Cerebral palsy (CP), which is the most common cause of physical disability in childhood, finds its etiology in damage to the immature brain, in the pre-, peri- or postnatal period (Odding, Roebroeck, & Stam, Reference Odding, Roebroeck and Stam2006). Its presentation is heterogeneous but mainly affects body movement, posture, and muscle coordination, causing activity and participation limitations. Cerebral palsy can be categorized in different types: spastic CP (characterized by stiff muscles), dyskinetic CP (characterized by involuntary movements), and ataxic CP (characterized by difficulties with coordination and balance). Moreover, many children with CP experience a wide range of comorbidities, such as health issues, pain, communication difficulties, cognitive impairments, sleep disorders, and behavioral problems (Lélis, Cardoso, & Hall, Reference Lélis, Cardoso and Hall2016; Novak, Hines, Goldsmith, & Barclay, Reference Novak, Hines, Goldsmith and Barclay2012). For parents, receiving the diagnosis of CP for their child has a profound effect and the parenting process comes along with a multitude of unique and complex challenges and responsibilities (Alaee, Shahboulaghi, Khankeh, & Kermanshahi, Reference Alaee, Shahboulaghi, Khankeh and Kermanshahi2015; Pousada et al., Reference Pousada, Guillamon, Hernandez-Encuentra, Munoz, Redolar, Boixados and Gomez-Zuniga2013). These additional difficulties and impairments affect not only the daily functioning and quality of life of the children themselves (e.g., limiting opportunities for social interaction; Majnemer, Shevell, Rosenbaum, Law, & Poulin, Reference Majnemer, Shevell, Rosenbaum, Law and Poulin2007; Rosenbaum, Reference Rosenbaum2003) but also those of their parents (Pinquart, Reference Pinquart2018; Pousada et al., Reference Pousada, Guillamon, Hernandez-Encuentra, Munoz, Redolar, Boixados and Gomez-Zuniga2013).
Research has established clearly that the parents of children with CP are at increased risk for experiencing parenting stress (Pinquart, Reference Pinquart2018). Uncertainty about the child's developmental progress and future, the intense involvement of multiple health care providers, and the practical and financial constraints that are associated with this condition require continuous adaptations and prolonged efforts on the part of parents (Alaee et al., Reference Alaee, Shahboulaghi, Khankeh and Kermanshahi2015, Pousada et al., Reference Pousada, Guillamon, Hernandez-Encuentra, Munoz, Redolar, Boixados and Gomez-Zuniga2013). In turn, the way that these parents adjust to these challenges affects the well-being and psychosocial development of their child with CP. Indeed, recent research has begun to demonstrate the importance of parenting behavior and high-quality parent–child relations for the health and well-being of children with CP (Aran, Shalev, Biran, & Gross-Tsur, Reference Aran, Shalev, Biran and Gross-Tsur2007; Barfoot, Meredith, Ziviani, & Whittingham, Reference Barfoot, Meredith, Ziviani and Whittingham2017; Cohen, Biran, Aran, & Gross-Tsur, Reference Cohen, Biran, Aran and Gross-Tsur2008; Ho et al., Reference Ho, Fung, Fung, Chow, Ip, Lee and Ha2008).
These findings suggest that parental support that targets parenting behavior might be effective in promoting the development of children with CP. In order to effectively support these parents, it is imperative that we understand which factors affect the way parents behave towards their child with CP. In contrast to the extensive research on antecedents of parenting in the general population, indicating that parenting is a multidetermined phenomenon that is shaped by both parental factors (e.g., parental well-being) and child characteristics (e.g., problem behavior; Belsky & Jaffee, Reference Belsky, Jaffee, Cicchetti and Cohen2006), there is a paucity of research on the antecedents of parenting behavior among parents that are raising a child with CP. Accordingly, the main goal of this study was to advance the understanding of parents’ behaviors when raising a child with CP by examining the role of parental and child factors.
The Influence of Parenting on the Development of Children With CP
Parenting behavior plays a substantial role in the psychosocial development of children (Collins, Maccoby, Steinberg, Hetherington, & Bornstein, Reference Collins, Maccoby, Steinberg, Hetherington and Bornstein2000). In the general parenting literature, three dimensions are increasingly identified as crucial parental resources for optimal child development: high autonomy-supportive parenting, high responsive parenting, and low psychologically controlling parenting (Joussemet, Landry, & Koestner, Reference Joussemet, Landry and Koestner2008; Prinzie, Stams, Deković, Reijntjes, & Belsky, Reference Prinzie, Stams, Deković, Reijntjes and Belsky2009). Autonomy-supportive parenting promotes the child's volitional functioning and consequently contributes to healthy psychological development (Grolnick, Levitt, & Caruso, Reference Grolnick, Levitt, Caruso, Soenens, Vansteenkiste and van Petegem2018; Soenens, Deci, & Vansteenkiste, Reference Soenens, Deci, Vansteenkiste, Wehmeyer, Little, Lopez, Shogren and Ryan2017). Autonomy-supportive parenting entails several facets. A first key element of autonomy-supportive parenting is showing an active interest in the child's mental world (i.e., feelings, interests, and preferences) and taking the child's perspective (Ryan & Deci, Reference Ryan and Deci2017). Another important element is encouraging initiative by, for instance, providing choices and allowing independent decision-making (Joussemet et al., Reference Joussemet, Landry and Koestner2008). Responsive parents enhance the child's emotional and social development by expressing their care and love for their child. Parental responsiveness includes two central elements (Davidov & Grusec, Reference Davidov and Grusec2006): (a) parents’ expression of affection and warmth (e.g., hugging, smiling) and (b) parents’ support and care when the child experiences distress (e.g., responding in a kind and comforting way when a child experiences negative emotions). Although autonomy-supportive parenting and responsiveness both require that parents are aware of and attentive to their child's feelings and perspective (Soenens et al., Reference Soenens, Deci, Vansteenkiste, Wehmeyer, Little, Lopez, Shogren and Ryan2017), these two supportive parenting dimensions also have distinct features. While parental warmth is unique to the concept of parental responsiveness, the encouragement of initiative and the provision of choice are unique to the concept of parental autonomy-support. Because both parenting dimensions share some common content but also have distinct features, they are typically positively (but not perfectly) correlated with each other in empirical research (Soenens et al., Reference Soenens, Deci, Vansteenkiste, Wehmeyer, Little, Lopez, Shogren and Ryan2017; Costa, Sireno, Larcan, & Cuzzocrea, Reference Costa, Sireno, Larcan and Cuzzocrea2019). Psychologically controlling parenting refers to the use of insidious and manipulative behaviors, such as love-withdrawal and guilt induction, to dominate the child's psychological world. This parenting behavior undermines children's healthy development and increases their risk to develop emotional and behavioral problems (Barber, Stolz, & Olsen, Reference Barber, Stolz and Olsen2005; Pinquart, Reference Pinquart2017).
These well-established parenting effects have also been demonstrated among children with CP. For example, Aran et al. (Reference Aran, Shalev, Biran and Gross-Tsur2007) demonstrated that supportive parenting dimensions related more strongly to the quality of life of children and adolescents with CP than other factors did, such as the severity of the CP. Child-reported autonomy-support was related to better mental health, higher self-esteem, fewer social and emotional problems, higher happiness with their physical condition, and better physical functioning. In addition, when youngsters perceived their parent as being responsive rather than rejecting, they also reported a better quality of life. In a study that used the same child-reported parenting dimensions, Cohen et al. (Reference Cohen, Biran, Aran and Gross-Tsur2008) found that rejecting parenting positively predicted an external locus of control (i.e., the perception of not being able to control one's life) in children and adolescents with CP. A third relevant study found that parents’ responsiveness, as observed during interactions with their child (aged between 2 and 12 years), related negatively to child behavioral problems and positively to prosocial child behavior (Barfoot et al., Reference Barfoot, Meredith, Ziviani and Whittingham2017). Further, research showed that child-perceived overprotection (i.e., an autonomy-suppressing type of parenting involving excessive protection) related to more anxiety and less happiness (Ho et al., Reference Ho, Fung, Fung, Chow, Ip, Lee and Ha2008) and to lower self-esteem (Manuel, Balkrishnan, Camacho, Smith, & Koman, Reference Manuel, Balkrishnan, Camacho, Smith and Koman2003) in children, adolescents, and early adults with CP. Overall, the quality of parenting seems to matter for the adjustment of children with CP. However, because most studies to date were cross-sectional in nature, parenting in the context of CP has been studied from a rather static perspective. This is an important shortcoming because recent research indicates that parenting varies substantially on a short-term basis (e.g., Aunola, Tolvanen, Viljaranta, & Nurmi, Reference Aunola, Tolvanen, Viljaranta and Nurmi2013; Dix, Reference Dix1991; Mabbe, Soenens, Vansteenkiste, Van der Kaap-Deeder, & Mouratidis, Reference Mabbe, Soenens, Vansteenkiste, Van der Kaap-Deeder and Mouratidis2018).
