conventional domain of parenting 147 morality/moral values 93, 145, 506 morbidity (disease rates) 191 More Fun with Sisters and Brothers program (MFWSB) 244 mortality (death rates) 191 Mother-Infant Transaction Program 452 mothers/mothering: authoritative mothering 172; depression and 25; infant parenting 8 – 11, 442 – 445; maternal intrusive behavior 69; middle childhood parenting 87 – 88; oxytocin (OT) hormone 22 – 23; parenting cognitions 11 – 13; parenting siblings 236 – 237; preterm births 433 – 434, 438 – 441, 446; refrigerator mother theory 528; teenage mothers 24; utterances by mothers to infants 15; warmth/responsiveness 175 multidimensional intergenerational support model (MISM) 194 multidimensionality in parenting emerging adults 192 – 183 Multidimensional Treatment Foster Care for Adolescents (MTFC-A) 386 Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) 376, 384 – 385 Multi-Ethnic Placement Act 323 multi-level modeling strategies 235 multiple regression analyses 292 mutual cognitions in middle childhood 88

National Adoption Competency Mental Health Training Initiative (NTI) 353 National Alliance for Autism Research 528 National Alliance for Caregiving and the American Association of Retired Persons 200 National Center for Children, Toddlers, and Families 4 National Child Abuse and Neglect Data System 389 National Down Syndrome Congress 582 National Down Syndrome Society 582 National Fragile X Foundation 582 National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development 24 National Survey of Family Growth 325 nature-nurture distinction 400 need-supportive parenting 134, 149, 151 need-thwarting parenting 133, 134 negative behaviors 226 negative emotionality 291, 293, 295 – 297, 299, 303 – 306, 503 negative parenting 30, 301 – 303; see also harsh discipline negative relationships in siblinghood 229 neglectful parenting 500 NEO-ACQUA Study Group 437 Neonatal Behavioral Assessment 439, 450 Neonatal Individualized Developmental Care Program (NIDCAP) 427 neural functioning 309 neurobiological changes during adolescence 114 neurodiversity and talented children 404 – 406 New Jersey Division of Youth and Family Services (DYFS) Institutional Abuse Investigation Unit (IAIU) 388 New School for Social Research 409 New York Children’s Aid Society 323 NICHD Study of Early Child Care and Youth Development 481, 486 nonconventional life-styles 407 nonfamilial daycare providers 10 non-relative foster homes 372 Nureyev, Rudolph 415 nursing homes for aging parents 205 nurturant caregiving 13 – 14 obsessive-compulsive disorders 404 offspring support of parents 197 – 198 Olshansky’s recurrent reactions model 575 open adoption 334 – 335 oppositional defiant disorder 295 oral phase of child development 7 Organization for Economic Co-operation and Development (OECD) 261 – 262 Origin of Species (Darwin) 6 overcontrolled behaviors 471, 481 overexcitability theory 408 overinvolved parenting 612 – 614

632

Index overly protective childrearing strategies 476, 479 – 480, 484 – 486 oversolicitous parenting 479 oxytocin (OT) hormone 22 – 23 Pakistani parental autonomy 260 paradoxical interactions 305 parasympathetic control 480, 484 parental behavioral control 126 – 127 Parental Bonding Instrument 612 Parental Investment in Child scale (PIC) 378 parental leave policies 261 – 262 parental peer management strategies 119 parental socialization 223 parental support: adolescents 126 – 128; aggressive children and 502 – 503; emerging adults 174 – 176; of grown children 196 – 197 Parent-Child Interaction Therapy (PCIT) 306, 387, 483 parent differential treatment (PDT) 224 – 225, 226, 234 – 235, 241 Parenting as Social Context Questionnaire-Toddlers (PSCQ-Toddlers) 67 parenting cognitions 11 – 13 Parenting Stress Index (PSI) 434, 569 Parenting Stress Index (PSI-SF) 533 parent management training (PMT) 244 parent-peer cross-pressures 97 – 98 parent-psychoeducational intervention (PEI) 544 parents/parenting: adolescent relationships 112 – 124; aggressive children 500 – 502; attachment theory of parenting 10, 19, 128 – 129; authoritarian parenting 124 – 125, 146, 171 – 172, 233, 292, 297, 301, 478; authoritative parenting 124 – 126, 128, 171 – 173, 478; autonomy-supportive parenting 138 – 141; behavioral control by 177; beliefs about behaviors 12; bright vs. dark side of 133 – 134; configurational approach to 124 – 126; conflict management styles 149 – 151; controlling parenting 134 – 135, 142, 144; demographics of 4; developmental systems theory 289 – 290; dimensional approach to 126 – 128, 129 – 130; emerging adults 176 – 180; emerging adults and 171 – 173, 183; helicopter parenting 179 – 180; legitimate parental authority 145 – 148; need-supportive parenting 134, 149, 151; negative parenting 30, 301 – 303; overinvolved parenting 612 – 614; permissive parenting 125, 140, 144, 171 – 172; positive parenting 303 – 308; preterm birth 432 – 453; psychological control by 177 – 178; self-determination theory 67, 122, 131 – 142, 133, 141; social support for 98; temperament and 291 – 293, 299 – 300; unconventional parenting systems 400; see also aging parents and adult children; temperament X parenting interaction partial disclosure by adolescents 148 patchwork families 70 paternal parenting see fathers/fathering PATHS program 245

