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Screening for problem parenting: Preliminary evidence on a promising instrument
Chdd Abuse & N&w. Vol 10, pp 157- 170. I986 Pm& m the L!.S.A. Al1 nghts rescmtd.
SCREENING
FOR PROBLEM
PARENTING:
EVIDENCE ON A PROMISING
PRELIMINARY
INSTRUMENT
WILLIAM R. AVISON, R. JAY TURNER AND SAMUEL NOH The University of Western Ontario. London. Ontario paper reports on efforts aimed toward the development of more effective procedures for identifying mothers who are at elevated risk for problems in parenting. We present data from two independent samples of known maladaptors and corresponding comparison mothers and report on our attempts to cross-vaiidate a promising screening inst~ment composed of items that index social support and parenting attitudes. The resultant tOGtern scale correctly identified over 90% of matadaptive and comparison mothers. When this scale was cross-validated on a second independent sample of maladaptors and comparison mothers, it ‘was again almost 90% accurate. Issues concerning the field application of this promising instrument are discussed and its possible limitations are considered. Abstract-This
RCsumb-Le present travail est consacre a l’analyse d’une recherche de moyens efficaces pour identifier ies meres qui prisentent un risque elevc de troubles relationnels parents-enfants. Les auteurs ont Ctudie deux cohortes indipendantes de meres mal adaptees et de meres ttmoins. 11sont teste la valeur dun inst~ment de depistage qui apparait comme prometteur, compose d’indicateurs tvaluant la quahte de i’appui social d’une part et le comportement parental d’autre part. Cet instrument semble valable puisque l’echelle composee de 20 indicateurs a permis d’identifier correctement plus de 90% des femmes a risque et des femmes temoins. Cette echelle d’appreciation a ttt remise a l’epreuve au moyen d’un deuxieme collectif de meres a risque et de meres temoins; a noveau la prediction s’est revelte valable dans plus du 90% des cas. Dans la discussion, les auteurs se penchent sur les consequences de l’apphcation sur le terrain de cet instrument predictif sans oublier les Iimites de son utiiisation.
INTRODUCTION THIS PAPER REPORTS on efforts to develop more effective procedures for distinguishing women who may be at elevated risk for problems in parenting. The importance of more clearly identifying significant risk factors can hardly be overemphasized. Observations that associate various factors with maladaptive parenting amount to clues or hypotheses concerning the possible causal relevance of such factors and provide what basis there is for proposing possible intervention strategies. Moreover, since resources will inevitably be limited, more effective means for identifying those who may need and perhaps benefit from an intervention are clearly required. While available evidence suggests that a number of parent demographic variables such as gender [l-4], age 15, 61, marital and socioeconomic status [7-IO] are associated with risk for The study from which this paper is drawn was supported by a grant from the Ontario Ministry of Community and Social Services. Child Abuse Program and a National Health Scientist Award from the National Health Research and Deveiopment Program (NHRDP) of Health and Welfare Canada to R. Jay Turner. This work was also supported, in part, by a grant from the Ontario Ministry of Health to the Health Care Research Unit. The University of Western Ontario. An earlier version of this paper was presented at the Fifth International Montreal, Canada. 1984.
Congress on Child Abuse and Neglect.
Address communications to R. Jay Turner. Director. Health Care Research Unit. C.F.C. Building, The University of Western Ontario. London. Ontario, Canada N6A 588. 157
William
158
R. Avison.
R. Jay Turner
and Samuel
Noh
maladaptation, these relationships are too weak to be of any real predictive utility. However. they do invite attention to the critical question of what underlying factors associated with these characteristics give rise to their relationship with maladaptive parenting. In our view. by addressing this question contributions are most likely to be made toward a more adequate understanding of differential risk for deviant parenting. The literature on child abuse and neglect has also suggested the possible relevance of an array of social psychological factors. In our view, one of the most promising of these is social support. Indeed, this research grows out of our findings reported elsewhere that social support was the most powerful factor in distinguishing known maladaptors from presumably normal mothers [ll]. Considerable evidence is also available suggesting the relevance of parental attitudes and perceptions. We have assumed in the work reported here that scales measuring these constructs may provide the bases for a more effective screening instrument [ 121.
Social Support The concept of social support has been variously addressed in terms of social bonds [ 13, 141 and social networks [ 151, social contact [ 161, the availability of confidants [ 17- 191, and human companionship [20], as well as social support. Although these concepts are not identical. they share a focus on the significance and relevance of human relationships. Several studies have directly suggested that social support may be importantly associated with maladaptive parenting [21-261. Additionally, there is ample evidence of a link between social support and mental health that further sustains the hypothesized relevance of this variable for problem parenting [27-311. A significant aspect of social support is the experience of being supported by others. Recent reviews [31-331 make it clear that the bulk of evidence linking social support with indices of health or well-being derives from studies that have addressed this emotional and perceptual component. Our own research [ 1 l] is consistent with this pattern. In an investigation of a sample of mothers with parenting problems and a matched sample of women who had recently given birth, we found that social support, as experienced or perceived by the individual, effectively distinguished among women who varied in their adaptation to the parenting role. While life stress and personal control were also significant in this context, these results suggested that experienced social support may be of dramatic adaptive relevance.
Parenting
Attitudes
and Behaviors
In the course of attempting to understand the phenomenon of maladaptive parenting, extensive efforts have been made to describe the parenting behaviors prevalent in problem families. Descriptions provided in the literature include high levels of punitiveness [34-361; rejection and hostility [34, 351; high levels of violence [34, 371; poor mothercraft skills [38, 391; poor nurturing ability or “motherliness” [36, 38, 391; assumed right to punish [40]; and unrealistic expectations of the child [4, 41, 421. Reviews of the literature refer to additional investigations of these issues [4, 6, 43, 441. Although these attitudes and behaviors are frequently cited in the literature as characteristic of maladapting parents, few of the reporting studies have been appropriately controlled and little is known about the prevalence of such characteristics in the population at large. However, despite this lack of normative data, the United States Department of Health, Education and Welfare [lo] concludes that unrealistic expections, lack of knowledge of child development and an idiosyncratic view of the child are common characteristics of the abusive parent.
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METHOD The procedures that we have adopted for generating a potential screening scale involves identifying items indicative of social support or of parenting attitudes and behaviors that effectively discriminate between a sample of maladaptors and a sample of comparison mothers and then cross-validating their discriminant power on additional samples of maladaptors and comparison mothers. In this section, we describe the measures that comprise the pool of potential screening items that we employed and the several samples of women from which these data were collected.
Measurement The measures employed in this study are multi-item indices, established instruments whose measurement properties are known
most of which are welland are satisfactory.
Social support. The measure we have employed to index experienced social support is an adaptation of the instrument developed by Kaplan [45]. She proposed and partially tested a story identification technique composed of 16 sets of vignettes. We adopted seven sets that, in our judgment, most effectively addressed the experience of being supported by others, changing only the names used to identify each story. Each set is composed of three stories describing individuals who have variable levels of support. Subjects are asked to identify themselves with one story or as falling midway between two stories by responding on a five-point scale. Each set is scored such that high scores indicate greater support. Evidence for the construct validity and internal reliability of this measure within several studies of diverse populations has been reported elsewhere [46].
Parenting attitudes and perceptions. As part of our efforts to assess attitudes toward and perceptions of parenting, a recent version (1978) of the Michigan Screening Profile of Parenting (MSPP) [47, 481 was administered to our samples. Although available evidence leaves considerable doubt about its adequacy as a screening device for problem parenting, it is perhaps the best known instrument and is apparently recognized by many to be the best available. Schneider and associates [41,42] have described in some detail the evolution of this instrument. The version we employed consists of 30 items; subjects respond to each item on a seven-point scale ranging from “strongly agree” to “strongly disagree.” A second measure employed to assess parenting attitudes and perceptions was the Parental Attitude Research Instrument (PARI) developed by Schaefer and Bell [49]. While some of the attitudes that are measured by the PARI scale have been found to be associated with abusive parenting, the PAR1 itself rarely has been used in analyses of child-abusing parents. Nevertheless, the scale appeared to hold promise. Despite our interest in the PARI, it was not possible to include the entire scale and still maintain our questionnaire at an acceptable length. Accordingly, only two clusters were selected from the 115-item instrument. In making this selection, we were influenced by Karrby [50] who observed that two dimensions have commonly emerged from analyses: (1) nurturance (warmth. love) versus rejection (hostility, coldness); and (2) control versus autonomy. These considerations led us to include the “demand for striving” and “punitive control” clusters from the larger instrument to index these two frequently used dimension. These clusters include a total of 40 items, each having a five-point Likert-type response scale.
160
Stu&
William
R. .4vison,
R. Jay Turner
and Samuel Noh
Samples
Data from four separate samples were employed in the analyses to be presented. One of these samples was obtained in the course of the Family Volunteer Study [5 11. This study was a longitudinal investigation of 293 women who had recently given birth at a large southwestern Ontario hospital or whose babies were treated at that hospital immediately following birth. Sampling procedures were such that half of the study population were mothers whose infants required care in the Neonatal Intensive Care Unit and half were mothers whose infants were cared for in the normal nursery. However, because we found no important or statistically significant differences between these two halves of the sample on any of the variables considered, they are treated here as a single population. Data were first gathered two to four weeks after the birth and follow-up questionnaires were administered at six and twelve months after baseline. The analyses presented here draw on data from the first and last data points. Because one of the goals of the Family Volunteer Study was to identify factors associated with adaptation to the mothering role, a comparison sample was obtained composed of 78 women who were thought to be having difficult in this role. This second sample was drawn from the child protection caseload of the Family and Children’s Services. Each woman was either known or suspected to have abused or neglected a child either physically or emotionally. These women were interviewed by their caseworker and responded to the full set of measures we have described. In order to allow cross-validation studies of developed scales. the same array of data was collected from two additional and independent samples. Two to three years after the initial samples were interviewed, a total of 87 different women were drawn from the child protection caseload of the Family and Children’s Service in the same manner as those selected for the initial sample of maladaptive mothers. The second sample of presumably normal mothers was obtained by sending interviewers to public swimming pools where they enlisted the participation of mothers who were waiting while their children took swimming lessons. While this sample cannot be claimed to be representative of normal mothers. we assumed that women who enrolled their children in such activities and who supervised them would be at less risk for maladaptation and might therefore serve as a reasonable control group. We were able to collect data from 100 such women.