Every Day Is Different: Daily Variation in Parenting Behavior
Both from a fundamental perspective and from an applied perspective, it is of essential importance to gain more insight into the parenting behaviors of parents that are raising a child with CP, thereby taking into account the dynamic nature of parenting. A growing literature shows that the way that parents behave towards their child is not set in stone but changes dynamically on a situational and momentary basis (Dix, Reference Dix1991; Holden & Miller, Reference Holden and Miller1999; Repetti, Reynolds, & Sears, Reference Repetti, Reynolds and Sears2015). Several studies, among both parents from general populations (e.g., Aunola et al., Reference Aunola, Tolvanen, Viljaranta and Nurmi2013; Aunola, Viljaranta, & Tolvanen, Reference Aunola, Viljaranta and Tolvanen2017; Mabbe, Soenens, et al., Reference Mabbe, Soenens, Vansteenkiste, Van der Kaap-Deeder and Mouratidis2018; Mabbe, Vansteenkiste, et al. Reference Mabbe, Vansteenkiste, Van der Kaap-Deeder, Dieleman, Mouratidis and Soenens2018; Van der Kaap-Deeder, Vansteenkiste, Soenens, & Mabbe, Reference Van der Kaap-Deeder, Vansteenkiste, Soenens and Mabbe2017; Van der Kaap-Deeder et al., Reference Van der Kaap-Deeder, Soenens, Mabbe, Dieleman, Mouratidis, Campbell and Vansteenkiste2019) and parents that were raising a child with a developmental disability (e.g., Dieleman et al., Reference Dieleman, Soenens, Vansteenkiste, Prinzie, Laporte and De Pauw2018) have consistently shown that the degree to which parents are supportive or more controlling varies considerably from one day to another.
Importantly, these daily variations in parenting have repercussions for children's daily adjustment. Children report more well-being on days when parents are autonomy-supportive, and they report more distress and problem behavior on days when parents use more controlling strategies (Aunola, et al., Reference Aunola, Tolvanen, Viljaranta and Nurmi2013; Mabbe, Vansteenkiste, et al., Reference Mabbe, Soenens, Vansteenkiste, Van der Kaap-Deeder and Mouratidis2018; Ng, Kenney-Benson, & Pomerantz, Reference Ng, Kenney-Benson and Pomerantz2004; Van der Kaap-Deeder et al., Reference Van der Kaap-Deeder, Vansteenkiste, Soenens and Mabbe2017). Most likely, these associations reflect bidirectional processes, with children's adjustment also affecting parenting (such that more adaptive child behavior evokes more supportive parenting and such that more maladaptive behavior elicits more controlling responses).
Although no research to date has addressed daily variations in parenting behavior among parents of children with CP, it can be expected that there are similar levels of daily variation in the parenting behavior of these parents because they face diverse challenges on a daily basis (Alaee et al., Reference Alaee, Shahboulaghi, Khankeh and Kermanshahi2015; Davis et al., Reference Davis, Shelly, Waters, Boyd, Cook and Davern2009; Wittingham, Wee, Sanders, & Boyd, Reference Wittingham, Wee, Sanders and Boyd2013). A dynamic examination of parenting behavior in the context of CP (i.e., an examination at the level of daily, intraindividual associations), allows for greater insight in how child behavior, parental experiences, and parenting are related within families (Keijsers, Reference Keijsers2016). Such an examination is also important for practice because this within-family level is precisely the level where parent support or interventions attempt to create change. Therefore, this study attempted to determine why parents’ behaviors towards their child with CP differ between days.
Sources of Daily Parenting Behavior: Child and Parent Factors
Parenting is a multidetermined phenomenon that is affected by both child and parent characteristics, and it occurs in specific contexts (Belsky & Jaffee, Reference Belsky, Jaffee, Cicchetti and Cohen2006). Regarding the child characteristics, we focused on the child's behavior and, more specifically, on emotional and behavioral problems and prosocial behavior. Regarding the parent characteristics, in this study we focused on parents’ psychological needs and mindful parenting. These factors are increasingly identified as being important determinants of (daily) parenting behavior (e.g., Gouveia, Carona, Canavarro, & Moreira, Reference Gouveia, Carona, Canavarro and Moreira2016; Mabbe, Soenens, et al., Reference Mabbe, Soenens, Vansteenkiste, Van der Kaap-Deeder and Mouratidis2018; Pinquart, Reference Pinquart2017).
Daily child behavior as a predictor of daily parenting behavior
Research among general populations (Pinquart, Reference Pinquart2017) and among parents of children with neurodevelopmental disabilities (Gannotti, Oshio, & Handwerker, Reference Gannotti, Oshio and Handwerker2013) has convincingly established that child behavior strongly influences (daily) parenting behavior. Maladaptive child behavior, and externalizing child behavior in particular, has been shown to evoke more psychologically controlling and less responsive and autonomy-supportive parenting (Grolnick & Apostoleris, Reference Grolnick, Apostoleris, Deci and Ryan2002; Hipwell et al., Reference Hipwell, Keenan, Kasza, Loeber, Stouthamer-Loeber and Bean2008; Pinquart, Reference Pinquart2017). These findings have also been replicated in studies that have evaluated parenting variation on a daily level. On days that children exhibit more externalizing problem behavior, parents report being more psychologically controlling towards their child (Aunola et al., Reference Aunola, Viljaranta and Tolvanen2017; Dieleman et al., Reference Dieleman, Soenens, Vansteenkiste, Prinzie, Laporte and De Pauw2018). Day-to-day variation in internalizing problems has a less consistent association with daily variation in parenting behavior, possibly because some parents provide more comfort when children display more internal distress than usual while other parents respond in more controlling ways (Aunola et al., Reference Aunola, Tolvanen, Viljaranta and Nurmi2013) or because anxious and withdrawn behavior is less visible and thus less noticed by parents. To date, there have been very few efforts to investigate the effect of behavioral problems on parenting among children with CP. This is unfortunate, as these children are at increased risk for emotional and behavioral problems (Parkes et al., Reference Parkes, White-Koning, Dickinson, Thyen, Arnaud, Beckung and Colver2008; Vrijmoeth, Monbaliu, Lagast, & Prinzie, Reference Vrijmoeth, Monbaliu, Lagast and Prinzie2012). As far as we know, only one study to date showed that conduct problems were related to more dysfunctional interactions between parents and children with CP (Brossard-Racine et al., Reference Brossard-Racine, Hall, Majnemer, Shevell, Law, Poulin and Rosenbaum2012).
Because a focus on the role of behavioral problems in parenting tells only half the story and offers limited keys to promoting constructive parenting, it is also important to consider the role of positive child behavior. Research in general populations has shown that prosocial child behavior (i.e., intentional actions that are directed at benefiting others such as helping and sharing) is an important precursor of more responsive parenting behavior (Newton, Laible, Carlo, Steele, & McGinley, Reference Newton, Laible, Carlo, Steele and McGinley2014; Pastorelli et al., Reference Pastorelli, Lansford, Kanacri, Malone, Di Giunta, Bacchini and Sorbring2016). A diary study among parents of children with autism spectrum disorder showed that daily prosocial child behavior related positively to daily autonomy-supportive parenting (Dieleman et al, Reference Dieleman, Soenens, Vansteenkiste, Prinzie, Laporte and De Pauw2018). In the context of CP, Brossard-Racine et al. (Reference Brossard-Racine, Hall, Majnemer, Shevell, Law, Poulin and Rosenbaum2012) showed that the more prosocial behaviors a child exhibited, the less dissatisfaction parents expressed about the interactions with their child.
