ASHLEY C. WOODMAN University of Wisconsin-Madison

Trajectories of Stress among Parents of Children

with Disabilities: A Dyadic Analysis

Parents of children with developmental disabili-ties (DD) face greater caregiving demands thanother parents, which may lead to heightenedlevels of stress. Characteristics of the child withDD as well as family resources may explainthe extensive variability observed in parentaladjustment. This study examined trajectoriesof parenting stress among 108 mother–fatherdyads parenting a child with DD, from earlychildhood (age 3) through adolescence (age15). Using multilevel dyadic analyses, stresswas found to increase from early to middlechildhood then subsequently decrease throughadolescence. Child-related stressors (behav-ior problems, adaptive behavior) and familyresources (social support, positive family cli-mate) in early childhood predicted initial levelsand change in stress. Mother–father differencesand recommendations for intervention are dis-cussed.

Some level of parenting stress and daily hassleis considered normal or adaptive (Crnic, Gaze,& Hoffman, 2005), but parents of children withdevelopmental disabilities (DD) tend to reportgreater than average levels of stress (Neece,Shulamite, & Baker, 2012). This is of particularconcern given the deleterious effects of stress ongeneral parent well-being and child emotional,

Waisman Center, 1500 Highland Avenue, Room 529,Madison, WI 53705 (awoodman2@waisman.wisc.edu)Key Words: behavior problems, developmental disabilities,dyad, social support, family climate, stress.

social, and behavioral outcomes (Crnic et al.,2005). Few studies have examined change inparenting stress beyond early childhood, there-fore little is known about how stress changes forparents, particularly fathers, during their child’smiddle childhood and adolescent years.

PARENTING STRESS

Stress is conceptualized in various distinctways but is generally viewed as behavioral,emotional, and physiological reactions to anunpleasant event that affect well-being (Crnic &Low, 2002). Within Abidin’s (1995) theoreticalframework, parent-related stress represents thelevel of dysfunction in the parent–child systemrelated to the parent’s functioning in particu-lar. Parent-related stress includes components ofpersonality and pathology, such as the parent’ssubjective feelings of emotional availability tothe child, parenting confidence, and investmentin parenting (Abidin, 1995). Stress related to sit-uational factors also contributes to parent-relatedstress in this framework, such as relationshipswith spouses or partners, perceptions of socialisolation, health, and feelings of restriction inthe parental role.

The majority of studies on stress amongparents of children with DD have been crosssectional, with most extant longitudinal studiesfocusing on stress during early childhood.Several of these studies have reported stressto remain stable during the early years(e.g., Hanson & Hanline, 1990), consistentwith studies of stress among parents of

Family Relations 63 (February 2014): 39–54 39DOI:10.1111/fare.12049

40 Family Relations

children without disabilities (Crnic et al.,2005). These findings may reflect the highand stable caregiving demands experiencedby parents during their child’s early years,regardless of their child’s disability status. Otherlongitudinal and cross-sectional studies suggestthat stress and daily hassles increase for parents,particularly mothers, of young children withDD (Gerstein, Crnic, Blacher, & Baker, 2009;Innocenti, Huh, & Boyce, 1993).

In line with these findings, several longitudi-nal studies have documented increases in stressfor parents of children with DD through middlechildhood. Hauser-Cram, Warfield, Shonkoff,and Krauss (2001) reported increases in parent-related stress among parents of children withDown syndrome, motor impairment, and otherdevelopmental delays from age 3 to 10. Neeceet al. (2012) reported perceptions of the child’simpact on the family to decline from age 3 to9 among parents of children with and withoutdevelopmental delays. Once changes in behaviorproblems were accounted for, however, parentsof children with delays showed increases instress whereas parents of children withoutdelays continued to show decreases in stress.Taken together, these studies suggest increasesin stress from early to middle childhood may beunique to parents of children with DD.

To date, few if any studies have reportedchange in stress among parents of children withDD through adolescence. Adolescence may bea particularly stressful period of developmentfor these parents, as they face challenges relatedto their teen’s social isolation, puberty, andtransition to adult services. The cumulative tollof caregiving may also lead to increased psycho-logical strain, consistent with the wear-and-tearhypothesis (Townsend, Noelker, Deimling, &Bass, 1989). Conversely, parents of childrenwith DD may adapt to caregiving demands overtime and perceive lower parent-related stressduring their child’s adolescence. Declines in theseverity of behavior problems in adolescencemay also contribute to reductions in stress(Totsika & Hastings, 2009). Cross-sectionalevidence suggests that parenting stress declinesafter middle childhood in this population,consistent with the latter explanations. Orr,Cameron, Dobson, and Day (1993) examinedparent- and child-related stress in mothers ofchildren with developmental delays. Stresswas highest for the middle childhood groupcompared to the preschool and adolescent

groups. Longitudinal research is needed toreplicate this developmental trend.

FAMILY SYSTEMS THEORY

Family systems theory views the family as acomplex and dynamic system of individuals andinteractions (Minuchin, 1985). At the core of asystems orientation is the view that the family isan organized whole and elements within the sys-tem are necessarily interdependent (Minuchin,1985). Accounting for the interdependence ofmothers and fathers is critical to research onfamily functioning (Lyons & Sayer, 2005), asone family member’s emotions or experiencescan relate to subsequent emotions or experiencesin another family member (Larson & Almeida,1999).

