Blackwell Publishing LtdOxford, UKCCHChild: Care, Health and Development0305-1862 2006 Blackwell Publishing 2006322177184Original ArticleAuthor?

itative parenting and parental stress in children with developmental disabilitiesL. Woolfson and E. Grant

Original Article

Authoritative parenting and parental stress in parents of pre-school and older children with developmental disabilities
L. Woolfson and E. Grant
Department of Psychology, University of Strathclyde, Glasgow, UK Accepted for publication 9 November 2005

Abstract
Background Rearing a child with a developmental disability is associated with increased parental stress. Theories of stress and adjustment and bi-directional theories of child development suggest that parenting could inuence these negative outcomes. Methods Relationships between parenting approaches and stress in parents of children with developmental disabilities (DD) (N = 53) were examined across two age groups, 35 years and 9 11 years and compared with a contrast group of typically developing children (TD) (N = 60). Measures used were the Parenting Stress Index-Short Form and Rickel and Biasattis modication of Blocks Child Rearing Practices Report, classied into Baumrinds parenting styles using Reitman and Grosss method. Results Parents in the older DD group used Authoritative parenting less than parents in the younger DD group, while the opposite developmental pattern was seen in the TD group. Multivariate analysis of variance showed a signicant group parenting style interaction for Parental Distress, Parent Child Dysfunctional Interaction and Difcult Child. Stress measures were higher for the DD group and seemed to be associated with Authoritative parenting approaches, an effect that was not observed in the TD group. Conclusions Findings suggest that the well-established effect of group on stress may be moderated by parenting style. Authoritative parenting may be highly stressful for parents of children with DD to implement, resulting in a decrease in its use across the two age groups.

Keywords childhood disability, parenting, stress

Introduction
Rearing a child with a disability has a wellestablished association with increased parental stress (Hauser-Cram et al. 2001). While child characteristics such as the nature of the disability (Sanders & Morgan 1997) and behaviour problems (Friedrich et al. 1985) may be important inuences, parents are also likely to experience other economic, social and emotional stressors related to

Correspondence: Dr Lisa Woolfson, Department of Psychology, University of Strathclyde, 40 George Street, Glasgow G1 1QE, UK E-mail: lisa.woolfson@strath.ac.uk

the childs disability (McCubbin et al. 1982). As many parents cope very well with these challenges, it is clear that the relationship between child developmental disability and problematic family outcomes is not a simple, causal one. Models that address the complexity of this relationship by emphasizing the role of parent and family variables in inuencing parental stress and adjustment outcomes (Hill 1958; McCubbin & Patterson 1983) have stimulated considerable research on social

Original Article
2006 Blackwell Publishing Ltd

177

178

L. Woolfson and E. Grant

support resources (Beresford 1994) and cognitive appraisal (Hassall et al. 2005), while another strand of research has focused on the bidirectionality of the relationship between child disability and family outcomes (Baker et al. 2003). Acknowledgements of complexity and bidirectionality both suggest that parent variables themselves can inuence parent outcomes such as stress and adjustment. While parenting behaviour itself has been acknowledged as a factor in coping and adjustment in parents of children with developmental disabilities (Beresford 1994) and in parent intervention programmes aimed at stress management (Risdal & Singer 2004), the relationship between parenting behaviour and parenting stress has been under-researched (Hastings & Beck 2004). The present study aims to address this. Baumrinds (1971) seminal work on parenting styles provides a useful framework for examining parenting. Her concept of Authoritative parenting emphasized parental control within an ethos of warm, responsive parenting that explains reasons, values the child as an individual and aims to encourage the child towards independence. Authoritarian parenting is controlling, values obedience to set standards, favours punishment and is less warm than Authoritative. Permissive parenting is where the parent lacks control, makes few demands on child, but is warm; and Rejecting Neglecting parenting is neither controlling, permissive, nor warm. Authoritative parenting is associated with supportive and developmentally appropriate child-rearing (Pettit et al. 1997); selfguided, purposeful behaviour in pre-schoolers and social responsibility (Baumrind, ibid); increased self-reliance in adolescents (Steinberg et al. 1994) better self-control as measured by delayed gratication (Reitman & Gross 1997) which itself has