In summary, based on diary research in other populations and on the budding parenting research in CP, we hypothesized that examining the contributions of both child behavioral problems and prosocial child behavior would provide insight into the daily fluctuations in parenting behavior of parents that are raising a child with CP.
The role of parents’ daily psychological need experiences in daily parenting
Another important source of parenting behavior is the parents’ own psychological experience in interacting with the child (Dix, Reference Dix1991). Recently, studies that are grounded in self-determination theory (Deci & Ryan, Reference Deci and Ryan2000), a macro-theory on human socialization that is applied increasingly in research on parenting (Grolnick et al., Reference Grolnick, Levitt, Caruso, Soenens, Vansteenkiste and van Petegem2018; Joussemet et al., Reference Joussemet, Landry and Koestner2008; Soenens et al., Reference Soenens, Deci, Vansteenkiste, Wehmeyer, Little, Lopez, Shogren and Ryan2017), have shown that parents’ daily psychological need-related experiences play a role in how parents interact with their child on a daily basis (Mabbe, Soenens, et al., Reference Mabbe, Soenens, Vansteenkiste, Van der Kaap-Deeder and Mouratidis2018). According to this theory, people have three basic psychological needs: the need for autonomy (i.e., experiencing self-direction), relatedness (i.e., experiencing reciprocal care), and competence (i.e., feeling effective; Deci & Ryan, Reference Deci and Ryan2000). On days that parents experience self-direction, feel closely connected to others, and feel effective in accomplishing their goals, they have more energy available to engage in more responsive and autonomy-supportive parenting (Mabbe, Soenens, et al., Reference Mabbe, Soenens, Vansteenkiste, Van der Kaap-Deeder and Mouratidis2018; Van der Kaap-Deeder et al., Reference Van der Kaap-Deeder, Soenens, Mabbe, Dieleman, Mouratidis, Campbell and Vansteenkiste2019). Conversely, daily frustration of these psychological needs (i.e., experiencing feelings of pressure, social alienation, and failure) renders parents vulnerable to interacting with children in a more psychologically controlling and a less responsive and autonomy-supportive way (Mabbe, Soenens, et al., Reference Mabbe, Soenens, Vansteenkiste, Van der Kaap-Deeder and Mouratidis2018; Van der Kaap-Deeder et al., Reference Van der Kaap-Deeder, Soenens, Mabbe, Dieleman, Mouratidis, Campbell and Vansteenkiste2019). This is because psychological need frustration increases parental stress and erodes parents’ psychological availability to attend to children's experiences (Van der Kaap-Deeder et al., Reference Van der Kaap-Deeder, Soenens, Mabbe, Dieleman, Mouratidis, Campbell and Vansteenkiste2019). While most of these studies have been conducted among parents of typically developing children, Dieleman et al. (Reference Dieleman, Soenens, Vansteenkiste, Prinzie, Laporte and De Pauw2018) recently showed that these processes apply also to parents of children with autism spectrum disorder.
Whether daily need-related experiences can also account for the daily variability in parenting behavior among parents of children with CP has not yet been examined. Yet, several findings point towards the importance of examining the psychological needs in parents of children with CP. For example, parents of children with CP have reduced opportunities to develop their own interests and to pursue a professional career, which limits satisfaction of their need for autonomy (Davis et al., Reference Davis, Shelly, Waters, Boyd, Cook and Davern2009; Pousada et al., Reference Pousada, Guillamon, Hernandez-Encuentra, Munoz, Redolar, Boixados and Gomez-Zuniga2013). Further, parents of children with CP also report lower levels of self-mastery (i.e., the extent to which they experience a sense of control over their life), indicating challenges for their feelings of competence (Florian & Findler, Reference Florian and Findler2001). Finally, these parents frequently experience social seclusion and report limited time to spend as a couple, problems that could signal frustration of parents’ need for relatedness (Alaee et al., Reference Alaee, Shahboulaghi, Khankeh and Kermanshahi2015; Florian & Findler, Reference Florian and Findler2001).
In summary, there are indications that raising a child with CP strongly affects parents’ need-related experiences. Based on the universality claim of self-determination theory (Deci & Ryan, Reference Deci and Ryan2000), which states that psychological needs are important for all individuals, we hypothesized that these need-related experiences would also be relevant to the daily behavior of parents of children with CP. Although this study focused on the role of parents’ needs with respect to their parenting behavior, it is important to keep in mind that parenting most likely also affects parents’ need-related experiences in a reciprocal fashion (Mabbe, Soenens, et al., Reference Mabbe, Soenens, Vansteenkiste, Van der Kaap-Deeder and Mouratidis2018). For example, when engaging in more controlling practices (possibly in response to a child's misbehavior), parents are more likely to feel pressured to react harshly (i.e., autonomy frustration), to feel less competent as a parent (i.e., competence frustration), and to experience distance from their child (i.e., relatedness frustration).
Mindful parenting as a source of parenting behavior
In addition to the role of parents’ psychological needs, mindful parenting is also increasingly recognized as an important parent factor that shapes parenting behavior. Mindful parenting is the expression of an attitude of mindfulness—an open and receptive awareness of what is happening in the moment within the parent–child relationship or interaction (Brown & Ryan, Reference Brown and Ryan2003; Duncan, Coatsworth, & Greenberg, Reference Duncan, Coatsworth and Greenberg2009). That is, parents that are high on mindful parenting display an attitude of compassion, acceptance, and awareness during parent–child interactions (Gouveia, et al., Reference Gouveia, Carona, Canavarro and Moreira2016). More specifically, these parents listen to their child with full attention, thereby showing high levels of awareness of their own feelings and the child's feelings during the interaction. Mindful parenting also entails the nonjudgmental acceptance of feelings, attributes and behaviors of the self and the child, and the recognition that parenting can be challenging. Furthermore, these parents are capable of identifying their own and their child's emotions without reacting automatically to them. Rather, they are able to effectively regulate their own emotions when interacting with the child, which allows them to respond in a way that is in accordance with their own values and goals. Finally, mindful parenting also includes the expression of empathic concern and the display of an attitude of compassion and forgiveness for themselves and the child (Duncan et al., Reference Duncan, Coatsworth and Greenberg2009).
Mindful parenting has been described as a psychological attitude or as a metacognitive stance (reflecting mainly receptive awareness of the parent's own feelings during parent–child interactions) that may influence parenting behavior, meaning the practices and communications that are directed towards the child (Duncan et al., Reference Duncan, Coatsworth and Greenberg2009; Townshend, Reference Townshend2016). Research shows that mindful parenting fosters adaptive parenting and protects parents from using dysfunctional parenting strategies (Gouveia et al., Reference Gouveia, Carona, Canavarro and Moreira2016; Parent, McKee, Mahon, & Foreh, Reference Parent, McKee, Mahon and Foreh2016). More specifically, mindful parenting correlates positively with responsive and autonomy-supportive parenting, whereas it relates negatively to psychologically controlling parenting (Geurtzen, Scholte, Engels, Tak, & van Zundert, Reference Geurtzen, Scholte, Engels, Tak and van Zundert2015). Listening with full attention enables parents to take their child's perspective and to understand the child's feelings better, an ability that is essential for autonomy-supportive parenting (Duncan et al., Reference Duncan, Coatsworth and Greenberg2009; Soenens et al., Reference Soenens, Deci, Vansteenkiste, Wehmeyer, Little, Lopez, Shogren and Ryan2017). By being compassionate, mindful parents are able to express more warmth and to attune better to their child's calls for comfort in times of distress (Duncan et al., Reference Duncan, Coatsworth and Greenberg2009; Geurtzen et al., Reference Geurtzen, Scholte, Engels, Tak and van Zundert2015). By being aware of and by self-regulating one's emotions when interacting with the child, these parents can refrain from impulsive reactions, including controlling parenting behaviors (Duncan et al., Reference Duncan, Coatsworth and Greenberg2009). Instead, these parents are able to halt their first impulsive response, pay attention towards their own and their child's feelings, and react in a more responsive way.