Patterns of Child Rearing (Sears, Maccoby, Levin) 258 peer interaction: consulting strategies of parental peer management 119; developmental impact of 469, 472, 474; foster children 370; heightened orientation by adolescents 117 – 120; introduction to 10; middle childhood 84, 94 – 95; parent-peer cross-pressures 97 – 98 perception in infancy 28 – 29 Perinatal Posttraumatic Stress Disorder Questionnaire 446, 447 Perinatal Risk Inventory (PERI) 441 permissive parenting 125, 140, 144, 171 – 172 personality in parenting 25 physical abuse 370, 388 physical punishment 12, 63 physical stature in infancy 27 – 28 Piaget, Jean 6 Pictorial Representation of Attachment Measure 439 PIPARI Study Group 438 Plato 6 play behavior and gender differences 270 – 272 Playing and Learning Strategies intervention (PALS) 452 – 453 positive behaviors 226 positive emotionality 297, 299 – 300 positive parenting 303 – 308, 481 – 482 positive problem solving 150 positive relationships 94 – 98, 229 post-adoptive services 328 Postpartum Bonding Questionnaire 439 postpartum depression 330 posttraumatic growth 603 posttraumatic stress disorder (PTSD) 599 – 600, 616 Posttraumatic Stress Disorder Questionnaire 441 poverty and infant parenting 21 Prader-Willi syndrome 571 Prader-Willi Syndrome Association 582 pre-adoptive adversity 350 – 351 pre-adoptive homes 372 preconception care 6 predictability in infant behavior 33 prefrontal cortex 170, 171 preparation-for-bias 337 – 338 preterm birth: acute biological risks 426 – 427; biomedical risks 447 – 450; developmental outcomes 424 – 426, 430 – 431, 445 – 450, 454 – 455; fathers/ fathering and 433, 435, 453 – 454; future directions 453 – 456; health and 424 – 426; intervention studies 450 – 453; introduction to 424; measure and design issues 455; observational studies 437 – 450, 445 – 450; parental bonding 437 – 439; parental care and 437 – 453; parental training programs 452 – 453; principles of parenting 432 – 433; psychological risk for parents 433 – 437; regulatory problems 427 – 430; risk and resilience 455 – 456; sensitive/responsive parenting of 439 – 442, 447 – 450; skin-to-skin contact 451, 456; social interactions, timing/bidirectional nature 442 – 445; stimulation interventions 450 – 451

633

Index primary stressors of caregivers 202 – 203 privacy in parent–adolescent relationships 148 – 149 problem-based learning 59, 82 problem-focused (PF) coping 539, 574 problem-solving skills 233 Program for Education and Enrichment of Relational Skills (PEERS) 540 prosocial behavior in middle childhood 92 – 93 prosocial behavior of emerging adults 182 prosodic features of infant-directed speech 23 protective parenting 130 psychoanalytic theory 496 psychodynamic perspective on siblinghood 229 psychological aggression in toddlers 63 psychological autonomy 176 psychological control 60, 177 – 178, 479 – 481 psychological determinants of parents 22 – 25 psychological needs of adolescents 131 – 133 psychometric evaluation 401 psychometrics of infant parenting 14 – 15, 15 psychomotor abilities in infancy 27 – 28 psychomotorical talent 415 psychosocial development in adolescents 124 – 130, 131 puberty 112 – 113, 116 Pulgar, Judit 415 punitive parenting see harsh discipline Quality Parenting Initiative (QPI) 389 Questionnaire for Resources and Stress (QRS) 569 racial considerations and adoption 323, 336 – 341 Rapid Stress Assessment 435 REACH II program 206 reciprocity in parent–adolescent relationships 151 – 152 redundancy features of infant-directed speech 23 – 24 refrigerator mother theory 528 regulatory problems in preterm birth 427 – 430 rejection parenting 133 relatedness needs of adolescents 131, 132 Relationship Code, The 246 – 247 relationships: aging parents and adult children measures 198 – 199; behavioral inhibition and social withdrawal 485 – 486; intergenerational relationship qualities 195 – 196; middle childhood 94 – 98; negative relationships in siblinghood 229; positive relationships 94 – 98, 229; privacy in parent–adolescent relationships 148 – 149; romantic relationships 169, 178; siblings/sibling parenting 238 – 240, 239, 240 – 242; toddler parenting 65; triadic family relationships 229 – 230 relative/“kinship” foster homes 372 responsibility concerns 4, 93 – 94 responsiveness in infant parenting 19 responsiveness in parenting 125 reunification process with foster children 372 Revised Infant Temperament Questionnaire 430