associations with higher school achievement and social competence in adolescence (Mischel 1974) but such positive effects may not apply uniformly across all minority groups (Steinberg et al. 1992; Vinden 2001). Parenting a child who has a developmental delay is a challenge for parents. Children are likely to be dependent for longer, placing demands on their parents across the lifespan and requiring qualitatively and quantitatively different support from typically developing children. It is not clear how parenting behaviours change in response to this challenge as few studies have examined parenting approaches over the pre-school to late primary school period or beyond (OConnor 2002). The present study aimed to examine the role of Authoritative parenting in parents of children with DD in the well-established relationship between disability and parental stress, by comparing parenting style and stress with parents of TD across two child age groups, pre-school and late primary school.

Methodology
Participants
Participants were 53 parents whose children had developmental disabilities (DD group) and a comparison group of 60 parents whose children were typically developing (TD group). Ninety-nine mothers and 12 fathers completed questionnaires. In two questionnaires it was not clear which parent had responded. Parents were recruited across two child age groups, those with children aged 3 5 years (mean age 51.2 months, SD 9.4 months) and those with children of 911 years (mean age 127.6 months, SD 16.2 months). There were 67 boys and 46 girls in total. Table 1 shows the gender

Developmental disabilities (girls, boys) 35-year olds 911-year olds Total 33 (7, 26) 20 (6, 14) 53

Typically developing (girls, boys) 22 (12, 10) 38 (21, 17) 60

Table 1. Participant data Total (girls, boys) 55 (19, 36) 58 (27, 31) 113

2006 Blackwell Publishing Ltd, Child: Care, Health & Development, 32, 2, 177184

Authoritative parenting and parental stress in children with developmental disabilities

179

distribution of children across the groups. The predominance of males in the DD group in our sample reects that in the general population, developmental disabilities are usually more prevalent in males (Eme 1992). All participants (TD and DD) resided in Paisley, west central Scotland. Families in the DD group were recruited from special schools and nurseries for children with severe/complex learning disabilities, and from special nursery units for children with signicant learning needs. Thus, all children in the DD group had been assessed by their local Educational Psychology Service as having moderate to severe developmental delays. Many also had signicant motor and communication impairments: moderate to severe developmental delay/ learning difculties (26 children), autistic spectrum and severe communication disorders (18 children), Down Syndrome (six children), cerebral palsy (three children). As there is an association between socio-economic status and developmental disabilities (Vrijheid et al. 2000; Sundrum et al. 2005), socio-economic status, parenting and stress (e.g. Felner et al. 1995; Bradley & Corwyn 2002) and socio-economic status and negative and controlling behaviours (Floyd & Saitzyk 1992), the inuence of socio-economic status as an explanation for any differences found between DD and TD groups was controlled for by drawing our TD sample from areas characterized by social disadvantage, low income and unemployment.

Measures
The Parenting Stress Index-Short Form (PSI-SF) (Abidin 1995) is a 36-item questionnaire with statements on a ve-point Likert scale. Three PSI-SF scales derived from factor-analytical studies (Abidin 1995) are Parental Distress (distress experienced in parenting), for example, I often have the feeling that I cannot handle things very well, ParentChild Dysfunction (perception that child does not meet parents expectations), for example, Sometimes I feel my child doesnt like me and doesnt want to be close to me, and Difcult Child (behavioural characteristics that make the child easy, or difcult, to manage) My child seems to cry or fuss more often than most children. Good internal consisten-