RESULTS Constructing
the Potential
Screening
Scale
We employed a three-stage strategy to select items for a potential screening scale. First, we entered all 77 items from the measures described earlier, Kaplan, MSPP and PAR1 [7, 3 1,411, into an orthogonal factor analysis. In the second stage, those items that loaded on each factor were entered into a discriminant function analysis [52] to determine which items on each factor could best distinguish maladaptors from comparison mothers. Finally, those items with the greatest discriminating power in each factor were pooled and entered into a final discriminant function analysis in order to identify the best set of predictors. Our initial application of this procedure using the first two comparison samples yielded 10 items that correctly classified more than 90% of the subjects considered. However. crossvalidating analyses on the two additional samples produced a disappointing accuracy rate of less than 80%. Consequently, we again applied the three-stage strategy using the two most recent samples and reserving the original comparison groups from the Family Volunteer Study for cross-validation purposes. The findings presented in this paper derive from this latter analysis.
Problem
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This procedure yielded eight items that effectively distinguished maladaptors from comparison mothers. In linear combination, these eight items correctly classified 85.1% of comparison mothers and 92.6% of maladaptors for a combined accuracy of 89.63%. These eight items, included in Appendix I, were: Kaplan 1, 5, 7; PAR1 14, 36, 40; MSPP 4, 29. In cross-validating these results using the the original comparison groups, it seemed essential to take account of the nature of the sample of presumably normal mothers involved. Because this group consisted entirely of women who had recently given birth, two sets of cross-validation analyses were conducted-one using the data obtained shortly after the birth (baseline) and one using data obtained a year later. When all eight variables were included in the discriminant function without regard to statistical significance, 91.4% of new mothers and 82.9% of maladaptors were accurately classified at baseline. The combined accuracy rate of these items was 89.55%. When entry into the discriminant function was constrained at a significant level of .05, MSPP 4, PARI 14 and 36 failed to enter; however, the overall accuracy rate declined only marginally to 89.04%. When the same eight items were analyzed for the one-year data, similar results were obtained. These variables comprise a discriminant function that correctly identifies 88.9% of the new mothers and 86.8% of the maladaptors for a total accuracy rate of 88.18%. Once again, if entry into the function is limited to statistically significant items, only a subset are included: Kaplan 1, 5, and 7; and MSPP 29 which accurately classify 86.9% of new mothers and 84.4% of maladaptors. The overall accuracy rate for this discriminant function is 86.04%. These results appear highly promising. Using only eight items we were able to discriminate maladapting mothers from normal mothers with nearly 90% accuracy. Moreover, this outcome has been cross-validated on separate comparison samples. There seems reason to hope that this combination of items may provide the basis for a more powerful screening scale than has so far been available.
Expanding the Screening Scale Despite the apparent power of these eight items in distinguishing women in the two comparison groups, it seemed unlikely to us that such a small number of items could sufficiently represent all relevant domains of content for different population groupings. Accordingly, we selected 12 additional items bringing the total scale size to 20 items. To select these items, we first entered all the best predictors from the factor by factor discriminant function analyses of the new data. The 20 most efficient predictors consisted of four Kaplan variables, six MSPP items and ten PAR1 indicators (Table 1). These items correctly identified 95.6% of the comparison mothers and 90.1% of the maladaptors for a total accuracy rate of 93.02% in the second data set. When these 20 items were applied to the Family Volunteer baseline data, they accurately predicted the group membership of 91.5% of the new mothers and 87.3% of the maladaptors for a 90.61% overall rate of accuracy. When the one-year data were considered, the results were almost identical: 90.6% of new mothers and 87.3% of maladaptors are accurately predicted for a total accuracy rate of 89.52%. Thus, this expanded set of items appears to represent a promising pool from which to develop an effective screening instrument. These items are presented in Appendix 1.
Some Issues of Interpretation Clearly the known-groups procedure that we have employed is less than .perfect, given our research objective. Since our goal is the prediction of maladaption, it is predictive validity that must be established. This requires a prospective study involving the long-term follow-up of a very large sample of screened individuals, including the observation of parenting practices. Because of the severe ethical and practical difficulties associated with such a research
162 Table 1.
William Cross-Validation
of Twenty
Second
R. .4won.
R. Jay Turner
and Samuel
Best predictors From the Second Volunteer Data
Data Set
Discrinunant Function Coefficients
Variables
Standardized
1
- ,393
5 6 7
MSPP MSPP MSPP MSPP MSPP MSPP PARI PARI PARI PAR1 PAR1 PAR1 PAR1 PAR1 PAR1 PAR1
KAPLAN KAPLAN KAPLAN KAPLAN
Unstandardized
Data Set on Baseline Family
Baseline
-
Volunteer
and One-k ear Farnil!
Stud)
Data
One-Year
Dlscrimmant Function Coefficients Standardized
Noh
Cnstandardized
Data
Discrlmlnant Function Coefticlenta Standardized
Unstandardized
,176 -.104 ,445
- ,399 .I73 -.I27 ,453
.259 .278 ,202 ,415
,296 ,291 ,249 ,352
.072. 150 .351 ,450
.07X .21X ,400 ,165
I 3 4 13 26 29
,116 ,145 ,512 .136 - ,062 ,146
.I04 ,101 .415 ,109 - ,045 ,104
-.I10
- ,064 -.I26 ,079 - ,032 ,017 ,027
- 038
-- 022
- ,235 ,149 - ,059 ,033 ,052
-.I52
- ,077 .0X5 - .07b
3 14 19 20 21 26 36 38 39 40
,135 ,258 ,200 .105 -.141 ,102 ,387 .128 - ,304 .220
,138 ,259 ,200 ,104 -.I43 .I04 ,390 ,131 - .297 ,240
,009 -.I35 ,012 -.016 ,010 .195 - ,077 ,097 ,042 ,242
,009 -.139 .I19 -- 016 .OlO ,205 - ,753 ,098 .044 ,173
.045 -.I52 .097
CONSTANT
% comparison mothers classified = 95.6%.
- 5.484
- 6.234
,168 -.I!X 00 ,072
00
,035 .045 -.I59 .I06 -.I32 ,032 711 .___
-.I'6
,031 .205 ,067 ,171 .21 I .05 I
.07 I .I77 .223 - .056 - 5.443
correctly = 91.5%
= 90.6F
% maladaptors correctly classified = 90.1%.
= 87.3%
= 87.37
Total % correctly classified = 93.02%.
= 90.61%
= 89.52sC
design, other researchers have had to be content, as we have, with variations of known-groups or case-comparison designs. While such designs, therefore, must be regarded as acceptable. the interpretation of results requires extreme caution. The use of screening measures derived from known-groups analyses requires that we make two assumptions: (1) that the assignment of cases to each of the known groups is relatively free of error; and (2) that indices that distinguish parents currently having problems from those who are not also can effectively predict who is likely to have such problems in the future. Regarding the first assumption, some mothers in the two maladaptive samples could possibly have been mislabled despite the fact that all cases in these two samples had been so identified on the basis of interviews with experienced caseworkers from Family and Children’s Services. Also there is the possibility that we may have been unaware of some problems in parenting that some mothers in the two comparison samples were experiencing. Indeed, some errors of misclassification would seem difficult if not impossible to avoid. However, important to note is the fact that misclassification in this context produces a conservative bias. This must be so since misclassification makes contrasted groups more alike and. thereby.
Problem
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more difficult to discriminate. In such a circumstance, computed accuracy rates tend to be underestimates because some cases counted as classification errors would, in fact, not be errors. As noted earlier, practical and ethical obstacles with prospective designs require the assumption that measures that distinguish between known groups can also predict who is likely to face parenting problems in the future. Relevant to this assumption is the question of whether extraneous, unmeasured, or unknown variables may have significantly affected the results observed. Could the elements of our measure that distinguish maladaptors from comparison mothers do so because of their association with some gross, systematic difference between the two samples? We have discussed this possibility at some length in a previous article [ 1 l] dealing with the original two samples. These prior analyses revealed no evidence that the discriminant power of social support items was an artifact of group differences in age, education, or socioeconomic circumstance. Moreover, neither recency of childbirth among Family Volunteer mothers nor involvement in the social support intervention could account for the results that we obtained. These observations and the fact that the MSPP and PARI instruments distinguished between our two known groups at levels comparable to those reported in other studies, make it unlikely that the predictive power of our measure results from any peculiarities in our samples since such peculiarities should presumably have affected the predictive power of the MSPP and PARI as well. Since our cross-validation procedures on the second sample of maladaptors and presumably normal mothers generated discriminant results that were highly similar to those that were obtained from the initial samples, we are confident that the predictive power of our measure cannot be regarded to be artifactual. Thus, we are convinced that the discriminant power of our measures, cross-validated on a second set of known groups, provides a fair test of our potential screening scale.
DISCUSSION Earlier in this paper, we expressed the view of the importance of pursuing the development of a screening instrument capable of distinguishing those individuals who are most likely to need, and perhaps benefit from, effective interventions that might be devised in the future. In our opinion, the reality of limited resources that characterize these times makes it inevitable that some form of screening will take place with respect to intervention programs, even in the absence of a formal effort. What is needed is an effective screening instrument that can be applied in community health and social program settings and which is also benign with respect to the labeling issue.
Issues of Field Application: Sensitivity and Specificity The requirement for practicality led us to consider issues of scoring and of interpretation with respect to the measures we have described. While both the &item and the 20-item scales proved to be highly accurate in distinguishing maladaptive mothers from comparison mothers. it should be remembered that this classification of cases was based on the optimal weights derived from the discriminant function coefficients. Clearly, to derive or to apply these complex weightings within a doctor’s office or other community setting would not be possible. If one were to compute a simple sum score and use the resulting value for screening purposes. the accuracy of discrimination would presumably decline somewhat. Despite the anticipated reduction in accuracy. we view the use of a simple summing procedure to be preferable for two reasons. First, the item weights derived from discriminant function analy-
164
William R. Avison. R. Jay Turner and Samuel Noh
ses are specific to the samples analyzed. This means that the utilization of such weights on new samples would be a questionable strategy. Second, practitioners and clinicians could use a simple summing procedure on location and without technical assistance. To assess the utility of this simplified scoring approach, sum scores were computed for the 204tem proposed screening instrument for the two initial samples and for the Family Volunteer baseline and maladaptive samples. Table 2 presents the cumulated frequency distribution of sum scores for the 20-item cross-validated scale. This table enables us to assess the discriminative power of the simple sum scoring procedure. For any score. we can identify the percentage of correctly identified maladaptors (true positives) and the corresponding percentage of comparison mothers who would be incorrectly classified as maladaptors (false positives). The proportion of true positives represents the sensitivity of our instrument. When the proportion of false positives is subtracted from 1.0, this represents the specificity of our instrument (the proportion of true negatives). For example, if one wished to identify that score that would be unlikely to produce many false positives, a score of 31 or less might be selected since this score yielded no false positives in either of the two comparison samples studied. However, it is important to note is that a score of 31 would identify only about 12% of the maladaptors from the Family Volunteer Study and less than 16% of the maladaptors from the new sample. Thus, while this particular
Table 2.