Richards, Martin 437 risks/risk management: adoption/adoptive families 349 – 350; middle childhood 84 – 86; preterm births 426 – 427, 433 – 437, 447 – 450 romantic relationships 169, 178 rule-breaking behavior 181 – 182 Russell, Bertrand 412 – 413 Sanger, Margaret 409 Schauffer, Carol 389 schizophrenia research 524 Scholastic Aptitude Test (SAT) 410 school experiences in middle childhood 98 – 100 secondary stressors of caregivers 203 – 204 self-awareness in toddlers 58 self-blame and autism spectrum disorder 531 self-care with chronic health conditions 610 – 611 self-centeredness 25 self-critical perfectionism 129, 174, 473 self-determination theory (SDT) 67, 122, 131 – 142, 133, 141 self-efficacy: chronic health conditions 614; emerging adults 179; of fathers 9; parents of ASD children 545; sibling parenting and 220 self-endorsement of behavior 122 self-esteem: adolescents 118; adoption and 336; behavioral inhibition and social withdrawal 478; emerging adults 174; gender differences 266 – 268; parenting styles and 129, 227; sexual self-esteem 174; siblings and 226 self-management 91 – 94, 310 self-produced locomotion 31 self-regulation: emotional competence and 472; middle childhood 82, 86 – 87; preterm births and 431, 449; sibling parenting 233; social withdrawal and 483; of temperament 291; toddlers 64, 69 sensation seeking of adolescents 143 sensitive mutual understandings 5 sensitive period interpretation of parenting 17 sensitive period of infant development 7 – 8 sensitive/responsive caregiving 352, 439 – 442, 447 – 450 separation-individuation theory 120 sexual abuse/assault 370, 417 sexual orientation and gender identity (SOGI) 259, 275 sexual self-esteem 174 Shockheaded Peter (Hoffmann) 496 shyness in children 30 sibling differentiation 222 sibling effects 237 – 238 Siblings Are Special (SIBS) program 245 siblings/sibling parenting: attachment security 225; caregiving of aging parents 204; central parenting issues with 223 – 225, 224; during childhood and adolescence 230 – 238; cultural context of relationships 239, 240 – 242; developmental trajectories 230 – 231; differential treatment

634

Index 234 – 235; with disabilities 242 – 243; family systems theory 227; future directions 245 – 247; historical considerations 221 – 223; infant parenting 9 – 10; interparental conflict 236 – 237; introduction to 219 – 221; middle childhood 94; practical information 243 – 245; relationships across adulthood 238 – 240; at siblinghood transition 227 – 230; social comparisons 226; social learning theory 226 – 227; summary 247; theory in parenting of 225 – 227 Sibshops program 243 SibworkS program 243 sickle-cell anemia 610 simplicity features of infant-directed speech 23 single-parent families 10 situational variables in infant parenting 33 – 34 skin-to-skin contact and preterm birth 451, 456 sleep-wake cycle in preterm births 428 – 430 slow-to-warm-up infants 481 smiling and social development 288 social anxiety disorder 483 social awareness/interaction of toddlers 57 social caregiving 14 social changes in aging parents and adult children 192 – 193 social cognitive theory 263 social communication deficits 533 Social Communication Questionnaire 526 social comparisons of siblings 226 social competence theory 470 – 471, 475 – 476 social development 30 – 31, 57 – 58, 288, 291 – 294 social effectiveness 470 social-emotional programs 245 social groups/networks 36, 83 – 84, 181 socialization: adolescents as active agents in 142 – 152; adoption/adoptive families 328 – 334; bicultural socialization 340 – 341; emerging adults 169; ethnic-racial socialization 337 – 338; gender differences in parenting 263 – 274; goals for aggressive children 508; maladaptive behavior 474; parental role in 338 – 340; temperament and 295 social learning theory 169, 226 – 227, 498 – 499 social responsibility in middle childhood 91 – 94 Social Security program 193 social support 34, 84, 174 social withdrawal 475 – 476 see behavioral inhibition and social withdrawal Society of Pediatric Psychology 598 socioeconomic status (SES): of adopted children 350 – 351; aging adults 193, 197; infant parenting 14, 24, 35; parenting aggressive children 506 – 507; preterm births 436 – 437; talented children 409; toddler parenting 65 – 66 solicitude feelings 4 spanking toddlers 63 speaking, in infancy 29 special-needs children and adoption 341 – 343 specificity in parenting emerging adults 192 – 183