Although related, there is considerable vari-ability in stress within dyads raising childrenwith DD (Essex, Seltzer, & Krauss, 1999). Thesocial role hypothesis postulates that womenare more likely to be exposed to strain-inducingcaregiving and household tasks (Deater-Deckard& Scarr, 1996). Because families of childrenwith DD tend to take on more traditional genderroles than other families (Roach, Orsmond, &Barratt, 1999), the additional strains of caringfor a child with DD may fall disproportionatelyto mothers (Rowbotham, Carroll, & Cuskelly,2011), resulting in higher stress than fathers(Hastings, 2003). Conversely, the gender sim-ilarities hypothesis (Hyde, 2005) emphasizesthe similarities rather than differences in thepsychological well-being of men and women.This perspective would predict similar levels ofstress for mothers and fathers. Within familiesraising children with DD, several studies havereported higher stress and depression for mothers(Oelofsen & Richardson, 2006), whereas othersreported no differences by parent gender (Hast-ings et al., 2005). Further research is needed toclarify these discrepant findings.

Models of stress based on family systemstheory have been applied to research on familiesraising children with DD. In McCubbin andPatterson’s (1983) double ABCX model, theimpact of stressors and hardships on familyadaptation over time is explained by severalfactors, including the nature of the stressors, theinternal and external resources of the family, andthe meaning ascribed to the stressors. Perry’s(2004) model of stress in families of childrenwith DD portrays parental outcomes as the result

Trajectories of Stress 41

of child and other life stressors intersectingwith personal and family resources as wellas informal and formal supports. Common toboth theoretical models, child-related stressorsand family resources affect parent and familyadaptation over time.

Child-Related Stressors

Several characteristics of children with DD havebeen identified as potential stressors for par-ents. Early studies focused on type of disability(Minnes, 1988) and cognitive skills (Beckman,1983; Frey, Greenberg, & Fewell, 1989). Morerecently, the focus has shifted to the role ofchild behavior problems as a more salient childcharacteristic to parental well-being. Behaviorproblems include internalizing symptoms, suchas anxiety, sadness, social withdrawal and fear-fulness; and externalizing symptoms, such ashyperactivity, poor impulse control, noncompli-ance, and aggression (Achenbach, Edelbrock,& Howell, 1987). Children with DD tend todisplay heightened levels of problematic behav-ior that persist over time (Totsika & Hastings,2009). Several studies have demonstrated that itis behavior problems, and not the severity of thechild’s disability per se, that predict lower psy-chological well-being (Abbeduto et al., 2004)and higher levels of stress (Hastings et al., 2005)among parents.

The child’s level of adaptive behavior mayalso play a role, albeit a lesser one. Adaptivebehavior refers to an overarching set of skills,including communication, socialization, anddaily living skills, that are related to generalintelligence but provide a more nuancedrepresentation of an individual’s strengths andlimitations in daily life (Paskiewicz, 2009).Unlike intelligence, adaptive behavior is viewedas malleable across the life span (Harrison& Boan, 2000). Lower adaptive behavior,particularly lower communication skills, isoften associated with higher stress amongparents (Hanson & Hanline, 1990), althoughthis association is weakened once behaviorproblems are controlled for statistically (Baker,Blacher, Crnic, & Edelbrock, 2002).

Although studies have shown child-relatedstressors to affect both parents, other studieshave suggested that mothers are affected by theirchild’s behavior to a greater extent than fathers.For instance, Hastings (2003) reported thatmothers’ stress levels were uniquely impacted

by their child’s level of behavior problems.Essex et al. (1999) likewise found childbehavior problems to uniquely impact mothers’depressive symptoms and perceived burden ofcare. To date, few if any studies have statisticallycompared the magnitude of the impact of childcharacteristics on mothers’ and fathers’ stress.

Family Resources

Many parents successfully adapt to the height-ened demands of raising a child with DD,however. A goal of recent research has beento explain this extensive variability througha strengths-based family perspective (Glidden,2012). According to models of stress from a fam-ily systems framework (McCubbin & Patterson,1983; Perry, 2004), the impact of child-relatedstressors on parent well-being is explained inpart by resources and supports at the individualand family level. Social support is a resourcethat has received considerable attention in thispopulation because it represents a potential pointof intervention (Hauser-Cram, Cannarella, Till-inger, & Woodman, 2012). Social support is amultidimensional construct that includes phys-ical and instrumental assistance, resource shar-ing, and emotional and psychological support(Dunst, Trivette, & Cross, 1986). For parents ofchildren with DD, social networks may consistof formal supports (e.g., professionals, serviceproviders) or informal supports (e.g., friends,neighbors). These sources of support may havedifferential impacts on family adaptation. Forinstance, Bailey, Nelson, Hebbeler, and Spiker(2007) reported that parents perceived positiveimpacts of early intervention if they receivedquality formal support services. Informal sup-port from family and community members didnot relate to perceived impacts of early interven-tion but strongly related to parenting confidenceand optimism. Perceptions of helpful supportacross sources are associated with lower levelsof stress among parents of children with DD(Smith, Oliver, & Innocenti, 1999).

The family emotional climate is a family-level resource that may protect parents ofchildren with DD from experiencing heightenedlevels of stress. The relational aspects of thefamily environment include the connectedness,expressiveness, and degree of conflict amongmembers of the family unit (Moos & Moos,1986). The quality of family relationships hasbeen found to affect various aspects of parent

42 Family Relations

well-being and child development (Hauser-Cram et al., 2001), including parenting stress(Warfield, Krauss, Hauser-Cram, Upshur, &Shonkoff, 1999). To date, few studies haveconsidered mothers’ and fathers’ perspectivesof the family environment within families ofchildren with DD.