Although there is a lack of research on mindful parenting among parents of children with CP, scholars have called for research on the potential benefits of incorporating mindfulness into parenting interventions for parents of children with a disability, including children with CP (Whittingham, Reference Whittingham2014; Whittingham, Sanders, McKinlay, & Boyd, Reference Whittingham, Sanders, McKinlay and Boyd2016). These scholars hypothesize that parents of children with a disability, who face additional challenges due to the child's disorder, might benefit from applying a mindful attitude in the relationship with their child.
The Present Study
The general purpose of this study was to enhance our understanding of parenting behavior among parents of children with CP. Specifically, this study was directed at understanding the day-to-day variation in autonomy-supportive, responsive, and psychologically controlling parenting behavior by looking at the role of child and parent factors. A first specific objective was to examine the associations between children's daily behaviors (i.e., problem behaviors and prosocial behavior) and daily parenting behavior. We hypothesized that children's problem behavior, especially externalizing problems, would relate to more daily parental psychological control, whereas prosocial child behavior would relate to more daily autonomy-supportive and responsive parenting. Second, we examined the associations between parents’ daily need-based experiences (need satisfaction and need frustration) and daily parenting behavior. We expected that daily need frustration would relate positively to daily psychological control and that daily need satisfaction would relate positively to daily autonomy-supportive and responsive parenting. A third objective of this study was to examine the role of mindful parenting. We hypothesized that parents who were generally more mindful about parenting would be more autonomy-supportive, more responsive, and less psychologically controlling across days (relative to parents who were less mindful about parenting).
As the severity of the motor impairments of children with CP can differ greatly, it was deemed important to control statistically for the level of motor impairments when examining these three research questions. This is because, in principle, associations between the child and parent factors and parenting behaviors may be spurious, meaning that they occur due to associations with the child's disability severity as a third variable.
Method
Participants and Procedure
This diary study is part of a broader, on-going, three-wave longitudinal study on parents of children with CP. Parents were first recruited in 2015 through seven Belgian service centers for children with physical disabilities. In order to participate, families had to meet the following inclusion criteria: the child had received a diagnosis of CP and was aged between 4 and 18 years. Initially, 135 parents were recruited and at the second follow-up, two years later, 97 parents participated. At this time, parents were also invited to participate in the present diary study. In total, 74 parents agreed to participate in the diary study, but 16 parents dropped out (due to time constraints or unexpected events) or failed to participate on more than two consecutive days of the diary week.
The final sample consisted of 58 parents (52 mothers, 5 fathers, and 1 guardian; M age = 43.82 years, SD = 5.01, range = 32.07–51.01) of children with CP (67.2% boys, M age = 12.68 years, SD = 2.83, range = 7.47–19.29). The majority of the children had spastic CP (72.4%), 10.3% of the children had dyskinetic CP, 3.4% had ataxic CP, and 12.1% was diagnosed with a mixed type of CP. Additional demographic information for both parents and children is summarized in Table 1.
Sample characteristics (n = 58)
Note: a Reported by parents. Includes comorbidity with AD(H)D, Specific Learning Disorders; Excludes intellectual disability (IQ <70). Parents could indicate more than one comorbidity. GMFCS = Gross Motor Function Classification System, CFCS = Communication Function Classification System.
In order to explain the study and provide the necessary documents, the parents were visited at home. During the home visit, the parents received information about the study and demographic characteristics were assessed. At that time, the parents also received a paper-and-pencil baseline questionnaire and a personal code to get access to the online diary questionnaire. Due to time constraints, seven parents preferred not to be visited at home and received the information and documents via e-mail and telephone. The parents were asked to answer the questionnaires for seven consecutive days, starting on a Monday. They were asked to report each evening (after their child went to bed, or before going to bed themselves) about their own experiences and behavior and about their child's behavior during the past day. The parents were able to skip a day if they did not have time to fill out the diary, forgot about it, or did not spend time with their child that day (e.g., when the child stayed overnight at school). In total, 7.64% of the data was missing due to these reasons. The online tool registered the date and time when parents filled out the questionnaires. Data that were entered on the wrong day (5.91%) were not included in the analyses. Ten parents (17.2%) preferred to fill out a paper-and-pencil diary questionnaire rather than using the online tool. These parents received an exact copy of the diary questionnaires on paper and were asked to note the date and time for each day. Written informed consent was obtained from all participants. The study received ethical approval from the organizing university's Institutional Review Board.
Measures
Demographic information
The parents reported about demographic information concerning themselves, such as their date of birth, education, and marital status. They also reported about the child's type of CP and co-occurring disorders (such as epilepsy). In addition, the parents were asked to rate their child's ability to communicate on the Communication Function Classification System (CFCS; Hidecker et al., Reference Hidecker, Paneth, Rosenbaum, Kent, Lillie, Eulenberg and Taylor2011). The rating of the CFCS is based on the child's effectiveness at sending and receiving information with familiar and unfamiliar people. The CFCS identifies five levels. Children in level I can effectively send and receive information with familiar and unfamiliar partners, and children in level V can seldom effectively send and receive information, even with familiar people.
GMFCS
The child's gross motor function was assessed with the Gross Motor Function Classification System Family Report (GMFCS-FR; Palisano, Rosenbaum, Bartlett, & Livingston, Reference Palisano, Rosenbaum, Bartlett and Livingston2008). The GMFCS is a classification system that determines the severity of CP based on the child's functional abilities and need for assistive technology for mobility. Parents had to categorize their child in one of the five levels. Children that are categorized in level I can walk without restrictions but have limitations in more advanced motor skills, and children in level V have very limited motor abilities. The family report of the GMFCS is a reliable method for measuring gross motor function (Morris, Galuppi, & Rosenbaum, Reference Morris, Galuppi and Rosenbaum2004).
Mindful parenting
Prior to the diary measurements, the parents completed the Bangor Mindful Parenting Scale (BMPS; Jones, Hastings, Totsika, Keane, & Rhule, Reference Jones, Hastings, Totsika, Keane and Rhule2014), a questionnaire that is used for assessing mindful parenting. The BMPS consists of 15 items, scored on a 5-point scale ranging from “completely not true” to “completely true,” that measures the five underlying aspects of mindfulness that are applied to the parenting role: observing (e.g., “I stay aware of my feelings towards my child”); describing (e.g., “I'm good at finding the words to describe my feelings about my child”); acting with awareness (e.g., “I rush through activities with my child without being really attentive to him/her,” reverse scored); nonreactivity (e.g., “In difficult situations with my child I can pause without reacting straight away”); and accepting without judgment (e.g., “I tend to make judgments about whether I am being a good or a bad parent,” reverse scored). All items together represent a total score for mindful parenting. The BMPS was developed for measuring mindful parenting among parents of children with autism spectrum disorders (Jones et al., Reference Jones, Hastings, Totsika, Keane and Rhule2014) and has been applied reliably in research among parents of children with diverse disabilities (Lunsky, Robinson, Reid, & Palucka, Reference Lunsky, Robinson, Reid and Palucka2015). Cronbach alpha for this instrument in the present study was .81.
Daily measures
All of the daily measures were based on well-validated general measures that were adapted and shortened to make them suitable for a diary format. All of the scales were scored on a 5-point scale, ranging from 1 (completely not true) to 5 (completely true). The selection of the daily items was based on their suitability for daily assessment scales and on previous diary studies among parents of typically developing children and children with autism spectrum disorder (Dieleman et al., Reference Dieleman, Soenens, Vansteenkiste, Prinzie, Laporte and De Pauw2018; Mabbe, Soenens, et al., Reference Mabbe, Soenens, Vansteenkiste, Van der Kaap-Deeder and Mouratidis2018; Mabbe, Vansteenkiste, et al., Reference Mabbe, Vansteenkiste, Van der Kaap-Deeder, Dieleman, Mouratidis and Soenens2018; Van der Kaap-Deeder et al., Reference Van der Kaap-Deeder, Vansteenkiste, Soenens and Mabbe2017). The internal consistencies of all of the daily instruments are presented in Table 2.