Cumulated Distributions
of Sum Scores for the Twenty Item Screening Instrument
SECOND DATA SET
SCORE 31 or less 32 33 34 35 36 31 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 51 58 59 60 61 62 or ereater
COMPARISON MOTHERS 8’8 f* 0 0 0 0 0
0 2 2 3 4 3 4
4
9
6 2 3 5 2 15
‘f = frequency **% = cumulated percentage
0 0 1.1 1.1 1.1 2.2 2.2 3.2 3.2 6.5 8.6 9.7 11.8 15.1 19.4 26.9 30.1 34.4 31.6 45.2 49.5 52.7 60.2 69.9 71.0 72.0 78.5 80.6 83.9 89.2 91.4 100.0
FAMILY
MALADAPTORS f’ %**
4 2 6
2
0
2 0 0
0 0 I
15.9 17.1 20.7 23.2 29.3 34. I 40.2 45.1 56.1 59.8 61.0 64.6 69.5 72.0 19.3 81.7 85.4 86.6 90.2 92.1 93.9 95.1 95.1 91.6 97.6 98.8 98.8 98.8 98.8 100.0
VOLUNTEER
COMPARISON MOTHERS f’ %** 0 I
2 1 4 2 2 2 4 8 5 9 4 5 13 9 13 14 15 13 18 13 II 15 15 6 I2 10 9 IO I 20
0
0.4 1.1 I.5 3.0 3.8 4.5 5.3 6.8 9.8 11.7 15.0 16.5 18.4 23.3 26.1 31.6 36.8 42.5 41.4 54.1 59.0 63.2 68.8 74.4 16.1 81.2 85.0 88.3 92.1 92.5 100.0
SAMPLES
MALADAPTORS f* %** 7 4 3 6 5 2 I 2 6 5 2 0
3 2 3 2 1 0 0 0 1 1 0 2 0 0 0 1
11.9 18.6 23.1 33.9 42.4 45.8 41.4 50.8 61.0 69.5 72.9 72.9 78.0 81.4 86.4 89.8 91.5 91.5 91.5 91.5 93.2 94.9 94.9 98.3 98.3 98.3 98.3 100.0
Problem parenting
165
score would minimize the number of false positives, it would also minimize the proportion of true positives that would be identified. Conversely, if the goal was to identify all true positives, our data suggest that a score of 58 or more might achieve this goal. This score would include essentially all maladaptors from both samples. However, this would be of little utility since the score would also mistakenly classify over 80% of the comparison mothers from both samples as maladaptors. Obviously, such a cut-point would represent little or no advance with respect to the goal of screening. Clearly, the practical application of the proposed scale requires the selection of a cut-point that simultaneously maximizes the percentage of true positives and minimizes the percentage of false positives. Table 3 presents the scores that appear optimal with respect to this objective. For each score, the percentages of true positives and false positives are shown for both sets of comparisons. Thus, for example, the sensitivity (proportion of maladaptors correctly identified) of a score of 45 is .79 in the new data set and .86 in the Family Volunteer study. The specificity (proportion of comparison mothers correctly identified) is .81 for the new sample and .77 for the Family Volunteer sample. While the accuracy level seems somewhat problematic, the most serious problem, in our view, arises from the fact that very small changes in raw scores tend to be associated with sizeable variations in the accuracy of resulting classification. Thus, very small differences in subjects’ responses considerably alter the probability of misclassification. To employ a test in which a score difference of one point profoundly affects the resulting classification is unacceptable, we feel. This is so because subject responses can hardly be expected to be perfectly stable over time. For example, a change of only a single point from 45 to 46 results in a 3.4% increase in false positives in the Family Volunteer data and a 7.5% increase in the other sample. Given the inevitability of measurement error, it seems important to develop a measure for which minor score variations do not so profoundly influence the classification of cases. Based on the data so far in hand, we conclude that the high level of sensitivity to minor sum score variations represents a significant weakness in the proposed scale. Future efforts at refinement should therefore concentrate in overcoming this apparent scaling problem. Improvements in this area may require either a larger set of items or a broadening of the item response scales or both. Notwithstanding the apparent weakness just identified, our conclusion remains that the proposed scale is among the most promising and powerful currently available. It appears to us to represent a clear advance over both the PAR1 and the MSPP. Therefore, in circumstances in which there is a pressing need for screening, this scale may represent the instrument of choice. However, it should be employed only in the context of a full realization of the limitations of its applicability.
Table 3.
Optimal Cut-Points
For the Twenty Item Proposed Screening
Second Data Set Cut-Point 144 < 45 2 46
Maladaptors’ 72.0% 79.3% 81.7%
Comparison Mothers** 15.1% 19.4% 26.9%
Scale
Familv Volunteer Samules Maladaptors* 81.4% 86.4% 89.8%
Comparison Mothers** 18.4% 23.3% 26.7%
* Percentage of correctly identified maladaptors. When the percentage is expressed as a proportion. this value represents the sensitiviry of the proposed screening scale for that particular cut-point. l * Percentage of comparison mothers incorrectly classified as maladaptors. When the percentage is expressed as a proportion and subtracted from 1.0, the results and value represents the specificity of the proposed screening scale for that particular cutpoint.
166
Limitations
William
R. Avison.
R. Jay Turner
and Samuel
Nob
and Cautions
We emphatically stress that the proposed measure cannot be regarded as a clinical or diagnostic instrument or used for such purposes. Moreover, none of the evidence we have gathered or presented bears in any direct way upon the specific problem of child abuse. The data we obtained were from undifferentiated samples of mothers who were known to be. or thought to be, experiencing some type of significant difficulty in the parenting role. Thus. the proposed screening scale can relate only in rather broadly conceived parental maladaptation. There is yet an additional consideration that further constrains the appropriate use of this scale. Even the most inflated estimates of the extent of problem parenting suggest that it characterizes a distinct minority of the population. Consequently. even an instrument that can discriminate with 90% accuracy will classify a large number of non-maladaptors into the maladaptor category. For example. if 1,000 women from the community were screened using an instrument that correctly identifies 90% of both maladaptors and non-maladaptors and the true prevalence of maladaptation was 10%. the following would obtain. Ninety of the 100 maladaptors (90%) would be correctly identified to be in need of some intervention and 90 of the 900 nonmaladaptors (10%) would be similarly, but mistakenly, identified. Thus, only one-half of those who would be classified as maladaptors would, in fact, be maladaptors. If the true prevalence is less than lo%, then a majority of the identified group would be nonmaladaptors. The fact that substantial misclassification will inevitably occur even when a highly sensitive instrument is used to identify a low prevalence problem in general populations suggests to some [55] that screening programs in the service of prevention cannot be ethically defended because of the social costs associated with labeling. In our view, there are two counterarguments to this position. First, when the purpose of screening is limited to identifying individuals who might need or be assisted by an intervention, the labeling involved would be both minimal and benign. Second, we are not distressed by the apparent fact that half or more of all those who would be identified would not be maladaptors. This is so because there seems good basis for contending that individuals with low scores on measures such as those proposed are likely to benefit importantly from voluntary participation in intervention programs whether or not they are at risk for problem parenting. We believe that with appropriate cautions, screening aimed at identifying those who might be offered intervention programs can be justified and useful. Finally, we believe that the measure proposed here represents a promising advance in our capacity to identify individuals with service needs. At a minimum, our findings justify further developmental efforts aimed toward achieving a powerful and practical screening instrument.
NOTES
AND
REFERENCES
I. PAULSON, M. J., ABDELMONEM, A., CHALEFF. A. A., LIU. V. and THOMASON. M. A discriminant function procedure for identifying abusing parents. Surcide 5: 104-I 14 (1975). 2. SCHLOESSER, P. T. The abused child. Bullerin of the Menninger Clinic 28:260-268 (1964). 3. SILVER, L. B., DUBLIN, C. C. and LAURIE, R. J. Agency action and interaction in cases of child abuse. Social Casework 52:164-171 (1971). 4. STEELE, B. and POLLOCK, C. A psychiatric study of parents who abuse infants and small children. In: The Buffered Child, R. E. Heifer and C. H. Kempe (Eds.), pp. 89-134. University of Chicago Press. Chicago (1974). 5. LAUER, B., TENBROECK, E. and GROSSMAN, M. Battered child syndrome: Review of 130 patients with controls. Pediatrrcs 54:67-70 (1974). 6. SMITH, S. M., HANSON, R. and NOBLE, S. Aspects of the battered baby syndrome. Brrrtsh Journal of Psychology 125:562-582 (1974). 7. MADEN, M. F. and WRENCH, D. F. Significant findings in child abuse research. Vv~rmolo~ 2:196-224 ( 1977). 8. PELTON, 1. H. Child abuse and neglect: The myth of ciasslessness. Amerrcan Journul of Orrhopsychmrcv 48:608-617 (1972).