Family resources convey a direct benefit toparental well-being, but they may also bufferthe impact of child-related stressors accordingto the double ABCX model (McCubbin &Patterson, 1983) and Perry’s model (2004).There is some empirical support for a bufferinghypothesis. Among mothers of preschool agechildren with DD (Plant & Sanders, 2007), theimpact of problematic behavior on well-beingwas reduced by high levels of social support.Similarly, positive views of the family emotionalclimate moderated the impact of child behavioralcharacteristics on the well-being of parentsof children with DD (Keller, 1999), althoughthis moderating effect has been understudiedto date. Identification of buffering factorshas important implications for intervention.Similarly, moderation analyses may indicatewhich subgroups of parents (e.g., parents ofchildren with high problematic behavior) shouldbe targeted for intervention. Few studies haveprobed the nature of these moderating effectsto determine whether social support and familyclimate nullify the impact of child behaviorproblems or simply reduce the impact of childbehavior problems.

The importance of family resources maydiffer for mothers and fathers. Although thesegender differences have been understudied todate, Krauss (1993) reported that more helpfulsocial support networks were associated withreduced parenting stress for mothers, but notfathers, of children with DD. Conversely, aspectsof the family emotional climate were moresalient to fathers’ stress than mothers’ stress.The findings were interpreted to indicate that‘‘fathers may turn inward, towards their families,whereas mothers turn outward, towards theirsocial support networks, in the face of a ‘crisis’regarding their child’s development’’ (Krauss,1993, p. 402). Further research is needed toclarify these gender differences.

THIS STUDY

This study aimed to address several gaps in theliterature by examining longitudinal changes

in parenting stress among mothers and fathersof children with diverse DD, from their child’searly childhood (age 3) through adolescence (age15). The first research question addressed howparenting stress changes over time. A modifiedmultilevel modeling approach was used to exam-ine change within parenting dyads and to permitdirect mother–father comparisons of trajectories.Parenting stress was expected to increase fromearly to middle childhood then subsequentlydecrease from middle childhood to adolescence,based on existing longitudinal (Hauser-Cramet al., 2001) and cross-sectional evidence (Orret al., 1993). Mothers were expected to reporthigher overall levels than fathers, becausemothers spend more time caring for their childwith DD (Rowbotham et al., 2011).

The second research question addressed howchild-related stressors and family resources inearly childhood related to trajectories of stressthrough adolescence. To date, few if any studieshave used a dyadic approach to compare themagnitude of the effects of child characteristicsand family resources on parenting stress formothers and fathers of children with DD. Basedon existing literature, higher behavior problemsand lower adaptive behavior were expected topredict higher levels of stress for both parents(Hanson & Hanline, 1990; Hastings et al., 2005).Child characteristics were expected to affectmothers to a greater extent than fathers, inline with previous findings (Hanson & Hanline,1990). Higher social support and more positiveperceptions of the family climate were expectedto predict lower levels of stress based on existingliterature (Warfield et al., 1999). Social supportwas expected to be a more salient predictorof stress for mothers while family climate wasanticipated to affect fathers to a greater extent,following previous research (Krauss, 1993).

The final research question examined moder-ating effects. Family resources were expected tomoderate the impact of child behavior problemson parenting stress, such that greater satisfactionwith social support networks and more positiveappraisals of the family climate would bufferthe impact of child behavior problems on par-enting stress. No hypotheses were made aboutparent gender differences in moderating effects,because no research to date has examined this. Itmay be reasonable to expect buffering effects tobe more evident for mothers, because they likelydeal with more behavior problems during dailycaregiving (Rowbotham et al., 2011).

Trajectories of Stress 43

METHOD

Participants

Data for this study were drawn from the EarlyIntervention Collaborative Study, a longitudinalinvestigation of children with developmentaldisabilities and their families (Hauser-Cramet al., 2001). This study focused on data collectedwhen the child was age 3 (Time 1), 5 (Time2), 10 (Time 3), and 15 (Time 4). Participantswere initially recruited at the time of theirchildren’s enrollment in 29 publicly funded earlyintervention (EI) programs in Massachusettsand New Hampshire. Families were invited toparticipate if their child was younger than age24 months with a diagnosis of Down syndrome,motor impairment, or developmental delay ofunknown etiology. These diagnostic categorieswere selected to represent the most commontypes of disability served by EI at that time.Medical records for each enrolled child werereviewed by research staff to confirm type ofdisability.

The analyses for this study focused on108 families with mother and father data onthe outcome measure. At Time 1, type ofdisability was roughly distributed across thethree diagnostic categories, with 34% with Downsyndrome, 34% with motor impairment, and32% with developmental delay of unknownetiology. Slightly more than one half of thechildren were male (54%). The majority ofchildren were White (90%). The average levelof child behavior problems was M = 50.48(SD = 9.96) based on mother report on theChild Behavior Checklist (Achenbach et al.,1987). Nineteen percent of children were atrisk for clinically significant behavior problems(t score > 60). The average level of adaptivebehavior for this sample was M = 64.46(SD = 13.74), over two standard deviationsbelow the mean of their same-age peers on theVineland Adaptive Behavior Scales (Sparrow,Balla, & Cicchetti, 1984).