Descriptive statistics, internal consistencies, between-person intraclass correlations (ICC), and correlations between the study variables
Note: GMFCS = Gross Motor Function Classification System; a Means and standard deviations of the daily variables are based on aggregated scores; *p < .05 **p < .01 *** p < .001.
Daily parenting behavior
The parents’ use of autonomy-supportive parenting was measured with four items that were adapted from the Autonomy Support Scale of the Perceptions of Parents Scale (POPS; Grolnick, Ryan, & Deci, Reference Grolnick, Ryan and Deci1991). These items tap into parents’ recognition of the child's perspective (e.g., “Today, I took my son's/daughter's point of view into account”) and parents’ encouragement of initiative and the provision of choice (e.g., “Today, I allowed my son/daughter to make his/her own plans”). In order to assess the degree to which parents engage in psychologically controlling practices, the parents completed four items of the parent version (Soenens, Vansteenkiste, Luyckx, & Goossens, Reference Soenens, Vansteenkiste, Luyckx and Goossens2006) of the Psychological Control Scale (PCS; Barber, Reference Barber1996; e.g., “Today, I was less friendly with my child if he/she did not see things my way”). Four items of the Child Report of Parent Behavior Inventory (CRPBI; Schaefer, Reference Schaefer1965; Schludermann & Schludermann, Reference Schludermann and Schludermann1988) were selected and adapted to assess daily responsiveness towards the child. The responsiveness scale used in this study included items tapping into both parental warmth (e.g., “Today, I smiled at my son/daughter often”) and parents’ responsiveness to distress (e.g., “Today, I made my son/daughter feel better when he/she was upset”).
Children's daily problem behavior
Parents filled out four items assessing the child's aggressive behavior (e.g., “Today my son/daughter was aggressive”); three items tapping into rule-breaking (e.g., “Today my son/daughter lied”); three items measuring withdrawn/depressive behavior (e.g., “Today my child preferred to be alone, rather than with others”); and three items tapping into anxious/depressive behavior (e.g., “Today my son/daughter was scared or anxious”). These items were selected, based on their suitability for a diary format, from the Child Behavior Checklist/6-18 (CBCL; Achenbach & Rescorla, Reference Achenbach and Rescorla2001). The items for aggressive and rule-breaking behavior were averaged into an overall score for externalizing problems, and the items for withdrawn/depressive and anxious/depressive behavior were averaged into an overall score for internalizing problems.
Children's daily prosocial behavior
Parents filled out three items tapping into their child's prosocial behaviors (e.g., “Today my son/daughter was nice to other people”). Two items were selected from the Prosociality Scale (Caprara, Steca, Zelli, & Capanna, Reference Caprara, Steca, Zelli and Capanna2005), and one item was selected from the Strengths and Difficulties Questionnaire (SDQ; Goodman, Reference Goodman2001).
Daily psychological need satisfaction and frustration
Parents’ daily satisfaction and frustration of their psychological needs for autonomy, relatedness, and competence were measured with 12 items from the Basic Psychological Need Satisfaction and Need Frustration scale (BPNSNF; Chen et al., Reference Chen, Vansteenkiste, Beyers, Boone, Deci, Duriez and Verstuyf2015). The items for assessing autonomy satisfaction (two items, e.g., “Today I felt a sense of choice and freedom in the things I undertook”); relatedness satisfaction (two items, e.g., “Today I felt connected with the people who care about me and who I care about”); and competence satisfaction (two items, e.g., “Today I felt confident that I could do things well”) were averaged into a composite score for need satisfaction. The items for assessing autonomy frustration (two items, e.g., “Today I felt forced to do things that I wouldn't choose to do”); relatedness frustration (two items, e.g., “Today I felt excluded from the group that I want to belong to”); and competence frustration (two items, e.g., “Today I felt insecure about my abilities”) were aggregated into a composite score for need frustration.
Plan of Analysis
The diary study design consisted of repeated measurements on seven consecutive days (level 1) nested within 58 parents (level 2). To take the nested structure into account, multilevel analyses were performed by using MLwiN 2.32 (Rasbash, Browne, Healy, Cameron, & Charlton, Reference Rasbash, Browne, Healy, Cameron and Charlton2015). In total, there were 13.55% missing values in the dataset. Missing value analyses indicated that the data were missing completely at random (Little's MCAR test: χ2 (8) = 10.90, p = .21) and were by default treated as structurally missing in MLwiN. The predictors at level 1 (i.e., within-person predictors) were group-mean centered (i.e., centered around the person's mean) and predictors at level 2 (i.e., between-person predictors) were grand-mean centered (i.e., centered around the group mean).
First, we examined whether there was significant variability in the daily variables by estimating the intercept-only models. The intercept-only models allowed for an estimation of intraclass correlations (ICC), which reflect the between-person and the within-person (i.e., day-to-day) variation. In order to examine the intraindividual associations between the day-to-day variation in the child and parent factors (i.e., within-person predictors) and parenting behavior, we first estimated models with daily child behavior and daily needs of the parents as separate predictors of daily parenting behavior. In order to limit the number of parameters in the models, we conducted three different models for each type of parenting behavior. In each model, we controlled for the potential effects of the severity of the motor disorder by including the GMFCS score. First, we examined the role of the child's behavior and parents’ psychological needs separately (i.e., respectively Model 1 and 2). Then, we tested a third model including only the significant predictors of Model 1 and Model 2 (i.e., Model 3). When there were multiple daily predictors, we tested for possible interaction effects (i.e., Model 3b). Next, we entered mindful parenting as a between-person predictor in the models (i.e., Model 4). When the slope of the associations between a daily predictor and parenting showed significant levels of variation, cross-level interactions between the within-person and between-person predictors were explored (Hox, Reference Hox2010). This allowed us to examine whether the daily association between two variables differed between parents with different scores on mindful parenting. Because we had no explicit hypotheses about the interactions between predictors based on the extant literature, the analyses examining interaction effects were explorative in nature.
Results
Descriptive Statistics and Preliminary Results
The descriptive statistics and correlations between all of the variables are shown in Table 2.
For the descriptive and preliminary analyses, the daily variables were aggregated across the 7 days. To examine the associations between the background variables and the study variables, we conducted a MANCOVA with all study variables as dependent variables. Child gender, the type of CP, parent-reported CFCS score, presence of epilepsy, the informant's educational level, and marital status were included as fixed variables and the child's and informant's ages were entered as covariates. There were no overall multivariate effects for child gender, Wilk λ = .46, F (9, 5) = .64, p = .73; type of CP, Wilk λ = .36, F (18, 10) = .37, p = .97; CFCS level, Wilk λ = .21, F (27, 15) = .40, p = .98; presence of epilepsy, Wilk λ = .65, F (9 ,5) = .29, p = .95, the informant's educational level, Wilk λ = .64, F (9, 5) = .32, p = .94; marital status of the informant, Wilk λ = .31, F (18, 10) = .44, p = .94; child's age, Wilk λ = .55, F (9, 5) = .46, p = .85; or informant's age, Wilk λ = .94, F (9, 5) = .04, p = 1.00. Because none of these demographic variables related to the study variables, we did not control for them in the main analyses.
Day-to-Day Variability
To examine the daily variation in parenting behaviors, we calculated the percentages of variance located at Level 1 (i.e., within-person variation) by creating random intercepts-only models for each of the study variables. The intraclass correlations, reflecting the between-person variance, of all study variables are displayed in Table 2. For autonomy-supportive, psychologically controlling, and responsive parenting, respectively, 61, 42, and 63% of the variance was situated at the between-person level, reflecting differences between participants. As a consequence, 39, 58, and 37% of the respective variances were situated at the within-person level, reflecting daily variability in autonomy-supportive, psychologically controlling, and responsive parenting. For externalizing, internalizing, and prosocial child behavior, respectively, 41, 39, and 34% of the variance was situated at the within-person level. For parents’ need satisfaction and frustration, respectively, 65% and 63% of the variance reflected within-person variance. When interpreting these results, it should be taken into account that the within-person variance includes error variance in addition to substantive daily fluctuation. However, the results do indicate that a significant part of the variance is located at the daily level, indicating considerable fluctuations in parenting behavior across the seven days.