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J. J. and RIGLER. D. The child abusing parent: A psych~~iogical review. P~~,cholf~gl[.ff/ Builetm 9. SPINETTA. 77:296-304 (1972). 10. UNITED STATES DEPARTMENT OF HEALTH, EDUCATION AND WELFARE. Child Abuse und Neglecr Programs: Proctrce and Theory. National Institute of Mental Health, DHEW (Adminl 78-344. Rockville (1977). 11. TURNER, R. J. and AVISON. W. R. Assessmg risk factors for problem parenting: The signiticance of social support. Joumnl of Marriage and rhe Fomi!v 47:88 l-892 ( 1985 ). 12. In previous analyses [1 I], we have presented evidence that life stress and personal control are also associated with elevated risk for maladaption. Since subsequent analyses did not result in items from measures of these concepts being included in our potential screening instrument. we have chosen not to discuss these constructs in this paper because of space limitations. 13. HENDERSON. S. The social network, social support and neurosis: The function of attachment m adult life, Brirish Journol ofPsychiorn, 131: 185-191 (1977). 14. HENDERSON. S. A development in social psychiatry: The systematic study of social bonds. Journal f$Nervous ond Mental Disease 16863-69 (1980). 15. MUELLER, D. P. Social networks: A promising direction for research on the relationshrp of the social environment to psychiatric disorder. S&u/ Scienre and Medrcrne 14: 147- 16 f ( I9RO). 16. CASSEL, J. The contribution of the social environment to host resistance. Amerrcon Journu/ of _ Eordemrokozv 1 ** 104107-123 (1976). 17. BROWN, G. W.. BHROLCHAIN. M. and HARRIS. T. Social class and psychiatric disturbance among women in an urban population. Soaolom 9:225-254 (1975). 18. LOWENTHAL. M. F. and HAVEN. C. Interaction and adaptation: Intimacy as a critical variable. Amencan Sociological Review 33:20-30 ( 1968). 19. MILLER. P. and INGHAM, J. Friends, confidants, and symptoms. Soaal &chiar~r II:Sl-58 (1976). 20. LYNCH, J. J. The Broken Heart: Medicaf Consequences of Loneliness. Basic Books. New York (1977). 21. NEWBERGER, E.. REED, R. B.. DANIEL, J. H., HYDE, J. N. and KOTELCHUCK. M. Pediatrrc social illness: Toward an etiologic classification. Pediatrics 60: 178- 185 (1977). 22. POLANSKY, N. A., CHALMERS, M. A., BUTTENWIESSER. E. and WILLIAMS. D. P. lsolatton of the neglectful family. American Journal of Orrhopsychialv 49: 149- 152 ( 1979). 23. EGELAND, B. and BRUNNQUELL, D. An at-risk approach to the study of child abuse. Journal qf the American Academy of Child Psychintrv 18:219-235 (1979). 24. CROCKENBERG. S. infant irritability. mother responsiveness. and social support influences on the security of infant-mother attachment. Child Deveiopmenr 52:857-865 (1981). 25. CRNIC. K.. GREENBERG, M., RAGOZIN. A., ROBINSON. N. and BASKAM. R. Effects of stress and social support on mothers and premature and full-term infants. Child Developmenr 54:209-217 (1983). 26. PASCOE. J. M. and EARP. J. A. The effects of mothers’ social sunoort and life chanees on the stimulatton of -’ their children in the home. American Journal of Public Health 74:3%360 (1984). 27. COBB, S. Social support as a moderator of life stress. Psrchosomortc Medicine 38:301-3 14 (1976). 28. DEAN, A. and LIN. N. The stress buffering role of social support. Journal of Nervous and Men& Diseases l&:403-417 (1977). 29. GOTTLIEB, B. H. Social networks and social support in community mental health. In: Social Metworks und Social Support, B. H. Gottlieb (Ed.), pp. 1 l-42. Sage Publications. Beverly Hills, CA (1981). 30. TURNER, R. J. Social support as a contingency for psychological well-being. Journal of Health and Socrai Behavior 221357-367 (1981). 31. TURNER, R. J. Direct, indirect and moderating effects of social support on psychological distress and associated conditions. In: Psychosocial Stress: Trends in Theocv and Research, H. B. Kaplan (Ed.). pp. 105- 155. Academic Press. New York (1983). 32. HOUSE, J. S. Work Stress and Social Support. Addison-Wesley. Reading, MA (1981). 33. KESSLER. R. C. and MCLEOD. J. Social support and mental health in community samples. in: Sociaf Supporz and He&h, S. Cohen and L. Syme (Eds.). pp. 219-240. Academic Press. New York (1985). 34. MARTIN. H. P.. BEEZLEY. P.. CONWAY. E. F. and KEMPE. C. H. The development of abused children. Advances in Pediorrics 21125-73 (1974). 35. SMITH, S. M. and HANSON, R. Interpersonal relationships and childbearing practices in 213 parents of battered children. Brirish Journaf of PsychiatT 127:5 13-525 (1975). 36. BAVOLEK, S. J., KLINE. D. F., MCLAUGHLIN. J. A. and PUBLICOVER. P. R. Primary prevention of child abuse and neglect: Identification of high-risk adolescents. Child Abuse and Negiecr 3: 1071-1080 (1979). 37. BALDWIN. J. and OLIVER. J. E. Epidemiology and family characteristics of severely abused children. Brirish Journal of Preventive Social Medtcine 29:205-221 (1975). 38. SMITH, S. The Botrered Child Syndrome. Butterworth. London (1975). 39. BAHER. E.. HYMAN. C., JONES, R.. KERR. A. and MITCHELL, R. Af Risk: An Accouni of rhe Work on the Battered Child. Routledge and Kegan Paul, London (1976). 40. FONTANA. V. J. Somewhere a Child is Cving: Mal~reaimen~ - Causes and Prevenrion. MacMillan. New York (1973). 41. SCHNEIDER, C. J.. HELFER. R. E. and POLLOCK. C. The predictive questionnaire: Preliminary report. In: Helping the Barrered Chrld and HIS Fami[v, C. H. Kempe and R. E. Helfer (Eds.). pp. 271-284. J. B. Lippincott. Philadelphia (1972). 42. SCHNEIDER. C. J.. HOFFMEISTER. J. K. and HELFER. R. E. A predictive screening questionnaire for potential problems in mother-child interactions. In: Child Abuse and Neglecr: The Fomib and rhe Cornmum!,: R. E. Helfer and C. H. Kempe (Eds.). pp. 393-407. Ballinger. Cambridge. MA (1976).
168 43
44 45 46.
47. 48. 49. 50. 51. 52.
53. 54. 55.
William
R. Avison,
R. Jay Turner
and Samuel Noh
SCHNEIDER, C. J., HELFER, R. E. and HOFFMEISTER. J. K. Screening for the potential to abuse: A review. In: The Battered Child (3rd ed.), C. H. Kempe and R. E. Helfer (Eds.), pp. 420-430. University of Chicago Press, Chicago (1980). WOLFE. D. A. Child-abusive parents: An empirical review and analysis. Psvchologlcal Builerm 97:462-482 (1985). KAPLAN, A. Social support: The construct and its measurement. thesis, Department of Psychology, Brown University (1977). TURNER, R. J., FRANKEL, B. G. and LEVIN, D. Social support: Conceptualization. measurement and implications for mental health. In: Research in Community and Mental Health (Vol. 3). J. R. Greenley (Ed.). pp. 67- 112. JAI Press, Greenwich, CT (1983). HELFER, R., HOFFMEISTER, J. K. and SCHNEIDER, C. Report on the Research Using the Michigan Screening Profile of Parenting (MSPP). Test Analysis and Development Corporation, Boulder, CO (1978). HELFER, R., HOFFMEISTER, J. K. and SCHNEIDER, C. MSPP (Michigan Screenrng Profile of Parentmgl. Test Analysis and Development Corporation. Boulder, CO (1978). SCHAEFER, E. S. and BELL, R. Q. Development of a parental attitude research instrument. Child Development 29:339-361 (1958). KARRBY, G. Child Rearing and the Development of Moral Structure. Almquist and Wilksell, Stockholm (1971). TURNER, R. J. et al. The Family Volunteer Study. Final report for the Ontario Ministry of Community and Social Services, unpublished, (1982). This technique selects the linear combination of variables that best discriminates between the samples under investigation. The unstandardized and standardized coefficients that make up the discriminant functions can be interpreted in a manner analogous to the coefficients generated by multiple regression, Once the optimal discriminant function has been generated, it is used to classify the cases that comprise the comparison samples. The function’s accuracy can be evaluated in terms of the percentage of cases correctly categorized (53. 541. NIE, N. H., HULL, C. H., JENKINS, J. G. and BENT, D. H. Statistical Package for rhe Social Sciences. McGraw-Hill, New York (1975). KLECKA, W. R. Discriminant Analysis. Sage Publications, Beverly Hills, CA (1980). DANIEL, J. H., NEWBERGER, B. H., REED, R. B. and KOTELCHUCK, M. Child abuse screening: Implications of the limited predictive power of abuse discriminants from a controlled family study of pediatric social illness. Child Abuse & Neglect 3:993-1002 (1978).
Problem
APPENDIX POTENTIAL (KAPLAN
169
parenting
SCREENING
I
SCALE OF 20 ITEMS
1) 1.
JANE Jane rarely knows that there are people she can lean on. She doesn’t belong to any group of different people who know each other and who will help her out when things get rough.
SONIA Sonia sometimes knows that there are people she can lean on and that they will sometimes help her out when things get rough.
VIKI Viki belongs to a group of many different people who know each other and who help her out when things get rough, Just because she is Viki. She always knows that there are a lot of different people she can lean on.
a) Check one. cl
cl
I’m like Jane. (KAPLAN
I’m halfway between Jane and Sonia.
Cl I’m like Sonia.
cl I’m halfway between Sonia and Viki.
cl I’m like Viki.
5) 2.
MOLLY Molly rarely knows that there are people she can lean on. She doesn’t belong to any group of different people who know each other and who will help her out when things get tough.
GINNY Ginny sometimes knows that there are people she can lean on and that they will sometimes help her out when things get rough.
SUSAN Susan belongs to a group of many different people who know each other and who help her out when things get rough, just because she is Susan. She always knows that there are a lot of different people she can lean on.
d) Check one.
q
cl I’m like Molly.
(KAPLAN
I’m halfway between Molly and Ginny.
Cl I’m like Ginny.
q I’m halfway between Ginny and Susan.
0 I’m like Susan.
6) 3.
PHYLLIS Phyllis is rarely admired and praised. There are very few people who think Phyllis is important and worthy.
MARTHA Martha is sometimes admired and praised by some people. She is not always being reminded of her worth.
TINA Tina is constantly being admired by people. They always praise her and think that she is important and worthy.
a) Check one.
cl I’m like Phylhs.
cl I’m halfway between Phyllis and Martha.
cl I’m like Martha.
q I’m halfway between Martha and Tina.
cl I’m like Tina.
170
William
R. Avison.
R. Jay Turner
and Samuel Noh
APPENDIX I (KAPLAN
7) 4.
CARRIE People believe that Carrie will make the right decisions and do the right things. They have confidence and faith in her.
RHODA Some people have confidence and faith in Rhoda. Sometimes they think that she will make the right decisions and do the right things.
SHARON People rarely believe that Sharon will make the right dectsions or do the right things. They hardly ever have confidence in her.
e) Check one.
cl
cl I’m like Carrie
(MSPP (MSPP
I’m halfway between Carrie and Rhoda. 1) 3j
(MSPP 29) (PAR1 20) (PAR1 21) (PAR1 36) (PAR1 40) (PAR1 26) (MSPP 4) (MSPP 13) (MSPP 26) (PAR1 14) (PAR1 38) (PAR1 39) (PAR1 3) (PAR1 19)
cl I’m like Rhoda.
cl I’m halfway between Rhoda and Sharon.
0 I’m like Sharon.
5. No one has ever really listened to me. 6. The main thing I remember from my childhood is the love and warm feelings my parents showed me. 7. As a child, I often felt that no one paid much attention to what I wanted or needed. 8. A wise parent will teach a child early just who is the boss. 9. Children who are held to firm rules grow up to be the best adults. 10. It is sometimes necessary for the parents to break the child’s will. 11. A child should be weaned away from the bottle or breast as soon as possible. 12. Raising children is a nerve-wracking job. 13. My life seems to have been one crisis after another. 14. I go through times when I feel helpless and unable to do the things I should. 15. Sometimes I just feel like running away. 16. A parent should never be made to look wrong in a child’s eye. 17. There is nothing worse than letting a child hear criticisms of his mother. 18. Loyalty to parents comes before anything else. 19. Home is the only thing that matters. 20. A women has to choose between having a well run home and hobnobbing around with neighbors and friends.