cies for PSI-SF were reported by Reitman and colleagues (2002) with a low-income US sample. Its use with parents of children with developmental disabilities is well established, for example, Button and colleagues (2001); Macias and colleagues (2004); Miller and colleagues (2001); Smith and colleagues (2001). Rickel and Biasattis (1982) modication of Blocks (1981) Child Rearing Practices Report (CRPR) was used to measure parenting behaviour. The CRPR is a self-report that corresponds well with how parents actually behave towards their children (Dekovic et al. 1991). It consists of a 91-item Q-sort which was felt to be too timeconsuming for participants in conjunction with completion of the PSI in the present study, so Rickel and Biasattis 40-item questionnaire version was used instead. It uses a Likert scale and yields two factors: Restrictiveness, which relates to parenting practices focusing on control of child behaviour, for example, I prefer my child not to try things if there is a chance s/he might fail; and Nurturance, related to parenting practices focusing on sharing feelings, for example, I express my affection by hugging, kissing and holding my child. Rickel and Biasatti reported high internal consistency (Cronbachs alpha = 0.82 for each scale) and reliability. While Rickel and Biasattis modication has been used in a number of studies (e.g. Mauro & Harris 2000; Ghazvini & Mullis 2002), it has not previously been used to any extent with children with developmental disabilities (Beck et al. 2004). However, the CRPRs internal consistency with the present studys sample of 53 DD children was good (alpha = 0.89 for the Restrictiveness scale, alpha = 0.80 for the Nurturance scale), suggesting that it was equally appropriate for use with this DD sample. Baumrinds four parenting styles which examine each individuals combination of Restrictiveness and Nurturance practices together were derived from CRPR data using Reitman and Grosss (1997) method in which Restrictiveness and Nurturance scores were classied as high or low using a median split. Authoritative parenting style is high on Restrictiveness, high on Nurturance; Authoritarian parenting is high on Restrictiveness but low on Nurturance; Permissive parenting is low on Restrictiveness, high on Nur-

2006 Blackwell Publishing Ltd, Child: Care, Health & Development, 32, 2, 177184

180

L. Woolfson and E. Grant

turance and Neglectful parenting is low on Restrictiveness, low on Nurturance.

Table 2. Means and standard deviations for stress measures PSI Parental distress Age (years) 35 911 Parentchild dysfunctional interaction Difcult child 35 911 35 911 Group DD TD DD TD DD TD DD TD DD TD DD TD Mean (SD) 32.73 (9.25) 23.55 (6.29) 30.85 (9.05) 24.66 (6.65) 28.61 (7.21) 18.50 (4.74) 26.10 (6.29) 20.05 (7.50) 37.79 (8.34) 26.14 (7.18) 36.05 (9.96) 23.66 (7.93)

Procedure
Questionnaire packages were issued via the schools to parents of children in the districts three special needs nurseries and those with children of upper primary school age in the districts three special schools (DD group), and to parents of children in the appropriate age groups (pre-school and primary 57) in three mainstream primary schools and four mainstream nurseries (TD group). Each pack contained a small piece of confectionery as incentive (Gajraj et al. 1990). We used follow-up reminders which are associated with higher response rates (Edwards et al. 2002). One hundred and ninety-nine questionnaires were issued and 119 were returned, indicating 60% return rate. Questionnaires from two mothers whose pre-school children had hearing impairments but no reported developmental delay were excluded from the analysis. Data from a further four respondents were omitted because questionnaires were incomplete. The remaining 113 questionnaires were used in the analyses. Half of each group was asked to complete the CRPR rst and the other half to complete PSI-SF rst to take account of any possible order effects. T-test analysis found no order effects.

DD, children with developmental disabilities; PSI, Parenting Stress Index; TD, typically developing children.

Results
Because of the predominance of males in the DD group, hierarchical regression analyses were rst carried out on the data for each of the dependant variables with gender entered at step 1. Gender was not found to be a signicant predictor for any of the CRPR variables or PSI variables. As the regression analyses showed that parent group subsumed gender, this study will focus on group differences. Table 2 shows group means and standard deviations for the three PSI stress measures. A multivariate analysis of variance of all three dependent variables with parent group and child age as between-subjects factors found a signicant main effect of parent group, F (3, 107) = 19.14,