All parents were jointly raising their childwith DD, with 93% of parents married at Time1. By age 15, six of these married coupleswho remained in the study were divorced butcontinued to be involved in parenting their childwith DD. The median household income at Time1 was $30,000 to $40,000, reflecting the medianhousehold income in Massachusetts and NewHampshire at the time when data were collected(1989–1991). The average number of years of

education was 14.38 (SD = 2.41) for mothersand 14.21 (SD = 3.26) for fathers. The averageage was 32.32 (SD = 5.02) years for mothers and34.61 (SD = 5.63) years for fathers at Time 1.The majority of fathers were employed (94%),with slightly less than one half of mothersemployed (46%).

Procedure

Six months prior to their child’s third, fifth, tenth,and fifteenth birthdays, parents were contacted torequest their continued participation in the EarlyIntervention Collaborative Study. Participatingfamilies were visited in their homes by two fieldstaff members blind to the study’s hypothesesand trained to be reliable for all measures. Whileone staff member conducted a multidimensional,structured evaluation of the child followed byan interview with the father, the other staffmember interviewed the mother. Home visitslasted approximately 2 to 3 hours. This studyused data on child characteristics and familyresources collected during home visits at Time1 and data on parenting stress collected duringhome visits at Times 1, 2, 3, and 4.

Measures

Socioeconomic status. Socioeconomic statuscomposite variables were created for mothersand fathers separately by averaging z-scores foryears of education and household income atTime 1.

Child adaptive behavior. Child adaptive behav-ior was assessed using the Vineland AdaptiveBehavior Scales–Interview form with the child’smother at Time 1 (VABS; Sparrow et al., 1984).The standardized score for the Adaptive Behav-ior Composite (Communication, Daily LivingSkills, Socialization) represents the child’s levelof adaptive behavior compared to his or hersame-age peers. The VABS has demonstratedgood reliability (Sparrow et al., 1984) and valid-ity (Middleton, Keene, & Brown, 1990). Internalconsistency was α = .98 for the present sample.

Child behavior problems. At Time 1, motherscompleted the Child Behavior Checklist/2-3(CBCL/2-3; Achenbach et al., 1987). The t scorefor total behavior problems was used in this studyto reflect each participant’s deviation from the

44 Family Relations

mean of his or her normative group, with higherscores indicating more significant behaviorproblems. The CBCL/2-3 demonstrates strongreliability and validity (Achenbach, 1992).Internal consistency was α = .93 for this sample.

Parental social support. Parents completed theFamily Support Scale (FSS; Dunst et al., 1986)at Time 1, a self-report measure designed toassess the degree to which potential sources ofsupport (e.g., friends, neighbors) have been help-ful to families rearing children. Higher scoresindicated higher perceived helpfulness of socialsupport. Informal and formal sources of sup-port were not examined separately because themeasure of formal sources had poor internal con-sistency (α < .50). The FSS demonstrated satis-factory reliability and validity among parents ofchildren with DD (Dunst, Trivette, & Hamby,1994). Internal consistency was α = .89 to .93.

Family climate. Mothers and fathers completedthe Family Environment Scale (FES; Moos &Moos, 1986) at Time 1. This study used the rela-tionship dimension, which represents cohesionand expressiveness net of conflict. Higher scoreson this scale represent more positive perceptionsof the family climate. The FES has demonstratedgood internal consistency and stability (Moos& Moos, 1986) as well as convergent validity(Sanford, Bingham, & Zucker, 1999). Internalconsistency was α = .69 to .70 for this sample.

Parenting stress. Mothers and fathers com-pleted the Parenting Stress Index (PSI; Abidin,1995) at each time point. The parent domainwas used as the outcome variable because thevalidity of the child domain has been ques-tioned for parents of children with DD (Bakeret al., 2003; Innocenti et al., 1993). The PSI hasdemonstrated strong reliability (Abidin, 1995)and validity among parents of children with DD(Hanson & Hanline, 1990). Although the PSI isnot recommended for children older than age 12,it was used as a measure of parenting stress at age15 because the average developmental age of thesample was equivalent to 6 years of age at thattime point (M = 6.05, SD = 3.53). Internal con-sistency in the present sample was α = .92 to .94.

Analytic Plan

The distribution of parenting stress was approxi-mately normal for mothers and fathers. Extreme

high and low scores were recoded to be proximalto the remaining distribution of scores. This top-and bottom-coding procedure retains the relativeordering of scores while minimizing the influ-ence of outliers. Missing data (11.81%) wereimputed using the Markov Chain Monte Carloprocedure in SPSS version 19, because exclud-ing cases with missing data can bias results(Widaman, 2006). The majority of missing datawas due to attrition, as few values on the predic-tor variables were missing (0.69%). Parents whodropped out of the study after Time 1 did notsignificantly differ from parents who remainedin the study on predictor or outcome variables.

The main analyses employed a multilevelmodeling approach adapted for dyads (Lyons& Sayer, 2005; Raudenbush, Brennan, &Barnett, 1995) using HLM software version 6(Raudenbush, Bryk, & Congdon, 2008). Thisapproach models change in stress over timefor mothers and fathers individually whileaccounting for similarities in stress within dyads.To examine the first research question, anunconditional growth model was conducted todetermine the level of parenting stress at thestart of the study (intercept) and the rate ofchange in parenting stress over the course of thestudy (slope) for mothers and fathers. Hypothesistesting was used to compare the initial levels andrates of change for mothers and fathers. Tests ofthe statistical assumptions were conducted.