SCREENING
FOR PROBLEM
PARENTING:
EVIDENCE ON A PROMISING
PRELIMINARY
INSTRUMENT
WILLIAM R. AVISON, R. JAY TURNER AND SAMUEL NOH The University of Western Ontario. London. Ontario paper reports on efforts aimed toward the development of more effective procedures for identifying mothers who are at elevated risk for problems in parenting. We present data from two independent samples of known maladaptors and corresponding comparison mothers and report on our attempts to cross-vaiidate a promising screening inst~ment composed of items that index social support and parenting attitudes. The resultant tOGtern scale correctly identified over 90% of matadaptive and comparison mothers. When this scale was cross-validated on a second independent sample of maladaptors and comparison mothers, it ‘was again almost 90% accurate. Issues concerning the field application of this promising instrument are discussed and its possible limitations are considered. Abstract-This
RCsumb-Le present travail est consacre a l’analyse d’une recherche de moyens efficaces pour identifier ies meres qui prisentent un risque elevc de troubles relationnels parents-enfants. Les auteurs ont Ctudie deux cohortes indipendantes de meres mal adaptees et de meres ttmoins. 11sont teste la valeur dun inst~ment de depistage qui apparait comme prometteur, compose d’indicateurs tvaluant la quahte de i’appui social d’une part et le comportement parental d’autre part. Cet instrument semble valable puisque l’echelle composee de 20 indicateurs a permis d’identifier correctement plus de 90% des femmes a risque et des femmes temoins. Cette echelle d’appreciation a ttt remise a l’epreuve au moyen d’un deuxieme collectif de meres a risque et de meres temoins; a noveau la prediction s’est revelte valable dans plus du 90% des cas. Dans la discussion, les auteurs se penchent sur les consequences de l’apphcation sur le terrain de cet instrument predictif sans oublier les Iimites de son utiiisation.
INTRODUCTION THIS PAPER REPORTS on efforts to develop more effective procedures for distinguishing women who may be at elevated risk for problems in parenting. The importance of more clearly identifying significant risk factors can hardly be overemphasized. Observations that associate various factors with maladaptive parenting amount to clues or hypotheses concerning the possible causal relevance of such factors and provide what basis there is for proposing possible intervention strategies. Moreover, since resources will inevitably be limited, more effective means for identifying those who may need and perhaps benefit from an intervention are clearly required. While available evidence suggests that a number of parent demographic variables such as gender [l-4], age 15, 61, marital and socioeconomic status [7-IO] are associated with risk for The study from which this paper is drawn was supported by a grant from the Ontario Ministry of Community and Social Services. Child Abuse Program and a National Health Scientist Award from the National Health Research and Deveiopment Program (NHRDP) of Health and Welfare Canada to R. Jay Turner. This work was also supported, in part, by a grant from the Ontario Ministry of Health to the Health Care Research Unit. The University of Western Ontario. An earlier version of this paper was presented at the Fifth International Montreal, Canada. 1984.
Congress on Child Abuse and Neglect.
Address communications to R. Jay Turner. Director. Health Care Research Unit. C.F.C. Building, The University of Western Ontario. London. Ontario, Canada N6A 588. 157
William
158
R. Avison.
R. Jay Turner
and Samuel
Noh
maladaptation, these relationships are too weak to be of any real predictive utility. However. they do invite attention to the critical question of what underlying factors associated with these characteristics give rise to their relationship with maladaptive parenting. In our view. by addressing this question contributions are most likely to be made toward a more adequate understanding of differential risk for deviant parenting. The literature on child abuse and neglect has also suggested the possible relevance of an array of social psychological factors. In our view, one of the most promising of these is social support. Indeed, this research grows out of our findings reported elsewhere that social support was the most powerful factor in distinguishing known maladaptors from presumably normal mothers [ll]. Considerable evidence is also available suggesting the relevance of parental attitudes and perceptions. We have assumed in the work reported here that scales measuring these constructs may provide the bases for a more effective screening instrument [ 121.
Social Support The concept of social support has been variously addressed in terms of social bonds [ 13, 141 and social networks [ 151, social contact [ 161, the availability of confidants [ 17- 191, and human companionship [20], as well as social support. Although these concepts are not identical. they share a focus on the significance and relevance of human relationships. Several studies have directly suggested that social support may be importantly associated with maladaptive parenting [21-261. Additionally, there is ample evidence of a link between social support and mental health that further sustains the hypothesized relevance of this variable for problem parenting [27-311. A significant aspect of social support is the experience of being supported by others. Recent reviews [31-331 make it clear that the bulk of evidence linking social support with indices of health or well-being derives from studies that have addressed this emotional and perceptual component. Our own research [ 1 l] is consistent with this pattern. In an investigation of a sample of mothers with parenting problems and a matched sample of women who had recently given birth, we found that social support, as experienced or perceived by the individual, effectively distinguished among women who varied in their adaptation to the parenting role. While life stress and personal control were also significant in this context, these results suggested that experienced social support may be of dramatic adaptive relevance.
Parenting
Attitudes
and Behaviors
In the course of attempting to understand the phenomenon of maladaptive parenting, extensive efforts have been made to describe the parenting behaviors prevalent in problem families. Descriptions provided in the literature include high levels of punitiveness [34-361; rejection and hostility [34, 351; high levels of violence [34, 371; poor mothercraft skills [38, 391; poor nurturing ability or “motherliness” [36, 38, 391; assumed right to punish [40]; and unrealistic expectations of the child [4, 41, 421. Reviews of the literature refer to additional investigations of these issues [4, 6, 43, 441. Although these attitudes and behaviors are frequently cited in the literature as characteristic of maladapting parents, few of the reporting studies have been appropriately controlled and little is known about the prevalence of such characteristics in the population at large. However, despite this lack of normative data, the United States Department of Health, Education and Welfare [lo] concludes that unrealistic expections, lack of knowledge of child development and an idiosyncratic view of the child are common characteristics of the abusive parent.
Problem
parenting
159
METHOD The procedures that we have adopted for generating a potential screening scale involves identifying items indicative of social support or of parenting attitudes and behaviors that effectively discriminate between a sample of maladaptors and a sample of comparison mothers and then cross-validating their discriminant power on additional samples of maladaptors and comparison mothers. In this section, we describe the measures that comprise the pool of potential screening items that we employed and the several samples of women from which these data were collected.
Measurement The measures employed in this study are multi-item indices, established instruments whose measurement properties are known
most of which are welland are satisfactory.
Social support. The measure we have employed to index experienced social support is an adaptation of the instrument developed by Kaplan [45]. She proposed and partially tested a story identification technique composed of 16 sets of vignettes. We adopted seven sets that, in our judgment, most effectively addressed the experience of being supported by others, changing only the names used to identify each story. Each set is composed of three stories describing individuals who have variable levels of support. Subjects are asked to identify themselves with one story or as falling midway between two stories by responding on a five-point scale. Each set is scored such that high scores indicate greater support. Evidence for the construct validity and internal reliability of this measure within several studies of diverse populations has been reported elsewhere [46].
Parenting attitudes and perceptions. As part of our efforts to assess attitudes toward and perceptions of parenting, a recent version (1978) of the Michigan Screening Profile of Parenting (MSPP) [47, 481 was administered to our samples. Although available evidence leaves considerable doubt about its adequacy as a screening device for problem parenting, it is perhaps the best known instrument and is apparently recognized by many to be the best available. Schneider and associates [41,42] have described in some detail the evolution of this instrument. The version we employed consists of 30 items; subjects respond to each item on a seven-point scale ranging from “strongly agree” to “strongly disagree.” A second measure employed to assess parenting attitudes and perceptions was the Parental Attitude Research Instrument (PARI) developed by Schaefer and Bell [49]. While some of the attitudes that are measured by the PARI scale have been found to be associated with abusive parenting, the PAR1 itself rarely has been used in analyses of child-abusing parents. Nevertheless, the scale appeared to hold promise. Despite our interest in the PARI, it was not possible to include the entire scale and still maintain our questionnaire at an acceptable length. Accordingly, only two clusters were selected from the 115-item instrument. In making this selection, we were influenced by Karrby [50] who observed that two dimensions have commonly emerged from analyses: (1) nurturance (warmth. love) versus rejection (hostility, coldness); and (2) control versus autonomy. These considerations led us to include the “demand for striving” and “punitive control” clusters from the larger instrument to index these two frequently used dimension. These clusters include a total of 40 items, each having a five-point Likert-type response scale.
160
Stu&
William
R. .4vison,
R. Jay Turner
and Samuel Noh
Samples
Data from four separate samples were employed in the analyses to be presented. One of these samples was obtained in the course of the Family Volunteer Study [5 11. This study was a longitudinal investigation of 293 women who had recently given birth at a large southwestern Ontario hospital or whose babies were treated at that hospital immediately following birth. Sampling procedures were such that half of the study population were mothers whose infants required care in the Neonatal Intensive Care Unit and half were mothers whose infants were cared for in the normal nursery. However, because we found no important or statistically significant differences between these two halves of the sample on any of the variables considered, they are treated here as a single population. Data were first gathered two to four weeks after the birth and follow-up questionnaires were administered at six and twelve months after baseline. The analyses presented here draw on data from the first and last data points. Because one of the goals of the Family Volunteer Study was to identify factors associated with adaptation to the mothering role, a comparison sample was obtained composed of 78 women who were thought to be having difficult in this role. This second sample was drawn from the child protection caseload of the Family and Children’s Services. Each woman was either known or suspected to have abused or neglected a child either physically or emotionally. These women were interviewed by their caseworker and responded to the full set of measures we have described. In order to allow cross-validation studies of developed scales. the same array of data was collected from two additional and independent samples. Two to three years after the initial samples were interviewed, a total of 87 different women were drawn from the child protection caseload of the Family and Children’s Service in the same manner as those selected for the initial sample of maladaptive mothers. The second sample of presumably normal mothers was obtained by sending interviewers to public swimming pools where they enlisted the participation of mothers who were waiting while their children took swimming lessons. While this sample cannot be claimed to be representative of normal mothers. we assumed that women who enrolled their children in such activities and who supervised them would be at less risk for maladaptation and might therefore serve as a reasonable control group. We were able to collect data from 100 such women.
RESULTS Constructing
the Potential
Screening
Scale
We employed a three-stage strategy to select items for a potential screening scale. First, we entered all 77 items from the measures described earlier, Kaplan, MSPP and PAR1 [7, 3 1,411, into an orthogonal factor analysis. In the second stage, those items that loaded on each factor were entered into a discriminant function analysis [52] to determine which items on each factor could best distinguish maladaptors from comparison mothers. Finally, those items with the greatest discriminating power in each factor were pooled and entered into a final discriminant function analysis in order to identify the best set of predictors. Our initial application of this procedure using the first two comparison samples yielded 10 items that correctly classified more than 90% of the subjects considered. However. crossvalidating analyses on the two additional samples produced a disappointing accuracy rate of less than 80%. Consequently, we again applied the three-stage strategy using the two most recent samples and reserving the original comparison groups from the Family Volunteer Study for cross-validation purposes. The findings presented in this paper derive from this latter analysis.