The Daily Associations Between Parents’ Psychological Needs, Child Behavior, and Parenting Behavior
Next, we examined to what extent daily child behavior (i.e., externalizing problems, internalizing problems, and prosocial behavior) and parents’ daily psychological needs experiences (i.e., need satisfaction and need frustration) related to daily parenting behavior. By examining these daily associations, we attempted to explain intraindividual fluctuations within parents (e.g., the question of why a specific parent is more autonomy-supportive on the one day than on the other day). The results for parental autonomy support, psychological control, and responsiveness are presented in Tables 3, 4, and 5, respectively.
Daily autonomy-supportive parenting as a function of daily child behavior, parents’ psychological needs, and mindful parenting
Note: B = unstandardized regression coefficient, SE = unstandardized standard error, † p < .10 *p < .05 **p < .01 *** p < .001.
Daily psychologically controlling parenting as a function of daily child behavior, parents’ psychological needs, and mindful parenting
Note: B = unstandardized regression coefficient, SE =unstandardized standard error, † p < .10 *p < .05 **p < .01 *** p < .001.
Daily responsive parenting as a function of daily child behavior, parents’ psychological needs, and mindful parenting
Note: B = unstandardized regression coefficient, SE = unstandardized standard error, NS = parents’ need satisfaction, EXT = Externalizing child behavior, INT = Internalizing child behavior, PRO = Prosocial child behavior; † p < .10 *p < .05 **p < .01 *** p < .001.
Concerning daily autonomy support (Table 3), we found a negative association with daily externalizing child behavior in Model 1, b = -.27, p < .001, and a positive association with daily parental need satisfaction in Model 2, b = .23, p < .01. When both main effects were included together (Model 3a), the effects of both daily externalizing child behavior and daily need satisfaction remained significant, b = -.25, p < .001 and b = .19, p < .01, respectively. There was no significant interaction between both predictors (Model 3b), b = .15, p = .27.
Concerning daily psychological control (Table 4), we found a positive association with daily externalizing child behavior in Model 1, b = .32, p < .001, and with daily parental need frustration in Model 2, b = .15, p < .01. In Model 3a, both associations remained significant when daily externalizing child behavior and daily need frustration were included together as predictors of daily psychological control, b = .32, p < .001 and b = .11, p < .01, respectively. In addition, there was a significant interaction effect between these predictors (Model 3b), b = .21, p < .05. This interaction effect (Figure 1) indicates that parents are especially likely to use psychologically controlling strategies on days when they experience both high levels of need frustration and when the child displays high levels of externalizing behaviors.
Interaction between daily parental need frustration and daily externalizing child behavior in the prediction of daily psychologically controlling parenting.
Table 5 presents the results concerning daily responsiveness. Daily externalizing child behavior related negatively to daily responsiveness, b = -.24, p < .001, while daily internalizing child behavior and daily prosocial behavior related positively to daily responsiveness, b = .15, p < .01 and b = .13, p < .01, respectively(Model 1). Daily parental need satisfaction also related positively to daily responsiveness, b = .14, p < .05 (Model 2). All of these daily associations remained significant when all of the significant predictors were included together in one model (Model 3a). In addition, there was a significant daily interaction between internalizing and prosocial child behavior, b = -.42, p < .01, indicating that parents are most likely to respond in a responsive way on days when their child exhibits high levels of prosocial behavior and low levels of internalizing problem behavior (Model 3b; Figure 2). When accounting for the interactions, the daily association between internalizing child behavior and responsiveness was no longer significant (Model 3b)Footnote 1.
Interaction between daily internalizing child behavior and daily prosocial child behavior in the prediction of daily responsive parenting.
In summary, the results indicate that parents are more likely to be autonomy-supportive on days when they experience high levels of need satisfaction and when they perceive low levels of externalizing child behavior. Parents rely more on psychologically controlling strategies on days when they experience a lot of need frustration and when they perceive their child as more aggressive or rule-breaking than on other days. Finally, parents are more responsive on days when they score high on need satisfaction and when their child is perceived as more prosocial and less aggressive or rule-breaking than on other daysFootnote 2.
The Role of Mindful Parenting
In a final step, parents’ general level of mindful parenting was entered into the models (i.e., Model 4). Because this variable is situated at the between-person level, these analyses explain interindividual differences between parents (e.g., the question of why the one parent is more autonomy-supportive than the other parent across the period of a week).
There was no significant association between mindful parenting and autonomy support (Table 3, Model 4), although there was a positive trend, b = .38, p = .06. Mindful parenting did relate negatively to psychologically controlling parenting, b = -.28, p < .01, and positively to responsive parenting, b = .46, p < .01, (Tables 4 and 5, Model 4). The interaction effect of parental need frustration and externalizing child behavior in the prediction of psychologically controlling parenting remained significant after adding mindful parenting to the model (Table 4, Model 4). However, the interaction effect between internalizing child problems and prosocial child behavior in the prediction of responsive parenting did not remain significant when mindful parenting was included as a person-level predictor (Table 5, Model 4). Because there was no significant variation on the slopes of the associations between daily predictors and daily parenting (all ps > .05), we did not test for cross-level interactions.
Discussion
The goal of this study was to examine the role of both child and parent factors in parenting behavior among parents of children with CP. By focusing on daily parenting behavior, this study intended to better understand why these parents are able to respond in an autonomy-supportive or responsive way on some days but are more likely to rely on psychologically controlling strategies on other days. The insight into these daily processes is important because it could provide opportunities to target specific factors that are directed towards shaping parenting behavior in interventions for families with children with CP.
The results indicated that parents’ autonomy-supportive, responsive, and psychologically controlling behaviors fluctuate considerably throughout the period of a week. More specifically, a third to up to half of the variance in the reports of parenting behavior reflected day-to-day variability (rather than interindividual differences between parents). Moreover, child behavior, parents’ psychological needs, and mindful parenting were related in meaningful ways to these daily fluctuations in parenting behavior.
Children's Daily Behaviors in Relation to Daily Parenting
Based on research in general populations, daily child behavior was expected to relate to day-to-day variability in parenting behavior. As hypothesized, daily externalizing child behavior was associated negatively with daily supportive parenting and positively with daily controlling parenting. Most likely, these child behaviors drain parents’ energy, which is required to be autonomy-supportive and responsive, and cause feelings of stress and agitation, lowering the threshold for responding in a controlling manner (Mackler et al., Reference Mackler, Kelleher, Shanahan, Calkins, Keane and O'Brien2015; Majnemer, Shevell, Law, Poulin, & Rosenbaum, Reference Majnemer, Shevell, Law, Poulin and Rosenbaum2012). On the other hand, anxious, withdrawn, and depressive child behavior had a less consistent association with daily parenting behavior. When the different types of child behavior were taken into account, internalizing child behavior related positively to responsiveness during the same day. This suggests that parents are more warm and supportive on days that they experience their child as being anxious, withdrawn, or depressed because they want to boost their child's mood and make their child feel better. However, the zero-order within-person correlation between internalizing problems and responsiveness was nonsignificant. Follow-up analyses showed that daily internalizing problems only relate significantly to daily responsiveness when externalizing problems are accounted for. This finding suggests that parents increase their responsiveness only when children exhibit emotional difficulties (e.g., sadness, anxiousness) without exhibiting aggressive or rule-breaking behavior. As this is the first study to report a positive daily association between internalizing child behavior and parents’ responsiveness and because this daily association was not consistently significant across all models, it needs to be replicated and caution is warranted when interpreting this result.
The results concerning prosocial child behavior indicate that parents are more responsive towards their child on days when the child is perceived as being more prosocial. Apparently, the child's daily prosocial behavior makes it easier for parents to respond in a warm, supportive, and empathic way towards the child. In contrast to findings that were obtained by Dieleman et al. (Reference Dieleman, Soenens, Vansteenkiste, Prinzie, Laporte and De Pauw2018), who conducted a diary study among parents of children with autism spectrum disorder, prosocial child behavior did not relate to more autonomy-supportive parenting during the same day. To the best of our knowledge, this is the first study to examine these daily associations among parents of children with CP, so more research is needed to better understand why daily prosocial child behavior is associated with parents’ responsiveness but not with autonomy support.