To address the second research question,early childhood factors were entered to pre-dict the initial levels and rates of change instress. First, a model with only child character-istics was conducted to compare the magnitudeof the impact of significant child characteristicson mothers’ and fathers’ stress. Next, familyclimate and social support were examined aspredictors above and beyond child characteris-tics in separate models, because these factorswere correlated (r = 0.17–0.22 for fathers andmothers, respectively). Models included motherand father report of family climate and socialsupport in order to examine cross-over effects(e.g., the impact of fathers’ social support onmothers’ stress). The magnitude of the impactof significant family resources on mothers’ andfathers’ stress was directly compared.

To address the final research question,the interactions of family climate and socialsupport by child behavior problems wereincluded in analyses. The interaction termswere created by centering each variable (i.e.,

Trajectories of Stress 45

subtracting each individual’s score from themean) and multiplying (a) family climate bychild behavior problems and (b) social supportby child behavior problems. When interactionseffects were significant, specific combinationsof child behavior problems (mean = 50.48,clinical = 70.00) and family resources (low = 1SD below mean, high = 1 SD above mean)were examined through simple slopes (Preacher,Curran, & Bauer, 2006).

RESULTS

Parents were moderately correlated on predictorand outcome variables (Table 1). At age 15,fathers reported significantly higher stress thanmothers. Mothers reported higher perceivedhelpfulness of social support and more positiveperceptions of the family climate than didfathers. The percentages of parents scoringabove the clinical cutoff on the Parenting StressIndex (> 153) at Times 1, 2, 3, and 4 were 11%,9%, 7%, and 3% for mothers and 9%, 10%, 7%,and 6% for fathers, respectively.

Unconditional Growth Model

Results indicated that 41% of the variance inparenting stress is between dyads (intraclasscorrelation [ICC] = .41). Given the ICC andsample size, the power to detect a medium effectwas large (0.87), but a small effect size waslow (0.37). Tests of the statistical assumptions(homogeneity of variance, normality) did notindicate estimates would be biased (Raudenbush& Bryk, 2002). For mothers and fathers, stresswas found to increase from early to middle child-hood then subsequently decrease from middlechildhood to adolescence, following a curvi-linear pattern. Initial levels significantly varied

across mothers (p < .001) and fathers (p < .001),indicating that parents greatly differed in theirlevels of stress at the start of the study.

Initial levels of stress were correlatedfor parents within dyads (Table 2). Therate of change in stress significantly variedacross mothers (p < .001) and fathers (p < .01),indicating that some parents increased in stressfrom early to middle childhood more rapidlythan others. Parents within dyads reportedsimilar changes in stress (Table 2). As oneparent increased in stress from early to middlechildhood, so did the other parent on average.Parents experienced similar decreases in stressfrom middle childhood to adolescence (p > .10).Overall, the pattern of change in parenting stressfrom early childhood to adolescence did notdiffer by parent gender.

Child-Related Stressors

Child gender and type of disability did not relateto trajectories of parenting stress for mothers orfathers in preliminary analyses, therefore thesevariables were excluded from the final modelsfor parsimony. For both parents, higher levelsof behavior problems predicted higher initiallevels of stress (p < .01) but lower increases instress from early to middle childhood (p < .01).In other words, higher child behavior problemspredicted a heightened and more stable patternof stress for both parents. Behavior problemshad a greater impact on mothers’ stress levelsat the start of the study (p < .01), but therewere no gender differences in the impact ofbehavior problems on change in stress (p > .50).Higher child adaptive behavior predicted lowerinitial levels of stress for fathers (p = .04) butnot mothers (p = .79). Adaptive behavior was

Table 1. Comparison of Mothers and Fathers on Predictor and Outcome Variables

Mothers Fathers

M SD M SD r t

PSI-Parent DomainTime 1 (child age 3) 119.40 24.60 119.28 24.56 0.45*** 0.05Time 2 (child age 5) 120.73 22.56 122.12 21.72 0.38*** −0.58Time 3 (child age 10) 120.45 20.56 122.97 17.82 0.31*** −1.11Time 4 (child age 15) 110.17 20.99 116.27 20.00 0.33*** −2.68**

FSS-Helpfulness 23.69 8.04 21.80 8.84 0.38*** 2.09*

FES-Relationship Dimension 11.60 3.44 10.60 3.71 0.33*** 2.50*

PSI = Parenting Stress Index; FSS = Family Support Scale; FES = Family Environment Scale.

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Table 2. Variance-Covariance Estimates for the Unconditional Growth Model

Random Effect Mothers’ Intercept Fathers’ Intercept Mothers’ Linear Slope Fathers’ Linear Slope

Mothers’ intercept, um0i 403.36 220.33 −12.07 −12.38Fathers’ intercept, uf0i 0.58 359.26 −7.80 −12.99Mothers’ linear slope, um1i −0.53 −0.36 1.28 0.92Fathers’ linear slope, uf1i −0.66 −0.73 0.87 0.88

Note: The area including the diagonal and above contains the covariances and the area below the diagonal contains thecorrelations.

unrelated to increases in stress from early tomiddle childhood for both parents (p > .10).