Problem
parenting
161
This procedure yielded eight items that effectively distinguished maladaptors from comparison mothers. In linear combination, these eight items correctly classified 85.1% of comparison mothers and 92.6% of maladaptors for a combined accuracy of 89.63%. These eight items, included in Appendix I, were: Kaplan 1, 5, 7; PAR1 14, 36, 40; MSPP 4, 29. In cross-validating these results using the the original comparison groups, it seemed essential to take account of the nature of the sample of presumably normal mothers involved. Because this group consisted entirely of women who had recently given birth, two sets of cross-validation analyses were conducted-one using the data obtained shortly after the birth (baseline) and one using data obtained a year later. When all eight variables were included in the discriminant function without regard to statistical significance, 91.4% of new mothers and 82.9% of maladaptors were accurately classified at baseline. The combined accuracy rate of these items was 89.55%. When entry into the discriminant function was constrained at a significant level of .05, MSPP 4, PARI 14 and 36 failed to enter; however, the overall accuracy rate declined only marginally to 89.04%. When the same eight items were analyzed for the one-year data, similar results were obtained. These variables comprise a discriminant function that correctly identifies 88.9% of the new mothers and 86.8% of the maladaptors for a total accuracy rate of 88.18%. Once again, if entry into the function is limited to statistically significant items, only a subset are included: Kaplan 1, 5, and 7; and MSPP 29 which accurately classify 86.9% of new mothers and 84.4% of maladaptors. The overall accuracy rate for this discriminant function is 86.04%. These results appear highly promising. Using only eight items we were able to discriminate maladapting mothers from normal mothers with nearly 90% accuracy. Moreover, this outcome has been cross-validated on separate comparison samples. There seems reason to hope that this combination of items may provide the basis for a more powerful screening scale than has so far been available.
Expanding the Screening Scale Despite the apparent power of these eight items in distinguishing women in the two comparison groups, it seemed unlikely to us that such a small number of items could sufficiently represent all relevant domains of content for different population groupings. Accordingly, we selected 12 additional items bringing the total scale size to 20 items. To select these items, we first entered all the best predictors from the factor by factor discriminant function analyses of the new data. The 20 most efficient predictors consisted of four Kaplan variables, six MSPP items and ten PAR1 indicators (Table 1). These items correctly identified 95.6% of the comparison mothers and 90.1% of the maladaptors for a total accuracy rate of 93.02% in the second data set. When these 20 items were applied to the Family Volunteer baseline data, they accurately predicted the group membership of 91.5% of the new mothers and 87.3% of the maladaptors for a 90.61% overall rate of accuracy. When the one-year data were considered, the results were almost identical: 90.6% of new mothers and 87.3% of maladaptors are accurately predicted for a total accuracy rate of 89.52%. Thus, this expanded set of items appears to represent a promising pool from which to develop an effective screening instrument. These items are presented in Appendix 1.
Some Issues of Interpretation Clearly the known-groups procedure that we have employed is less than .perfect, given our research objective. Since our goal is the prediction of maladaption, it is predictive validity that must be established. This requires a prospective study involving the long-term follow-up of a very large sample of screened individuals, including the observation of parenting practices. Because of the severe ethical and practical difficulties associated with such a research
162 Table 1.
William Cross-Validation
of Twenty
Second
R. .4won.
R. Jay Turner
and Samuel
Best predictors From the Second Volunteer Data
Data Set
Discrinunant Function Coefficients
Variables
Standardized
1
- ,393
5 6 7
MSPP MSPP MSPP MSPP MSPP MSPP PARI PARI PARI PAR1 PAR1 PAR1 PAR1 PAR1 PAR1 PAR1
KAPLAN KAPLAN KAPLAN KAPLAN
Unstandardized
Data Set on Baseline Family
Baseline
-
Volunteer
and One-k ear Farnil!
Stud)
Data
One-Year
Dlscrimmant Function Coefficients Standardized
Noh
Cnstandardized
Data
Discrlmlnant Function Coefticlenta Standardized
Unstandardized
,176 -.104 ,445
- ,399 .I73 -.I27 ,453
.259 .278 ,202 ,415
,296 ,291 ,249 ,352
.072. 150 .351 ,450
.07X .21X ,400 ,165
I 3 4 13 26 29
,116 ,145 ,512 .136 - ,062 ,146
.I04 ,101 .415 ,109 - ,045 ,104
-.I10
- ,064 -.I26 ,079 - ,032 ,017 ,027
- 038
-- 022
- ,235 ,149 - ,059 ,033 ,052
-.I52
- ,077 .0X5 - .07b
3 14 19 20 21 26 36 38 39 40
,135 ,258 ,200 .105 -.141 ,102 ,387 .128 - ,304 .220
,138 ,259 ,200 ,104 -.I43 .I04 ,390 ,131 - .297 ,240
,009 -.I35 ,012 -.016 ,010 .195 - ,077 ,097 ,042 ,242
,009 -.139 .I19 -- 016 .OlO ,205 - ,753 ,098 .044 ,173
.045 -.I52 .097
CONSTANT
% comparison mothers classified = 95.6%.
- 5.484
- 6.234
,168 -.I!X 00 ,072
00
,035 .045 -.I59 .I06 -.I32 ,032 711 .___
-.I'6
,031 .205 ,067 ,171 .21 I .05 I
.07 I .I77 .223 - .056 - 5.443
correctly = 91.5%
= 90.6F
% maladaptors correctly classified = 90.1%.
= 87.3%
= 87.37
Total % correctly classified = 93.02%.
= 90.61%
= 89.52sC
design, other researchers have had to be content, as we have, with variations of known-groups or case-comparison designs. While such designs, therefore, must be regarded as acceptable. the interpretation of results requires extreme caution. The use of screening measures derived from known-groups analyses requires that we make two assumptions: (1) that the assignment of cases to each of the known groups is relatively free of error; and (2) that indices that distinguish parents currently having problems from those who are not also can effectively predict who is likely to have such problems in the future. Regarding the first assumption, some mothers in the two maladaptive samples could possibly have been mislabled despite the fact that all cases in these two samples had been so identified on the basis of interviews with experienced caseworkers from Family and Children’s Services. Also there is the possibility that we may have been unaware of some problems in parenting that some mothers in the two comparison samples were experiencing. Indeed, some errors of misclassification would seem difficult if not impossible to avoid. However, important to note is the fact that misclassification in this context produces a conservative bias. This must be so since misclassification makes contrasted groups more alike and. thereby.
Problem
parenting
163
more difficult to discriminate. In such a circumstance, computed accuracy rates tend to be underestimates because some cases counted as classification errors would, in fact, not be errors. As noted earlier, practical and ethical obstacles with prospective designs require the assumption that measures that distinguish between known groups can also predict who is likely to face parenting problems in the future. Relevant to this assumption is the question of whether extraneous, unmeasured, or unknown variables may have significantly affected the results observed. Could the elements of our measure that distinguish maladaptors from comparison mothers do so because of their association with some gross, systematic difference between the two samples? We have discussed this possibility at some length in a previous article [ 1 l] dealing with the original two samples. These prior analyses revealed no evidence that the discriminant power of social support items was an artifact of group differences in age, education, or socioeconomic circumstance. Moreover, neither recency of childbirth among Family Volunteer mothers nor involvement in the social support intervention could account for the results that we obtained. These observations and the fact that the MSPP and PARI instruments distinguished between our two known groups at levels comparable to those reported in other studies, make it unlikely that the predictive power of our measure results from any peculiarities in our samples since such peculiarities should presumably have affected the predictive power of the MSPP and PARI as well. Since our cross-validation procedures on the second sample of maladaptors and presumably normal mothers generated discriminant results that were highly similar to those that were obtained from the initial samples, we are confident that the predictive power of our measure cannot be regarded to be artifactual. Thus, we are convinced that the discriminant power of our measures, cross-validated on a second set of known groups, provides a fair test of our potential screening scale.
DISCUSSION Earlier in this paper, we expressed the view of the importance of pursuing the development of a screening instrument capable of distinguishing those individuals who are most likely to need, and perhaps benefit from, effective interventions that might be devised in the future. In our opinion, the reality of limited resources that characterize these times makes it inevitable that some form of screening will take place with respect to intervention programs, even in the absence of a formal effort. What is needed is an effective screening instrument that can be applied in community health and social program settings and which is also benign with respect to the labeling issue.
Issues of Field Application: Sensitivity and Specificity The requirement for practicality led us to consider issues of scoring and of interpretation with respect to the measures we have described. While both the &item and the 20-item scales proved to be highly accurate in distinguishing maladaptive mothers from comparison mothers. it should be remembered that this classification of cases was based on the optimal weights derived from the discriminant function coefficients. Clearly, to derive or to apply these complex weightings within a doctor’s office or other community setting would not be possible. If one were to compute a simple sum score and use the resulting value for screening purposes. the accuracy of discrimination would presumably decline somewhat. Despite the anticipated reduction in accuracy. we view the use of a simple summing procedure to be preferable for two reasons. First, the item weights derived from discriminant function analy-
164
William R. Avison. R. Jay Turner and Samuel Noh
ses are specific to the samples analyzed. This means that the utilization of such weights on new samples would be a questionable strategy. Second, practitioners and clinicians could use a simple summing procedure on location and without technical assistance. To assess the utility of this simplified scoring approach, sum scores were computed for the 204tem proposed screening instrument for the two initial samples and for the Family Volunteer baseline and maladaptive samples. Table 2 presents the cumulated frequency distribution of sum scores for the 20-item cross-validated scale. This table enables us to assess the discriminative power of the simple sum scoring procedure. For any score. we can identify the percentage of correctly identified maladaptors (true positives) and the corresponding percentage of comparison mothers who would be incorrectly classified as maladaptors (false positives). The proportion of true positives represents the sensitivity of our instrument. When the proportion of false positives is subtracted from 1.0, this represents the specificity of our instrument (the proportion of true negatives). For example, if one wished to identify that score that would be unlikely to produce many false positives, a score of 31 or less might be selected since this score yielded no false positives in either of the two comparison samples studied. However, it is important to note is that a score of 31 would identify only about 12% of the maladaptors from the Family Volunteer Study and less than 16% of the maladaptors from the new sample. Thus, while this particular
Table 2.