specific learning disability (SLD) 405 speech and infants 9 spillover effect in parent-adolescent conflict 117 stability in parenting cognitions and practices 14 – 15 STEM education 269 – 270 Stepping Stones Triple P (SSTP) Positive Parent Program 545 – 546 stigma of autism spectrum disorder 531 Strange Situation Procedure 373, 374 – 375, 472, 541 stress-coping models 569 – 570 stress/stressors: adoption/adoptive families 347 – 348; autism spectrum disorder 526, 529, 533 – 535; caregivers/caregiving 202 – 205; diathesis-stress interactions 304; economic stress 485 – 486; parenting children with chronic health conditions 602; preterm births 433 – 434 structural characteristics of infancy 26 – 27 structure by parents 132, 136 – 138 surrogate caregivers 3 synchronous interactions 5 systems perspective of intelligence 401 Taiwan parents of ASD children 539 talent, defined 399 talented children: diversity and adversity 402 – 404; family system and 406 – 409; introduction to 399 – 402; neurodiversity and 404 – 406; parenting of 409 – 411; recognition of 411 – 413; summary of 416 – 417; sustaining development of 413 – 415 tangible support 196 – 197 task environment 388 technology-dependent children 604 teenage mothers 24, 237 Teller, Edward 408 temperament X parenting interaction: aggressive children 505; child effects on parenting 295 – 299; developmental systems theory 289 – 293; effects on child 299 – 300; effortful control 297 – 300, 302 – 303, 307 – 308; future directions 308 – 311; in infancy 29 – 30; introduction to 288; methodological considerations 294, 308 – 310; moderator effects 300 – 308; negative emotionality 291, 293, 295 – 297, 299; negative parenting 30, 301 – 303; positive emotionality 297, 299 – 300; positive parenting 303 – 308; social development 293 – 294; studies on 294 – 295; summary 311 – 312; theory directions 310 – 311 temporary care 378 – 379 terrestrial infant mammals 3 testosterone hormone 23, 113 theory of mind 220 thinking on in infancy 28 – 29 This Is My Baby Interview (TIMB) 378, 381 – 382 time-out techniques 62 tobacco use/abuse 21 toddler parenting: adoption and 330 – 331; behaviormodification techniques 62 – 63; development during 56 – 58; disruptive behaviors 502; diversity

635

Index in 65 – 67; family configuration 69 – 70; fathers 68 – 69; granting autonomy 58 – 60; impact of 67 – 68; introduction to 56; measurements during 67; media use 70 – 71; minority groups and 66 – 67; overview of 58 – 65; relationship changes 65; setting rules 60 – 63; social development 57 – 58; socioeconomic status and 65 – 66; structure and discipline 60, 61; summary of 71; warmth and support 63 – 65 toddlers, defined 4 Toddler Temperament Scale 430 – 431 toilet training 7 top-down neurocognitive processes 82 transaction principle in development 18, 486 transracial paradox 337 triadic family relationships 229 – 230 troublesome children and adoption 329 – 330, 344 – 345 trust/mistrust development 7 Turkish emerging adults 175 Turtle Program 483 twin research studies 222 – 223, 296, 483 unconventional parenting systems 400 understanding in infancy 29 uninvolved parenting 500

University Centers for Excellence in Developmental Disability (UCEDD) 582 U.S. Bureau of Labor Statistics 8 utterances by mothers to infants 15 variations in parenting cognitions and practices 14 very low birth weight (VLBW) 434 violence in middle childhood 85 – 86 vocalizations of infants 21 vocational rehabilitation programs 547 Volunteer Advocacy Project (VAP) 581 vulnerability hypothesis 301 vulnerability in middle childhood 87 warmth and support needs: of aggressive children 508 – 509; developmental systems theory 289 – 290; mothers/mothering 175; temperament and 292; toddler parenting 63 – 65 Williams syndrome 571 withdrawal problem solving 150 wobble effect 407 Working Model of the Child Interview 438, 439 world-class performers study 410, 411 – 412 Younger European American mothers 24 Youth Law Center 389

636