Family Resources

As seen in Table 3, mother and father perceptionsof the family climate predicted mothers’ stress

trajectories, such that more positive perceptionsof the family climate were associated withlower initial levels but greater increases instress from early to middle childhood. In otherwords, mothers followed higher and more stablepatterns of stress when both parents were lesssatisfied with the family environment. Father

Table 3. Family Climate and Parenting Stress within Dyads

Mothers Fathers

Fixed Effects Coefficient SE Coefficient SE

Intercept 119.07 1.65∗∗∗ 119.38 1.91∗∗∗

Socioeconomic status 1.52 1.98 −1.20 1.88Child behavior problems (CBC) 0.71 0.17∗∗∗ 0.50 0.18∗∗

Child adaptive behavior 0.10 0.11 −0.29 0.11∗

Family climateMother report −2.74 0.47∗∗∗ −0.22 0.67Father report −0.88 0.39∗ −2.08 0.70∗∗

Family climate x CBCMother report −0.02 0.05 −0.01 0.05Father report −0.04 0.03 0.10 0.04∗

Age of child (linear slope) 1.47 0.49∗∗ 1.62 0.62∗∗

Socioeconomic status −0.40 0.20∗ −0.10 0.19Child behavior problems (CBC) −0.03 0.02# −0.06 0.02∗∗∗

Child adaptive behavior −0.01 0.01 0.01 0.01Family climate

Mother report 0.11 0.05∗ −0.04 0.04Father report 0.11 0.05∗ 0.08 0.06

Family climate x CBCMother report 0.001 0.01 < −0.001 0.01Father report < 0.001 0.003 −0.003 0.004

Age of child2 (quadratic slope) −0.18 0.04∗∗∗ −0.16 0.05∗∗

Random effects Variance Component SD

Intercept – mother, um0i 182.00 13.49∗∗∗

Intercept – father, uf0i 246.54 15.70∗∗∗

Age of child slope – mother, um1i 0.90 0.95∗∗

Age of child slope – father, uf1i 0.66 0.81∗

Level-1 (R) 160.44 12.67

CBC = Child Behavior Checklist.#p < .10; ∗p < .05; ∗∗p < .01; ∗∗∗p < .001.

Trajectories of Stress 47

FIGURE 1. PROTOTYPICAL TRAJECTORIES OF STRESS BY FAMILY CLIMATE.

CBS = Child Behavior Checklist; FES = Family Environment Scale.

perceptions, but not mother perceptions, of thefamily climate predicted fathers’ initial levelsof stress, such that more positive perceptions ofthe family climate were associated with lowerinitial levels of stress. Family climate had asimilar impact on initial levels and change instress for mothers and fathers (p > .10).

The impact of family climate on initial levelsof stress was moderated by child behaviorproblems for fathers only. An examinationof simple slopes revealed that when fathershave low levels of satisfaction with the familyclimate, child behavior problems have noimpact on their initial levels of stress (p > .10).When fathers have high levels of satisfactionwith the family climate, behavior problemssignificantly affect their initial levels of stress(p < .01). Figure 1 plots the stress trajectories ofprototypical cases with mean or clinical levelsof child behavior problems and low or highlevels of satisfaction with the family climate.For both mothers and fathers, the combinationof clinical child behavior problems and lowsatisfaction with family climate resulted in thehighest trajectory of parenting stress.

Greater maternal social support predictedlower initial levels of stress for mothers,but social support was unrelated to mothers’increases in stress from early to middlechildhood (Table 4). Greater maternal socialsupport also predicted lower initial levelsof stress for fathers (trend level only), butgreater increases in stress from early to middlechildhood. In other words, fathers experiencedheightened and more stable patterns of stresswhen their partner had less helpful socialnetworks. Mothers’ social support buffered theimpact of high levels of behavior problems on

mothers’ initial levels of stress. The associationbetween behavior problems and initial levels ofstress was stronger for mothers with low levelsof social support (p < .01) than mothers withhigh levels (p < .01) of social support.

For fathers, higher social support reducedthe impact of behavior problems on changein stress from early to middle childhood.In other words, more helpful social supportnetworks prevented fathers of children withproblematic behaviors from experiencing morerapid increases in stress from early to middlechildhood. Behavior problems predicted lowerincreases in stress for fathers with high levelsof social support (p < .01) than for fathers withlow levels of social support (p > .10). Figure 2plots the stress trajectories of prototypical caseswith mean or clinical levels of child behaviorproblems and low or high levels of helpfulnessin social support networks. For both parents, thecombination of clinical child behavior problemsand low social support resulted in the highesttrajectory of parenting stress.

DISCUSSION

The first research question addressed howparenting stress changes over time for parentsof children with DD. Parenting stress was foundto increase from early to middle childhood thensubsequently decrease through adolescence formothers and fathers. These results replicate andextend the findings of Hauser-Cram et al. (2001)and mirror the curvilinear pattern observedby Orr et al. (1993) within a cross-sectionalframework. The majority of parents in thissample did not report clinically significant levelsof stress, in line with the perspective that parents