P < 0.001, 2 = 0.349. Examination of betweensubjects effects for each dependent variable indicated that all stress measures were signicant (Parental Distress P < 0.001, 2 = 0.187; Parent Child Dysfunctional Interaction P < 0.001, 2 = 0.257; Difcult Child P < 0.001, 2 = 0.336). There was no main effect of age, nor interaction effects. Thus, as expected, the parents of DD children in the sample experienced a greater degree of distress, more dysfunctional parentchild interaction, and found their childrens behaviour more difcult than did the parents of the TD and this applied across the two child age groups. Furthermore, 57% of the DD group presented clinically signicant PSI Total Stress scores using Abidins (1995) criterion of scores >90, compared with 8% of the TD group. Using the method described earlier, each parents combination of Restrictive and Nurturing parenting practices was categorized as Authoritarian, Authoritative, Permissive or Neglectful parenting style (see Table 3). Differences in parenting styles between the pre-school and older school age groups were found for parents in both the DD and TD groups; DD P = 0.048, 2 = 7.908, d.f. = 3; TD P = 0.069 (borderline signicance), 2 = 7.081, d.f. = 3. While Neglectful, Permissive and Authoritarian parenting styles were each similarly utilized across age groups for both DD and TD children (2 not signicant), the use of Authoritative parenting (high restrictiveness, high nurturance) differed for the DD and TD groups across the two age groups. Thirty-six per cent of parents of younger children

2006 Blackwell Publishing Ltd, Child: Care, Health & Development, 32, 2, 177184

Authoritative parenting and parental stress in children with developmental disabilities

181

Table 3. Parenting style frequency data Parenting style Age (years) Developmental disabilities Total Typically developing Total 35 911 35 911 Neglectful 4 5 9 2 7 9 Permissive 8 9 17 9 9 18 Authoritarian 9 5 14 9 9 18 Authoritative 12 1 13 2 13 15 Total 33 20 53 22 38 60

Table 4. Group parenting style means and standard deviations PSI Parental Distress ParentChild Dysfunctional Interaction Difcult Child Group DD TD DD TD DD TD Neglectful 28.22 (7.82) 31.22 (6.51) 28.89 (3.59) 28.00 (8.31) 36.00 (7.91) 33.00 (7.45) Permissive 30.06 (9.07) 22.61 (6.51) 24.53 (7.84) 16.83 (4.048) 35.35 (11.03) 20.56 (5.80) Authoritarian 32.07 (7.46) 22.83 (5.61) 27.21 (7.07) 19.28 (5.11) 39.43 (9.49) 25.11 (6.39) Authoritative 37.15 (10.29) 23.73 (5.12) 31.39 (5.72) 17.80 (5.92) 37.77 (5.66) 23.67 (7.72)

DD, children with developmental disabilities; PSI, Parenting Stress Index; TD, typically developing children.

in the DD group reported using Authoritative parenting, while only 5% of parents of older children used it. The opposite developmental pattern was seen in the TD group with 34% of parents of older children in the TD group using it, but only 9% of parents of younger children (P < 0.001, 2 = 17.374, d.f. = 1). Table 4 shows group parenting style means for the three stress variables. Age groups have been collapsed here to avoid small cell sizes for Neglectful parenting. A two-way multivariate analysis of variance was carried out to explore whether relationships between parenting style and stress were different for DD and TD groups. This found main effects of parent group, F (3, 103) = 20.18, P < 0.001, 2 = 0.370; and parenting style, F (9, 250.83) = 2.96, P = 0.002, 2 = 0.079; and a signicant interaction effect between parenting style and group, F (9, 250.83) = 2.44, P = 0.011, 2 = 0.066. Subsequent examination of univariate F-tests showed that the interaction effect was signicant for all dependant variables: Parental Distress, P = 0.004; ParentChild Dysfunctional Interaction, P = 0.010; Difcult Child, P = 0.052. Simple effects analysis showed the different relationships between parenting styles and stress measures for the TD group and DD groups. With the TD group, Neglectful parenting (low restric-

tiveness, low nurturance) was signicantly more stressful than other parenting styles for each stress variable. This was not the case with the DD group. Instead, increased Parental Distress in the DD group seemed to be associated with more controlling parenting styles (Authoritarian and Authoritative). For ParentChild Dysfunctional Interaction, simple effects analysis found a signicant difference between Authoritative and Permissive parenting styles, with the former again associated with greater stress. There was no relationship between parenting style and Difcult Child Behaviour for the DD group. Additionally, the breakdown of parenting styles used by those parents in the DD group who presented clinically signicant PSI Total Stress scores (n = 30) was as follows: Neglectful (5), Permissive (6), Authoritarian (9), Authoritative (10), pointing up the predominance of those using controlling parenting (63%).