Cumulated Distributions
of Sum Scores for the Twenty Item Screening Instrument
SECOND DATA SET
SCORE 31 or less 32 33 34 35 36 31 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 51 58 59 60 61 62 or ereater
COMPARISON MOTHERS 8’8 f* 0 0 0 0 0
0 2 2 3 4 3 4
4
9
6 2 3 5 2 15
‘f = frequency **% = cumulated percentage
0 0 1.1 1.1 1.1 2.2 2.2 3.2 3.2 6.5 8.6 9.7 11.8 15.1 19.4 26.9 30.1 34.4 31.6 45.2 49.5 52.7 60.2 69.9 71.0 72.0 78.5 80.6 83.9 89.2 91.4 100.0
FAMILY
MALADAPTORS f’ %**
4 2 6
2
0
2 0 0
0 0 I
15.9 17.1 20.7 23.2 29.3 34. I 40.2 45.1 56.1 59.8 61.0 64.6 69.5 72.0 19.3 81.7 85.4 86.6 90.2 92.1 93.9 95.1 95.1 91.6 97.6 98.8 98.8 98.8 98.8 100.0
VOLUNTEER
COMPARISON MOTHERS f’ %** 0 I
2 1 4 2 2 2 4 8 5 9 4 5 13 9 13 14 15 13 18 13 II 15 15 6 I2 10 9 IO I 20
0
0.4 1.1 I.5 3.0 3.8 4.5 5.3 6.8 9.8 11.7 15.0 16.5 18.4 23.3 26.1 31.6 36.8 42.5 41.4 54.1 59.0 63.2 68.8 74.4 16.1 81.2 85.0 88.3 92.1 92.5 100.0
SAMPLES
MALADAPTORS f* %** 7 4 3 6 5 2 I 2 6 5 2 0
3 2 3 2 1 0 0 0 1 1 0 2 0 0 0 1
11.9 18.6 23.1 33.9 42.4 45.8 41.4 50.8 61.0 69.5 72.9 72.9 78.0 81.4 86.4 89.8 91.5 91.5 91.5 91.5 93.2 94.9 94.9 98.3 98.3 98.3 98.3 100.0
Problem parenting
165
score would minimize the number of false positives, it would also minimize the proportion of true positives that would be identified. Conversely, if the goal was to identify all true positives, our data suggest that a score of 58 or more might achieve this goal. This score would include essentially all maladaptors from both samples. However, this would be of little utility since the score would also mistakenly classify over 80% of the comparison mothers from both samples as maladaptors. Obviously, such a cut-point would represent little or no advance with respect to the goal of screening. Clearly, the practical application of the proposed scale requires the selection of a cut-point that simultaneously maximizes the percentage of true positives and minimizes the percentage of false positives. Table 3 presents the scores that appear optimal with respect to this objective. For each score, the percentages of true positives and false positives are shown for both sets of comparisons. Thus, for example, the sensitivity (proportion of maladaptors correctly identified) of a score of 45 is .79 in the new data set and .86 in the Family Volunteer study. The specificity (proportion of comparison mothers correctly identified) is .81 for the new sample and .77 for the Family Volunteer sample. While the accuracy level seems somewhat problematic, the most serious problem, in our view, arises from the fact that very small changes in raw scores tend to be associated with sizeable variations in the accuracy of resulting classification. Thus, very small differences in subjects’ responses considerably alter the probability of misclassification. To employ a test in which a score difference of one point profoundly affects the resulting classification is unacceptable, we feel. This is so because subject responses can hardly be expected to be perfectly stable over time. For example, a change of only a single point from 45 to 46 results in a 3.4% increase in false positives in the Family Volunteer data and a 7.5% increase in the other sample. Given the inevitability of measurement error, it seems important to develop a measure for which minor score variations do not so profoundly influence the classification of cases. Based on the data so far in hand, we conclude that the high level of sensitivity to minor sum score variations represents a significant weakness in the proposed scale. Future efforts at refinement should therefore concentrate in overcoming this apparent scaling problem. Improvements in this area may require either a larger set of items or a broadening of the item response scales or both. Notwithstanding the apparent weakness just identified, our conclusion remains that the proposed scale is among the most promising and powerful currently available. It appears to us to represent a clear advance over both the PAR1 and the MSPP. Therefore, in circumstances in which there is a pressing need for screening, this scale may represent the instrument of choice. However, it should be employed only in the context of a full realization of the limitations of its applicability.
Table 3.
Optimal Cut-Points
For the Twenty Item Proposed Screening
Second Data Set Cut-Point 144 < 45 2 46
Maladaptors’ 72.0% 79.3% 81.7%
Comparison Mothers** 15.1% 19.4% 26.9%
Scale
Familv Volunteer Samules Maladaptors* 81.4% 86.4% 89.8%
Comparison Mothers** 18.4% 23.3% 26.7%
* Percentage of correctly identified maladaptors. When the percentage is expressed as a proportion. this value represents the sensitiviry of the proposed screening scale for that particular cut-point. l * Percentage of comparison mothers incorrectly classified as maladaptors. When the percentage is expressed as a proportion and subtracted from 1.0, the results and value represents the specificity of the proposed screening scale for that particular cutpoint.
166
Limitations
William
R. Avison.
R. Jay Turner
and Samuel
Nob
and Cautions
We emphatically stress that the proposed measure cannot be regarded as a clinical or diagnostic instrument or used for such purposes. Moreover, none of the evidence we have gathered or presented bears in any direct way upon the specific problem of child abuse. The data we obtained were from undifferentiated samples of mothers who were known to be. or thought to be, experiencing some type of significant difficulty in the parenting role. Thus. the proposed screening scale can relate only in rather broadly conceived parental maladaptation. There is yet an additional consideration that further constrains the appropriate use of this scale. Even the most inflated estimates of the extent of problem parenting suggest that it characterizes a distinct minority of the population. Consequently. even an instrument that can discriminate with 90% accuracy will classify a large number of non-maladaptors into the maladaptor category. For example. if 1,000 women from the community were screened using an instrument that correctly identifies 90% of both maladaptors and non-maladaptors and the true prevalence of maladaptation was 10%. the following would obtain. Ninety of the 100 maladaptors (90%) would be correctly identified to be in need of some intervention and 90 of the 900 nonmaladaptors (10%) would be similarly, but mistakenly, identified. Thus, only one-half of those who would be classified as maladaptors would, in fact, be maladaptors. If the true prevalence is less than lo%, then a majority of the identified group would be nonmaladaptors. The fact that substantial misclassification will inevitably occur even when a highly sensitive instrument is used to identify a low prevalence problem in general populations suggests to some [55] that screening programs in the service of prevention cannot be ethically defended because of the social costs associated with labeling. In our view, there are two counterarguments to this position. First, when the purpose of screening is limited to identifying individuals who might need or be assisted by an intervention, the labeling involved would be both minimal and benign. Second, we are not distressed by the apparent fact that half or more of all those who would be identified would not be maladaptors. This is so because there seems good basis for contending that individuals with low scores on measures such as those proposed are likely to benefit importantly from voluntary participation in intervention programs whether or not they are at risk for problem parenting. We believe that with appropriate cautions, screening aimed at identifying those who might be offered intervention programs can be justified and useful. Finally, we believe that the measure proposed here represents a promising advance in our capacity to identify individuals with service needs. At a minimum, our findings justify further developmental efforts aimed toward achieving a powerful and practical screening instrument.
NOTES
AND
REFERENCES
I. PAULSON, M. J., ABDELMONEM, A., CHALEFF. A. A., LIU. V. and THOMASON. M. A discriminant function procedure for identifying abusing parents. Surcide 5: 104-I 14 (1975). 2. SCHLOESSER, P. T. The abused child. Bullerin of the Menninger Clinic 28:260-268 (1964). 3. SILVER, L. B., DUBLIN, C. C. and LAURIE, R. J. Agency action and interaction in cases of child abuse. Social Casework 52:164-171 (1971). 4. STEELE, B. and POLLOCK, C. A psychiatric study of parents who abuse infants and small children. In: The Buffered Child, R. E. Heifer and C. H. Kempe (Eds.), pp. 89-134. University of Chicago Press. Chicago (1974). 5. LAUER, B., TENBROECK, E. and GROSSMAN, M. Battered child syndrome: Review of 130 patients with controls. Pediatrrcs 54:67-70 (1974). 6. SMITH, S. M., HANSON, R. and NOBLE, S. Aspects of the battered baby syndrome. Brrrtsh Journal of Psychology 125:562-582 (1974). 7. MADEN, M. F. and WRENCH, D. F. Significant findings in child abuse research. Vv~rmolo~ 2:196-224 ( 1977). 8. PELTON, 1. H. Child abuse and neglect: The myth of ciasslessness. Amerrcan Journul of Orrhopsychmrcv 48:608-617 (1972).