48 Family Relations

Table 4. Social Support and Parenting Stress within Dyads

Mothers Fathers

Fixed Effects Coefficient SE Coefficient SE

Intercept 119.07 1.73∗∗∗ 119.38 2.01∗∗∗

Socioeconomic status 2.27 1.97 −2.23 1.89

Child behavior problems (CBC) 1.20 0.17∗∗∗ 0.60 0.17∗∗∗

Child adaptive behavior −0.08 0.10 −0.31 0.13∗

Social support

Mother report −0.92 0.21∗∗∗ −0.43 0.23#

Father report −0.10 0.22 −0.32 0.21

Social support x CBC

Mother report −0.05 0.02∗ −0.01 0.02

Father report 0.02 0.02 0.02 0.02

Age of child (linear slope) 1.48 0.49∗∗ 1.62 0.62∗∗

Socioeconomic status −0.40 0.18∗ −0.07 0.18

Child behavior problems (CBC) −0.05 0.02∗∗ −0.05 0.02∗∗∗

Child adaptive behavior −0.002 0.01 0.01 0.01

Social support

Mother report 0.03 0.02 0.03 0.02∗

Father report 0.03 0.02 0.01 0.02

Social support x CBC

Mother report 0.001 0.002 0.001 0.001

Father report < −0.001 0.002 −0.003 0.002∗

Age of child2 (quadratic slope) −0.18 0.04∗∗∗ −0.16 0.05∗∗

Random Effects Variance Component SD

Intercept – mother, um0i 213.38 14.61∗∗∗

Intercept – father, uf0i 277.11 16.65∗∗∗

Age of child slope – mother, um1i 1.03 1.02∗∗∗

Age of child slope – father, uf1i 0.53 0.73∗

Level-1 (R) 161.62 12.71

CBC = Child Behavior Checklist.#p < .10; ∗p < .05; ∗∗p < .01; ∗∗∗p < .001.

of children with DD are more alike than distinctfrom parents of children without DD (Innocentiet al., 1993). The findings point to middlechildhood as a particularly stressful period forthese parents, however. This is also the age atwhich the children in this sample report thehighest level of behavior problems, suggestingthis heightened level of stress may in part beexplained by problematic behavior, although thisrelationship remains to be explored.

Trajectories of stress did not significantly dif-fer by parent gender, contrary to the expectationsof the social role hypothesis (Deater-Deckard &Scarr, 1996). Instead, these findings are in linewith the gender similarities hypothesis (Hyde,

2005), which emphasizes the similarities ratherthan differences in the psychological well-beingof men and women. Parents within families weresimilar, but not identical, in their levels of stressat each time point, highlighting the importanceof considering individual parent well-beingwhile accounting for similarities within families.

The second research question addressedhow child characteristics and family resourcesrelate to trajectories of stress. Consistentwith the double ABCX model (McCubbin &Patterson, 1983) and Perry’s model (2004),child-related stressors impacted parent well-being. Problematic behavior in early childhoodwas a strong predictor of stress for mothers and

Trajectories of Stress 49

FIGURE 2. PROTOTYPICAL TRAJECTORIES OF STRESS BY SOCIAL SUPPORT.

CBS = Child Behavior Checklist; FSS = Family Support Scale.

fathers, lending further support to the salience ofbehavior problems to parental well-being (Bakeret al., 2003). Nearly one fourth of the children inthis sample reported clinically significant levelsof behavior problems, suggesting that someparents in this sample deal with considerableinternalizing and externalizing problems.

Mothers were affected by their child’s behav-iors to a greater extent than fathers, suggestingcaregiving strains may indeed disproportion-ately affect mothers (Roach et al., 1999). Incontrast, fathers were uniquely impacted bytheir child’s level of adaptive behavior in earlychildhood. Fathers are less likely to be involvedin child care (Roach et al., 1999) and earlyintervention programs (Flippen & Crais, 2011)and may therefore feel less prepared to handlethe functional limitations of their child. Consis-tent with this notion, Roach et al. (1999) foundthat less involvement in day-to-day caregivingpredicts higher stress for fathers of children withDown syndrome. Future work should considerparents’ involvement in caregiving tasks as wellas their caregiving difficulty.

Also in line with theoretical models of stress(McCubbin & Patterson, 1983; Perry, 2004),family resources during early childhood servedas protective factors for parents. Consistent withprevious findings (Warfield et al., 1999), parents’perceptions of the family emotional climateimpacted their respective stress levels. Thisfinding underscores the long-lasting importanceof the family’s level of cohesion, expressiveness,and conflict during their child’s early years.Mothers’ stress was affected by fathers’ views

of the family climate, whereas the reverse cross-over effect was not observed. If mothers aretaking more responsibility for aspects of familymanagement (Roach et al., 1999), they maybe more sensitive to their partner’s well-beingand satisfaction with the family environment.A similar finding was reported by Hastings(2003) among parents of children with autism,where fathers’ mental health affected mothers’stress levels, but the reverse direction of effectswas not found. Mothers’ satisfaction with theirsocial support networks affected their stress,consistent with previous research (Hauser-Cramet al., 2012), but mothers’ satisfaction with theirsocial support networks also affected fathers’stress. It may be the case that fathers rely onmothers’ sources of support to a greater extentthan mothers rely on fathers’ sources of support.Mothers’ social support connections may conferan indirect benefit to fathers.

The final research aim examined moderatingeffects. Social support and family climate werefound to moderate the relationship betweenchild behavior problems and parenting stress.These results are consistent with theoreticalmodels of stress (McCubbin & Patterson, 1983;Perry, 2004). Behavior problems had less ofan impact on mothers’ stress when mothershad more satisfying social support networks.Similarly, fathers who found their socialsupport networks to be helpful experienced lessincrease in stress over time than other fathers.In other words, social support buffered theotherwise negative consequences of behaviorproblems for both parents. These findings add

50 Family Relations

to existing literature showing social support tobe particularly beneficial to parents of childrenwith high levels of problematic behavior(Plant & Sanders, 2007). Family climate hada greater impact on fathers’ initial stresswhen behavior problems were low, runningcounter to a traditional buffering hypothesis.Unlike social support, family climate onlyserved as a protective factor for stress in thecontext of low child behavior problems. Whenproblematic behaviors are high, internalizingand externalizing behaviors may be moreimmediate and taxing issues than concerns withfamily relationships. Alternatively, behaviorproblems may contribute to family relationshipproblems (or the reverse).