Discussion
The study set out to examine the relationship between parenting styles and parental stress in children with developmental disabilities across two age groups. It provided further evidence that parenting children with developmental disabilities is indeed more stressful and problematic than parenting typ-

2006 Blackwell Publishing Ltd, Child: Care, Health & Development, 32, 2, 177184

182

L. Woolfson and E. Grant

ically developing children, with parents of children with developmental disabilities scoring higher on all stress measures than those typically developing. This, together with the nding of clinically significant stress scores in over half the DD sample, suggests that parental coping support interventions (e.g. Beresford 1994) are required for parents of children with developmental disabilities, as well as interventions to help directly with parenting skills in child behaviour management. Parents of the younger DD group used Authoritative parenting more than parents of the younger TD group but this pattern was reversed with the older children with developmental disabilities. The observed group parenting style interaction effect on stress measures suggests that parenting style may moderate the effect of group on stress. Perhaps parents of children with developmental disabilities nd implementing Authoritative parenting a constant challenge because of factors related to the childrens disability, the amount of repetition needed, the limited success achieved and other demands on parental time and energies. Haldy and Hanzliks (1990) nding that mothers of infant children with Down syndrome felt less competent in their child-rearing as their children moved from infancy to school age may reect the difculties parents of children with developmental disabilities experience. Similarly, Zirpoli and Bell (1987) suggested that the lack of responsiveness of children with severe learning disabilities to their parents initiations may result in parents reduced awareness of the cues presented by their children. Low societal expectations of disabled childrens behaviour and their future participation in society may also impact on parents attempts at Authoritative parenting (Woolfson 2004). Furthermore, parents of children with developmental disabilities are likely to be involved in addressing daily care needs not experienced by parents of typically developing children of the same age (Roberts & Lawton 2000) which will draw further on parents energies. This could include help with feeding, toileting, entertaining the child, or providing attention during the night. Adoption of a less demanding parenting style, as the child with developmental disabilities grows older, may be a parental adaptive coping response. Because of the complexity of interrela-

tionships between parent and child, it is likely though that the parenting style adopted is driven not only by parent factors such as stress, but also as a response to factors within the individual child. In contrast, the TD group showed no differences in Parental Distress between Authoritarian, Authoritative and Permissive parenting styles, suggesting that a range of parenting styles are suitable and not stress-producing when parenting typically developing children. Thompson and colleagues (2002) similarly concluded that there was a wide range of normal, effective, parenting behaviour. Changes in parenting style across the two age groups in the study were indicated for both the DD and TD groups. Like Thompson and colleagues (2002), we found a wide range of parenting styles in the typically developing 10-year-old group, but we found less variation in the 3-year olds where mostly Permissive and Authoritative styles were used. Limitations of the study include the use of a cross-sectional rather than a longitudinal design, which does not allow analysis of parenting change in individual families across time. The quasiexperimental design using pre-existing groups, often a problem when working with this population (Woolfson 1999), further limits the conclusions that can be drawn about causality. Small sample size, in this case 57% of the total number of questionnaires issued, is another problem that pervades this area of research and may mean that the study sample is not representative of the population.

Conclusions
The results showed a relationship between Authoritative parenting and stress in parents of children with developmental disabilities but not in parents of typically developing children. Some parents may require emotional and social support in the oftenstressful task of parenting children with developmental disabilities, particularly when they are trying to help set behavioural limits.

References
Abidin, R. (1995) Parenting Stress Index: Third Edition. Professional Manual. NFER-Nelson, Windsor, UK.