Problem
parenting
167
J. J. and RIGLER. D. The child abusing parent: A psych~~iogical review. P~~,cholf~gl[.ff/ Builetm 9. SPINETTA. 77:296-304 (1972). 10. UNITED STATES DEPARTMENT OF HEALTH, EDUCATION AND WELFARE. Child Abuse und Neglecr Programs: Proctrce and Theory. National Institute of Mental Health, DHEW (Adminl 78-344. Rockville (1977). 11. TURNER, R. J. and AVISON. W. R. Assessmg risk factors for problem parenting: The signiticance of social support. Joumnl of Marriage and rhe Fomi!v 47:88 l-892 ( 1985 ). 12. In previous analyses [1 I], we have presented evidence that life stress and personal control are also associated with elevated risk for maladaption. Since subsequent analyses did not result in items from measures of these concepts being included in our potential screening instrument. we have chosen not to discuss these constructs in this paper because of space limitations. 13. HENDERSON. S. The social network, social support and neurosis: The function of attachment m adult life, Brirish Journol ofPsychiorn, 131: 185-191 (1977). 14. HENDERSON. S. A development in social psychiatry: The systematic study of social bonds. Journal f$Nervous ond Mental Disease 16863-69 (1980). 15. MUELLER, D. P. Social networks: A promising direction for research on the relationshrp of the social environment to psychiatric disorder. S&u/ Scienre and Medrcrne 14: 147- 16 f ( I9RO). 16. CASSEL, J. The contribution of the social environment to host resistance. Amerrcon Journu/ of _ Eordemrokozv 1 ** 104107-123 (1976). 17. BROWN, G. W.. BHROLCHAIN. M. and HARRIS. T. Social class and psychiatric disturbance among women in an urban population. Soaolom 9:225-254 (1975). 18. LOWENTHAL. M. F. and HAVEN. C. Interaction and adaptation: Intimacy as a critical variable. Amencan Sociological Review 33:20-30 ( 1968). 19. MILLER. P. and INGHAM, J. Friends, confidants, and symptoms. Soaal &chiar~r II:Sl-58 (1976). 20. LYNCH, J. J. The Broken Heart: Medicaf Consequences of Loneliness. Basic Books. New York (1977). 21. NEWBERGER, E.. REED, R. B.. DANIEL, J. H., HYDE, J. N. and KOTELCHUCK. M. Pediatrrc social illness: Toward an etiologic classification. Pediatrics 60: 178- 185 (1977). 22. POLANSKY, N. A., CHALMERS, M. A., BUTTENWIESSER. E. and WILLIAMS. D. P. lsolatton of the neglectful family. American Journal of Orrhopsychialv 49: 149- 152 ( 1979). 23. EGELAND, B. and BRUNNQUELL, D. An at-risk approach to the study of child abuse. Journal qf the American Academy of Child Psychintrv 18:219-235 (1979). 24. CROCKENBERG. S. infant irritability. mother responsiveness. and social support influences on the security of infant-mother attachment. Child Deveiopmenr 52:857-865 (1981). 25. CRNIC. K.. GREENBERG, M., RAGOZIN. A., ROBINSON. N. and BASKAM. R. Effects of stress and social support on mothers and premature and full-term infants. Child Developmenr 54:209-217 (1983). 26. PASCOE. J. M. and EARP. J. A. The effects of mothers’ social sunoort and life chanees on the stimulatton of -’ their children in the home. American Journal of Public Health 74:3%360 (1984). 27. COBB, S. Social support as a moderator of life stress. Psrchosomortc Medicine 38:301-3 14 (1976). 28. DEAN, A. and LIN. N. The stress buffering role of social support. Journal of Nervous and Men& Diseases l&:403-417 (1977). 29. GOTTLIEB, B. H. Social networks and social support in community mental health. In: Social Metworks und Social Support, B. H. Gottlieb (Ed.), pp. 1 l-42. Sage Publications. Beverly Hills, CA (1981). 30. TURNER, R. J. Social support as a contingency for psychological well-being. Journal of Health and Socrai Behavior 221357-367 (1981). 31. TURNER, R. J. Direct, indirect and moderating effects of social support on psychological distress and associated conditions. In: Psychosocial Stress: Trends in Theocv and Research, H. B. Kaplan (Ed.). pp. 105- 155. Academic Press. New York (1983). 32. HOUSE, J. S. Work Stress and Social Support. Addison-Wesley. Reading, MA (1981). 33. KESSLER. R. C. and MCLEOD. J. Social support and mental health in community samples. in: Sociaf Supporz and He&h, S. Cohen and L. Syme (Eds.). pp. 219-240. Academic Press. New York (1985). 34. MARTIN. H. P.. BEEZLEY. P.. CONWAY. E. F. and KEMPE. C. H. The development of abused children. Advances in Pediorrics 21125-73 (1974). 35. SMITH, S. M. and HANSON, R. Interpersonal relationships and childbearing practices in 213 parents of battered children. Brirish Journaf of PsychiatT 127:5 13-525 (1975). 36. BAVOLEK, S. J., KLINE. D. F., MCLAUGHLIN. J. A. and PUBLICOVER. P. R. Primary prevention of child abuse and neglect: Identification of high-risk adolescents. Child Abuse and Negiecr 3: 1071-1080 (1979). 37. BALDWIN. J. and OLIVER. J. E. Epidemiology and family characteristics of severely abused children. Brirish Journal of Preventive Social Medtcine 29:205-221 (1975). 38. SMITH, S. The Botrered Child Syndrome. Butterworth. London (1975). 39. BAHER. E.. HYMAN. C., JONES, R.. KERR. A. and MITCHELL, R. Af Risk: An Accouni of rhe Work on the Battered Child. Routledge and Kegan Paul, London (1976). 40. FONTANA. V. J. Somewhere a Child is Cving: Mal~reaimen~ - Causes and Prevenrion. MacMillan. New York (1973). 41. SCHNEIDER, C. J.. HELFER. R. E. and POLLOCK. C. The predictive questionnaire: Preliminary report. In: Helping the Barrered Chrld and HIS Fami[v, C. H. Kempe and R. E. Helfer (Eds.). pp. 271-284. J. B. Lippincott. Philadelphia (1972). 42. SCHNEIDER. C. J.. HOFFMEISTER. J. K. and HELFER. R. E. A predictive screening questionnaire for potential problems in mother-child interactions. In: Child Abuse and Neglecr: The Fomib and rhe Cornmum!,: R. E. Helfer and C. H. Kempe (Eds.). pp. 393-407. Ballinger. Cambridge. MA (1976).
168 43
44 45 46.
47. 48. 49. 50. 51. 52.
53. 54. 55.
William
R. Avison,
R. Jay Turner
and Samuel Noh
SCHNEIDER, C. J., HELFER, R. E. and HOFFMEISTER. J. K. Screening for the potential to abuse: A review. In: The Battered Child (3rd ed.), C. H. Kempe and R. E. Helfer (Eds.), pp. 420-430. University of Chicago Press, Chicago (1980). WOLFE. D. A. Child-abusive parents: An empirical review and analysis. Psvchologlcal Builerm 97:462-482 (1985). KAPLAN, A. Social support: The construct and its measurement. thesis, Department of Psychology, Brown University (1977). TURNER, R. J., FRANKEL, B. G. and LEVIN, D. Social support: Conceptualization. measurement and implications for mental health. In: Research in Community and Mental Health (Vol. 3). J. R. Greenley (Ed.). pp. 67- 112. JAI Press, Greenwich, CT (1983). HELFER, R., HOFFMEISTER, J. K. and SCHNEIDER, C. Report on the Research Using the Michigan Screening Profile of Parenting (MSPP). Test Analysis and Development Corporation, Boulder, CO (1978). HELFER, R., HOFFMEISTER, J. K. and SCHNEIDER, C. MSPP (Michigan Screenrng Profile of Parentmgl. Test Analysis and Development Corporation. Boulder, CO (1978). SCHAEFER, E. S. and BELL, R. Q. Development of a parental attitude research instrument. Child Development 29:339-361 (1958). KARRBY, G. Child Rearing and the Development of Moral Structure. Almquist and Wilksell, Stockholm (1971). TURNER, R. J. et al. The Family Volunteer Study. Final report for the Ontario Ministry of Community and Social Services, unpublished, (1982). This technique selects the linear combination of variables that best discriminates between the samples under investigation. The unstandardized and standardized coefficients that make up the discriminant functions can be interpreted in a manner analogous to the coefficients generated by multiple regression, Once the optimal discriminant function has been generated, it is used to classify the cases that comprise the comparison samples. The function’s accuracy can be evaluated in terms of the percentage of cases correctly categorized (53. 541. NIE, N. H., HULL, C. H., JENKINS, J. G. and BENT, D. H. Statistical Package for rhe Social Sciences. McGraw-Hill, New York (1975). KLECKA, W. R. Discriminant Analysis. Sage Publications, Beverly Hills, CA (1980). DANIEL, J. H., NEWBERGER, B. H., REED, R. B. and KOTELCHUCK, M. Child abuse screening: Implications of the limited predictive power of abuse discriminants from a controlled family study of pediatric social illness. Child Abuse & Neglect 3:993-1002 (1978).
Problem
APPENDIX POTENTIAL (KAPLAN
169
parenting
SCREENING
I
SCALE OF 20 ITEMS
1) 1.
JANE Jane rarely knows that there are people she can lean on. She doesn’t belong to any group of different people who know each other and who will help her out when things get rough.
SONIA Sonia sometimes knows that there are people she can lean on and that they will sometimes help her out when things get rough.
VIKI Viki belongs to a group of many different people who know each other and who help her out when things get rough, Just because she is Viki. She always knows that there are a lot of different people she can lean on.
a) Check one. cl
cl
I’m like Jane. (KAPLAN
I’m halfway between Jane and Sonia.
Cl I’m like Sonia.
cl I’m halfway between Sonia and Viki.
cl I’m like Viki.
5) 2.
MOLLY Molly rarely knows that there are people she can lean on. She doesn’t belong to any group of different people who know each other and who will help her out when things get tough.
GINNY Ginny sometimes knows that there are people she can lean on and that they will sometimes help her out when things get rough.
SUSAN Susan belongs to a group of many different people who know each other and who help her out when things get rough, just because she is Susan. She always knows that there are a lot of different people she can lean on.
d) Check one.
q
cl I’m like Molly.
(KAPLAN
I’m halfway between Molly and Ginny.
Cl I’m like Ginny.
q I’m halfway between Ginny and Susan.
0 I’m like Susan.
6) 3.
PHYLLIS Phyllis is rarely admired and praised. There are very few people who think Phyllis is important and worthy.
MARTHA Martha is sometimes admired and praised by some people. She is not always being reminded of her worth.
TINA Tina is constantly being admired by people. They always praise her and think that she is important and worthy.
a) Check one.
cl I’m like Phylhs.
cl I’m halfway between Phyllis and Martha.
cl I’m like Martha.
q I’m halfway between Martha and Tina.
cl I’m like Tina.
170
William
R. Avison.
R. Jay Turner
and Samuel Noh
APPENDIX I (KAPLAN
7) 4.
CARRIE People believe that Carrie will make the right decisions and do the right things. They have confidence and faith in her.
RHODA Some people have confidence and faith in Rhoda. Sometimes they think that she will make the right decisions and do the right things.
SHARON People rarely believe that Sharon will make the right dectsions or do the right things. They hardly ever have confidence in her.
e) Check one.
cl
cl I’m like Carrie
(MSPP (MSPP
I’m halfway between Carrie and Rhoda. 1) 3j
(MSPP 29) (PAR1 20) (PAR1 21) (PAR1 36) (PAR1 40) (PAR1 26) (MSPP 4) (MSPP 13) (MSPP 26) (PAR1 14) (PAR1 38) (PAR1 39) (PAR1 3) (PAR1 19)
cl I’m like Rhoda.
cl I’m halfway between Rhoda and Sharon.
0 I’m like Sharon.
5. No one has ever really listened to me. 6. The main thing I remember from my childhood is the love and warm feelings my parents showed me. 7. As a child, I often felt that no one paid much attention to what I wanted or needed. 8. A wise parent will teach a child early just who is the boss. 9. Children who are held to firm rules grow up to be the best adults. 10. It is sometimes necessary for the parents to break the child’s will. 11. A child should be weaned away from the bottle or breast as soon as possible. 12. Raising children is a nerve-wracking job. 13. My life seems to have been one crisis after another. 14. I go through times when I feel helpless and unable to do the things I should. 15. Sometimes I just feel like running away. 16. A parent should never be made to look wrong in a child’s eye. 17. There is nothing worse than letting a child hear criticisms of his mother. 18. Loyalty to parents comes before anything else. 19. Home is the only thing that matters. 20. A women has to choose between having a well run home and hobnobbing around with neighbors and friends.