Parents’ Daily Psychological Needs in Relation to Daily Parenting
As expected based on previous diary studies in other populations (e.g., Dieleman et al., Reference Dieleman, Soenens, Vansteenkiste, Prinzie, Laporte and De Pauw2018; Mabbe, Soenens, et al., Reference Mabbe, Soenens, Vansteenkiste, Van der Kaap-Deeder and Mouratidis2018; Mabbe, Vansteenkiste, et al., Reference Mabbe, Vansteenkiste, Van der Kaap-Deeder, Dieleman, Mouratidis and Soenens2018), the results indicate that parents’ psychological needs also are important sources of day-to-day variability in parenting. In line with previous research, the associations between parents’ need-related experiences and their parenting behavior can be differentiated into a “bright” and a “dark” pathway (Dieleman et al., Reference Dieleman, Soenens, Vansteenkiste, Prinzie, Laporte and De Pauw2018; Vansteenkiste & Ryan, Reference Vansteenkiste and Ryan2013). The “bright” pathway indicates that daily need satisfaction relates to more adaptive parenting behavior (i.e., autonomy-supportive and responsive parenting). Daily feelings of self-direction, reciprocal care, and self-efficacy enable parents to promote their child's volitional functioning and to be supportive and warm towards their child. These need-satisfying experiences probably provide parents with the required energy to focus on the child's perspective, attune to the child's needs and pace of development, and support the child with warmth and responsive interactions (Dieleman et al., Reference Dieleman, Soenens, Vansteenkiste, Prinzie, Laporte and De Pauw2018; Van der Kaap-Deeder et al., Reference Van der Kaap-Deeder, Soenens, Mabbe, Dieleman, Mouratidis, Campbell and Vansteenkiste2019). The “dark” pathway, on the other hand, concerns the association between daily need frustration and dysfunctional parenting behavior. This pathway indicates that daily feelings of pressure, social alienation, and personal failure leave parents vulnerable to relying on pressuring behaviors when interacting with their child. The need-frustrating experiences probably cause feelings of stress and agitation among parents, feelings that, in turn, prompt parents to engage in more dysfunctional parenting behaviors (Barfoot et al., Reference Barfoot, Meredith, Ziviani and Whittingham2017; Dieleman et al., Reference Dieleman, Soenens, Vansteenkiste, Prinzie, Laporte and De Pauw2018, Van der Kaap-Deeder et al., Reference Van der Kaap-Deeder, Soenens, Mabbe, Dieleman, Mouratidis, Campbell and Vansteenkiste2019).
The Interplay Among Multiple Factors in Predicting Daily Parenting Behavior
In addition to the main effects of parents’ psychological needs and child behavior, this study examined in a more explorative fashion the interplay between the significant daily predictors. There was a significant interaction between parental need frustration and externalizing child behavior, with the combined presence of both factors being related to elevated levels of psychologically controlling parenting. Parents are most prone to rely on psychologically controlling parenting on days when they experience high levels of need frustration and perceive their child as being highly aggressive or rule-breaking at the same time. With high levels of need frustration, parents already have little energy available. When the child then additionally displays difficult behavior, parents’ patience probably becomes eroded and their threshold for resorting to pressuring parenting strategies might be surpassed more quickly.
A second significant interaction effect indicated that the association between prosocial behavior and responsiveness depends on the level of internalizing problems. Parents appear to be most responsive on days when their child exhibits much prosocial child behavior and low levels of internalizing problem behaviors. The combined presence of desirable behavior and absence of internal distress appears to create the optimal conditions for parents to engage in warm and friendly interactions with their child. However, this effect was less consistent, as it was no longer significant when the role of mindful parenting was taken into account.
The Beneficial Influence of Mindful Parenting on Daily Parenting Behavior
Consistent with our expectations, we found that parents who reported that they are generally more mindful during interactions with their child are more responsive than parents who report being less mindful. In addition, mindful parenting related negatively to the use of controlling strategies throughout the week. It is likely that these parents are more aware of their own emotions and of the effects that their parenting behavior can have on their child, which helps them to refrain from pressuring reactions. In contrast to our expectations, mindful parenting did not relate significantly to autonomy support (although there was a positive trend). More research is needed to replicate and understand this nonsignificant association. There might, for instance, be something specific about raising a child with CP that allows less variation in autonomy-supportive parenting.
We initially planned to examine whether mindful parenting would moderate the daily associations between parents’ psychological needs, child behavior, and parenting behavior via exploratory analyses. However, this possibility could not be tested because there was no significant variation around the slopes of the associations of parents’ needs and child behavior with daily parenting behavior. The relatively small sample size might be responsible for this nonsignificant variation in the strength of the daily associations. Therefore, future research with larger samples is needed to revisit the possibility that mindful parenting is a factor of resilience in the face of need-frustrating parental experiences and problematic child behaviors.
Implications
In addition to advancing the theoretical understanding of parents’ behaviors when raising a child with CP, the findings from this study have potentially valuable practical implications. A first practical implication stems from the observation that the way parents behave towards their child with CP changes from day to day. The finding that each parent can deviate from his/her general level of parenting behavior highlights parents’ potential to change. When practitioners focus on the dynamic nature of parenting, they avoid the pitfalls that are associated with parent-blaming. Accordingly, parents might become more receptive to support and more positive about their potential to change. For example, instead of directly targeting controlling parenting behavior, it might be beneficial to start by focusing parents’ attention on the moments when they are able to be autonomy-supportive or responsive because this might foster parents’ belief in their own potential.
Second, the finding that the daily fluctuations in parenting relate to day-to-day variation in parents’ psychological needs and in child behavior suggests that interventions that target parenting behavior will be most effective when taking into account both the parent's and the child's functioning. That is, to promote more supportive parenting, it is important that parents are aware of and attend to their own psychological needs. The main focus of support programs for parents of children with CP (e.g., parent-mediated therapy) is often on parenting skills and their benefits for the child. The current findings suggest that the effectiveness of parent support programs could be enhanced by additionally encouraging parents to be sensitive for and take care of their own psychological needs. When parents indicate that they experience little need satisfaction or often experience need frustration, practitioners might help them to identify and invest in life domains or moments in which they experience (or used to experience) psychological freedom and authenticity, reciprocal care, and personal efficacy (specifically within the context of parenting or on a more general level; see Sheldon et al., Reference Sheldon, Abad, Ferguson, Gunz, Houser-Marko, Nichols and Lyubomirsky2010; Weinstein, Khabbaz, & Legate, Reference Weinstein, Khabbaz and Legate2016 for examples of need-based interventions). Similarly, practitioners might help parents in detecting need-thwarting situations and offer advice about how to reduce the likelihood of encountering these situations. Practitioners might also help to diminish the negative effects of need frustration by promoting effective ways to cope with these need-frustrating experiences. It is also important to keep parents’ psychological needs in mind when working together with these parents or when designing parent support or interventions. That is, when parents’ psychological needs are supported in their contacts with practitioners, parent support might be more effective (Ryan, Lynch, Vansteenkiste, & Deci, Reference Ryan, Lynch, Vansteenkiste and Deci2011). For example, parents’ need for competence might be supported by explicitly recognizing their efforts to adapt to their child's disability-related needs and by acknowledging the parents as the experts of their own child.
Regarding child behavior, it is important for parenting interventions to target the child's externalizing behaviors and—if needed—to try to reduce them by applying specific interventions. For example, practitioners can directly try to diminish the externalizing behavior by searching, together with the parents, for possible triggers of this behavior or by examining the functionality of this behavior for the child (e.g., aggressive behavior as a way to escape a task that is too difficult; Patterson, Reference Patterson1982). In addition, it is important to pay attention to adaptive child behavior in interventions. For example, parents may be advised to attend to their child's prosocial behavior even if the child also engages in problem behaviors. By recognizing and paying more attention to this adaptive behavior, parents might find it easier to respond in a warm and sensitive way towards their child.