2006 Blackwell Publishing Ltd, Child: Care, Health & Development, 32, 2, 177184

Authoritative parenting and parental stress in children with developmental disabilities

183

Baker, B., McIntyre, L., Blacher, J., Crnic, K., Edelbrock, C. & Low, C. (2003) Preschool children with and without developmental delay: behaviour problems and parenting stress over time. Journal of Intellectual Disability Research, 47, 217230. Baumrind, D. (1971) Current patterns of parental authority. Developmental Psychology Monograph, 4, 1103. Beck, A., Daley, D., Hastings, R. & Stevenson, J. (2004) Mothers expressed emotion towards children with and without intellectual disabilities. Journal of Intellectual Disability Research, 48, 628638. Beresford, B. (1994) Resources and strategies: how parents cope with the care of a disabled child. Journal of Child Psychology and Psychiatry, 35, 171209. Block, J. (1981) The Child Rearing Practices Report (CRPR). University of California, Berkley, CA, USA. Bradley, R. & Corwyn, R. (2002) Socioeconomic status and child development. Annual Review of Psychology, 3, 371399. Button, S., Pianta, R. & Marvin, R. (2001) Partner support and maternal stress in families raising young children with cerebral palsy. Journal of Developmental and Physical Disabilities, 13, 6181. Dekovic, M., Janssens, J. & Gerris, J. (1991) Factor structure and construct validity of the Block Child Rearing Practices Report (CRPR). Psychological Assessment, 3, 182187. Edwards, P., Roberts, I., Clarke, M., DiGuiseppi, C., Pratrap, S., Wentz, R. & Kwan, I. (2002) Increasing response rates to postal questionnaires: systematic review. British Medical Journal, 324, 11831185. Eme, R. (1992) Selective female afiction in the developmental disorders in childhood: a literature review. Journal of Clinical Child Psychology, 21, 354364. Felner, R., Brand, S., Du Bois, D., Adan, A., Mulhall, P. & Evans, E. (1995) Socioeconomic disadvantage, proximal environmental experiences, and socioemotioal and academic adjustment in early adolescence: investigation of a mediate effects model. Child Development, 65, 296318. Floyd, F. & Saitzyk, A. (1992) Social class and parenting children with mild and moderate mental retardation. Journal of Pediatric Psychology, 17, 607631. Friedrich, W., Wilturner, L. & Cohen, D. (1985) Coping resources and parenting mentally retarded children. American Journal of Mental Deciency, 90, 130139. Gajraj, A., Faria, A. & Dickinson, J. (1990) A comparison of the effect of promised and provided lotteries, monetary and gift incentives on mail survey response rate, speed and cost. Journal of the Market Research Society, 32, 141162. Ghazvini, A. & Mullis, R. (2002) Centre-based care for young children: examining predictors of quality. Journal of Genetic Psychology, 163, 112125.

Haldy, M. & Hanzlik, J. (1990) A comparison of perceived competence in child-rearing between mothers of children with Down syndrome and mothers of children without delays. Education and Training in Mental Retardation, 25, 12141. Hassall, R., Rose, J. & McDonald, J. (2005) Parenting stress in mothers of children with an intellectual disability: the effects of parental cognitions in relation to child characteristics and family support. Journal of Intellectual Disability Research, 4, 405418. Hastings, R. & Beck, A. (2004) Practitioner review: stress intervention for parents of children with intellectual disabilities. Journal of Child Psychology and Psychiatry, 45, 13381349. Hauser-Cram, P., Wareld, M., Shonkoff, J. & Krauss, M. (2001) Children with disabilities: a longitudinal study of child development and parent well-being. Monographs of the Society for Research in Child Development, 66(3), Serial No. 266. Hill, R. (1958) Generic features of families under stress. Social Casework, 49, 139150. Macias, M., Saylor, C., Rowe, B. & Bell, N. (2004) Agerelated parenting stress differences in mothers of children with spina bida. Psychological Reports, 93, 12231232. Mauro, C. & Harris, Y. (2000) The inuence of maternal child-rearing attitudes and teaching behaviours on preschoolers delay of gratication. Journal of Genetic Psychology, 161, 292306. McCubbin, H., Cauble, A. & Patterson, J. (1982) Family Stress, Coping and Social Support. Charles C Thomas, Springeld, IL, USA. McCubbin, H. & Patterson, J. (1983) Family stress and adaptation to crisis: a double ABCX model of family behaviour. In: Family Studies Review Yearbook (eds D. Olsen & B. Miller), pp. 88106. Sage, Beverly Hills, CA, USA. Miller, A., Cate, I. & Johann-Murphy, M. (2001) When chronic disability meets acute stress: psychological and functional changes. Developmental Medicine and Child Neurology, 43, 214216. Mischel, W. (1974) Processes in delay of gratication. In: Advances in Experimental Social Psychology (ed. L. Berkowitz), pp. 249292. Academic Press, San Diego, CA, USA. OConnor, T. (2002) Annotation: the effects of parenting reconsidered: ndings, challeges, and applications. Journal of Child Psychology and Psychiatry, 43, 555572. Pettit, G., Bates, J. & Dodge, K. (1997) Supportive parenting, ecological context, and childrens adjustment: a seven year longitudinal study. Child Development, 68, 908923. Reitman, D., Currier, R. & Stickle, T. (2002) A critical evaluation of the Parenting Stress Index-Short Form