This study is not without its limitations.As with any correlational study, causal effectscannot be determined. Child behavior problemswere postulated to affect parenting stress in thisstudy, although the reverse direction may alsobe possible given that patterns of interactionswithin families are circular rather than linear.This study did not capture change in childcharacteristics or family resources over thecourse of the study, which would contributeto our understanding of the dynamics of child-related stressors, family resources, and parentwell-being. The sample consisted primarilyof White middle-class families, limiting thegeneralizability of the findings to other ethnic,racial, or socioeconomic groups. In addition, allmeasures were based on parent report, whichcould contribute to shared variance issues.Stressed mothers may have appraised theirchild’s behavior problems and adaptive behaviormore negatively, for example, and there may bemethod bias as well. This study lacked sufficientpower to detect small effects, potentiallymasking additional buffering effects. A furtherlimitation of this study is its exclusive focus onstress. Ideally, research in this population shouldmeasure negative and positive aspects of parentwell-being, however, parallel positive measureswere not available for use in this study.

Despite its limitations, findings from thisstudy have important implications for researchand practice involving children with DD andtheir families. Child-related stressors andfamily resources at the time families werereceiving early intervention services (age 3)had lasting impacts on parental well-being.Interventions should target multiple aspects ofthe family system during this early childhood

period of development. Several family-basedinterventions for child behavior problems havebeen empirically supported (Sanders & Markie-Dadds, 2002). Many of these interventions takea family systems approach and require partici-pation of children and parents to optimize long-term outcomes. Parent management training andbehavioral family interventions, for instance,train parents to contingently respond to theirchild’s behavior and plan activities to minimizeopportunities for disruptive behavior (Roberts,Mazzacchelli, Studman, & Sanders, 2006). Onesuch intervention, Stepping Stones Triple P,demonstrated reductions in child behavior prob-lems and parental stress and improvements inparenting style within families raising childrenwith developmental and behavioral problems(Roberts et al., 2006). An alternative behavioralapproach is functional communication training(Durand, Hieneman, Clarke, Wang, & Rinaldi,2013; Durand & Merges, 2009), which targetsparent–child communication as a mechanismfor behavioral change.

Social support and family climate likewiserepresent malleable family resources that canbenefit from intervention (Hastings & Beck,2004). The format and goals of social supportinterventions vary widely (e.g., informal supportgroups, formal instrumental support), but manyhave been found to be effective in reducing stresswithin families of children with DD (Singer,Ethridge, & Aldana, 2007). Some interventionsprovide direct emotional, informational, andinstrumental support to parents, which renderspositive feelings of being supported andultimately leads to reductions in psychologicalsymptoms. Other interventions aim to help theindividual gain support from naturally occurringsources (Hogan, Linden, & Najarian, 2002).Such interventions target improvement in theindividual’s social skills or improvement in theindividual’s perceptions of the helpfulness oftheir existing network. An additional socialsupport intervention is the parent-to-parentmodel, in which parents of children with DDreceive training in support techniques to providesupport for other parents of younger childrenwith DD (Singer et al., 2007).

Dimensions of the family emotional climatehave also been successfully targeted for inter-vention in this population. These interventionsfocus on improving parents’ ability to managethe home environment (Bristol, Gallagher,& Holt, 1993), promoting perceptions of the

Trajectories of Stress 51

family as a ‘‘team’’ (Hudson et al., 2003),and improving communication and conflict-resolution skills (Schultz, Schultz, Bruce,& Smyrnios, 1993). One such intervention,the Programme d’Intervention Familiale, sawimprovements among parents of children withDown syndrome and cleft palate in harmonyand relationships with their child, their spouse,and others (Pelchat, Bisson, Ricard, Perreault,& Bouchard, 1999). Following the results of thisstudy, parents of children with high levels ofbehavior problems may represent an importantsubgroup to target for intervention.

This study extended previous research on par-ents raising children with DD by examining thelong-term associations between early child char-acteristics and family resources with changes inparental stress across 12 years. In contrast toprevious work in this area, an adapted ana-lytic strategy was used to explicitly model thedependency within dyads and directly comparetrajectories and predictors of stress for moth-ers and fathers. The well-being of an individualparent cannot be isolated from the larger fam-ily context (Minuchin, 1985), a notion which issupported by the current findings. Above andbeyond child-related stressors, family strengthsexplained variability in outcomes for mothersand fathers of children with DD. Interventionsthat reduce child-related stressors, particularlybehavior problems, while concurrently promot-ing helpful social support networks and positivefamily climate, may reduce levels of stressamong parents of children with DD over time.

ACKNOWLEDGMENT

The Early Intervention Collaborative Study (EICS) is fundedby Grant No. R40 MC08956 through the U.S. Department ofHealth and Human Services, Health Resources and ServicesAdministration, Maternal and Child Health ResearchProgram. This study was approved by the institutional reviewboard at Boston College, 140 Commonwealth Avenue,Chestnut Hill, MA 02467. The author would like to thankthe members of her dissertation committee, Penny Hauser-Cram, Eric Dearing, and James Mahalik, for their guidanceas well as the participating families that made this researchpossible.

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