Third, the current results also point towards the potential of incorporating mindful parenting into interventions for families with children with CP. Several studies among different populations have already shown that mindful parenting is a skill that can be acquired through practice (e.g., Meppelink, de Bruin, Wanders-Mulder, Vennik, & Bögels, Reference Meppelink, de Bruin, Wanders-Mulder, Vennik and Bögels2016; Ridderinkhof, de Bruin, Blom, & Bögels, Reference Ridderinkhof, de Bruin, Blom and Bögels2018). Moreover, mindful parenting training has been shown to decrease parents’ use of dysfunctional parenting behavior and to increase parents’ adaptive parenting behaviors (Bögels, Hellemans, van Deursen, Römer, & van der Meulen, Reference Bögels, Hellemans, van Deursen, Römer and van der Meulen2014; Ridderinkhof et al., Reference Ridderinkhof, de Bruin, Blom and Bögels2018). Therefore, by teaching parents how to apply an attitude of awareness, acceptance, and compassion in their interactions with their child, parents might become less vulnerable to responding in a psychologically controlling way and be better able to respond in a warm and sensitive way.
Limitations and Future Directions
When interpreting the current results, some limitations need to be taken into account. First, the generalizability of the findings is limited by the sample characteristics. More specifically, the participants were mostly mothers. Research with a more balanced parental gender distribution is needed to examine the generalization of our findings across parental gender. In addition, the age range of the children with CP was quite broad, including children from middle childhood to late adolescence. Therefore, future research could focus on more specific age groups and examine whether the reported associations remain similar or change across the lifespan of the child. Finally, the relatively small sample size may have created limited variation in the daily associations. Studies with a larger sample size might allow for a better examination of the potential moderating role of mindful parenting and other individual difference variables.
Second, the use of a single-informant study design contributes to shared method variance, affecting the reported daily associations (Williams & Brown, Reference Williams and Brown1994). Therefore, shared method variance could have inflated the reported associations, for example, when parents who experience high levels of need frustration interpret both their child's behavior and their own parenting behavior more negatively. Future research can address this by including multiple informants or by using observational measures.
A third limitation is that the design of this diary study does not allow one to draw causal conclusions about the direction of effects. Therefore, when interpreting these results concerning the daily relations between child behavior, parents’ needs, and parenting behavior, it is important to keep in mind that parenting behavior might affect the child's behavior and parents’ need-related experiences in addition to child behavior and parents’ needs shaping parenting behavior. Theoretical accounts (Bell, Reference Bell1968; Sameroff & Chandler, Reference Sameroff, Chandler, Horowitz, Hetherington, Scarr-Salapatek and Siegal1975) and empirical research (Pinquart, Reference Pinquart2017) have established convincingly that child and parenting behavior affect each other bidirectionally. More specifically, behavioral problems elicit more controlling parenting behaviors that, in turn, provoke more behavioral problems (Soenens, Luyckx, Vansteenkiste, Duriez, & Goossens, Reference Soenens, Luyckx, Vansteenkiste, Duriez and Goossens2008). Moreover, in addition to autonomy-supportive and responsive parenting behavior eliciting positive child behavior, positive child behavior allows parents to be more autonomy-supportive and responsive (Padilla-Walker, Carlo, Christensen, & Yorgason, Reference Padilla-Walker, Carlo, Christensen and Yorgason2012). Further, parents’ own parenting behavior may also influence their need-related experiences (Deci, La Guardia, Moller, Scheiner, & Ryan Reference Deci, La Guardia, Moller, Scheiner and Ryan2006; Legate, De Haan, Weinstein, & Ryan, Reference Legate, De Haan, Weinstein and Ryan2013; Mabbe, Soenens, et al., Reference Mabbe, Soenens, Vansteenkiste, Van der Kaap-Deeder and Mouratidis2018). For example, being autonomy-supportive can create feelings of need satisfaction, whereas using controlling behavior can create feelings of need frustration in the person exhibiting the behavior (Deci et al. Reference Deci, La Guardia, Moller, Scheiner and Ryan2006; Legate et al. Reference Legate, De Haan, Weinstein and Ryan2013; Mabbe, Soenens, et al., Reference Mabbe, Soenens, Vansteenkiste, Van der Kaap-Deeder and Mouratidis2018). Most likely then, most of the associations that were demonstrated in this study are inherently reciprocal in nature, with children's behaviors, parents’ behaviors, and parents’ experiences reinforcing one another mutually in a cascade of effects (see also Supplementary file B for additional analyses addressing the direction of effects in associations between the study variables). In order to address this daily bidirectional interplay, future research could use diary studies with multiple assessments throughout the day (to examine bidirectionality of effects within the day), longitudinal designs (examining bidirectionality across longer periods), or experimental designs (e.g., inducing momentary frustrations of parental needs). Ideally, future research using multiple assessments throughout the day would include separate measures for parental need-based experiences that are encountered during parent–child interactions and for need-based experiences that are obtained outside of the home context (e.g., at work). Such separate measures would allow for a more detailed examination of carry-over effects from work-related experiences to in-home experiences and for a purer assessment of the specific (bidirectional) role of experiences within the parent–child relationship in parenting and child behavior.
A final limitation is that this study focused only on parental experiences and child behaviors as factors involved in parenting behavior without considering the role of social context. In line with the social-contextual model of parenting that was developed by Belsky (Reference Belsky1984), extensive research has demonstrated that parenting behaviors are not only shaped by parent and child factors but also by contextual factors such as marital satisfaction, social support, work experiences, and socioeconomic status (Dix, Reference Duncan, Coatsworth and Greenberg1991; Grolnick, Weiss, McKenzie, & Wrightman, Reference Grolnick, Weiss, McKenzie and Wrightman1996; Taraban & Shaw, Reference Taraban and Shaw2018). While financial strain (Bøe, Sivertsen, Heiervang, Goodman, Lundervold, & Hysing, Reference Bøe, Sivertsen, Heiervang, Heiervang, Goodman, Lundervold and Hysing2014) and social pressure (Wuyts, Chen, Vansteenkiste, & Soenens, Reference Wuyts, Chen, Vansteenkiste and Soenens2015) have been found to increase risk for dysfunctional parenting, social support (from partners or from the broader social context) contributes to more adaptive parenting behaviors (Andresen & Telleen, Reference Andresen and Telleen1992; van Bakel & Riksen-Walraven, Reference van Bakel and Riksen-Walraven2002). Given the important role of the social context in parenting and parental experiences, an important avenue for future research is to examine also the role of social context among parents of children with CP. Possibly, contextual risk factors further exacerbate the challenges with which these parents are already confronted. Conversely, social support may be even more important for these parents than for parents in the general population. Knowledge about the role of the social context in parenting a child with CP may also inform practice. The effectiveness of interventions that are directed at increasing parenting skills and improving parents’ needs-based experience may be short-lived when parents are confronted with adverse social contexts. These parents may need tangible help with their financial situation and with their social network before interventions to strengthen their parenting skills and psychological resilience are implemented.
Conclusion
The purpose of this study was to gain insight into the sources of variation in daily parenting behavior among parents of children with CP. The results indicated that parents’ autonomy-supportive, psychologically controlling, and responsive behaviors fluctuate considerably across days. These daily fluctuations were associated with day-to-day variability in both parents’ own psychological needs and child behavior. In addition, mindful parenting was identified as being an important dispositional predictor of lower psychologically controlling parenting and higher responsiveness. These findings point towards the variability of parenting behavior among parents of children with CP and suggest that parent support needs to take into account both the parents’ psychological needs and the child's behavior. Moreover, supporting these parents in applying a mindful attitude during parent–child interactions might strengthen their ability to engage in constructive parenting on a daily basis.
Supplementary Material
The supplementary material for this article can be found at https://doi.org/10.1017/S0954579419001688.
Acknowledgments
The authors wish to thank all of the participating families and the service centers that contributed to this research. Special thanks to Joachim Waterschoot for his help with the data analysis and for updating CaviR (https://watjoa.shinyapps.io/CaviR/) in order to conduct the multilevel interaction plots.
Financial Support
This research was funded by grants from the Marguerite-Marie Delacroix Support Fund (GV/B-202) and the Flemish Research Foundation (FWO) (11X6516N).