2006 Blackwell Publishing Ltd, Child: Care, Health & Development, 32, 2, 177184

184

L. Woolfson and E. Grant

(PSI-SF) in a Head Start population. Journal of Clinical Child and Adolescent Psychology, 31, 384392. Reitman, D. & Gross, A. (1997) The relation of maternal child-rearing attitudes to delay of gratication among boys. Child Study Journal, 27, 279300. Rickel, A. & Biasatti, L. (1982) Modication of the Block Child Rearing Practices Report. Journal of Clinical Psychology, 38, 129134. Risdal, D. & Singer, G. (2004) Marital adjustment in parents of children with disabilities: a historical review and meta-analysis. Research and Practice in Persons with Severe Disabilities, 29, 95103. Roberts, K. & Lawton, D. (2000) Acknowledging the extra care parents give their disabled children. Child: Care, Health and Development, 27, 307319. Sanders, J. & Morgan, S. (1997) Family stress and adjustment as perceived by parents of children with autism or Down syndrome: implications for intervention. Child and Family Behaviour Therapy, 19, 1532. Smith, T., Oliver, M. & Innocenti, M. (2001) Parenting stress in families of children with disabilities. American Journal of Orthopsychiatry, 71, 257261. Steinberg, L., Lamborn, S., Darling, N., Mounts, N. & Dombusch, S. (1994) Over-time changes in adjustment and competence among adolescents from authoritative, authoritarian, indulgent and neglectful families. Child Development, 65, 754770. Steinberg, L., Lamborn, S., Dombusch, S. & Darling, N. (1992) Impact of parenting practices on adolescent

achievement: authoritative parenting, school involvement and encouragement to succeed. Child Development, 63, 12661281. Sundrum, R., Logan, S., Wallace, A. & Spencer, N. (2005) Cerebral palsy and socio-economic status: a retrospective cohort study. Archives of Disease in Childhood, 90, 1518. Thompson, M., Raynor, A., Cornah, D., Stevenson, J. & Sonuga-Barke, E. (2002) Parenting behaviour described by mothers in a general population sample. Child: Care, Health and Development, 28, 149155. Vinden, P. (2001) A comparison of Korean American and Anglo-American families. Cognitive Development, 16, 793809. Vrijheid, M., Dolk, H., Stone, D., Alberman, E. & Scott, J. (2000) Socioeconomic inequalities in risk of congenital anomaly. Archives of Disease in Childhood, 82, 349352. Woolfson, L. (1999) Educational interventions for infants and preschool children with cerebral palsy: methodological difculties and future directions in evaluation research. European Journal of Special Needs Education, 14, 240253. Woolfson, L. (2004) Family wellbeing and disabled children: a psychosocial model of disability-related child behaviour problems. British Journal of Health Psychology, 9, 113. Zirpoli, T. & Bell, R. (1987) Unresponsiveness in children with severe disabilities: potential effects on parentchild interactions. Exceptional Child, 34, 3140.

2006 Blackwell Publishing Ltd, Child: Care, Health & Development, 32, 2, 177184