maternal empathy, self-confidence, and stress as antecedents of preschool children's behavior...

JSPN Vol. 12, No. 2, April, 2007 93

Accepted for publication August 14, 2006

Blackwell Publishing IncMalden, USAJSPNJournal for Specialists in Pediatric Nursing1539-0136© 2007 Blackwell Publishing Ltd.122

ORIGINAL ARTICLE

Maternal Empathy, Self-Confidence, and Stress as Antecedents of Preschool Children’s Behavior Problems


Lorraine O. Walker and Ching-Yu Cheng

PURPOSE.

To test psychosocial antecedents

(maternal stress, self-confidence, and empathy) of

preschoolers’ behavior problems.

DESIGN AND METHODS.

One hundred and

twenty-two postpartum mothers completed a 24-

month longitudinal mail survey. A structural

equation model that included empathy was tested.

RESULTS.

Stress, but not maternal self-confidence

or empathy, was directly related to child behavior

problems (

t

= 1.98,

p

= .05). Maternal empathy in

combination with self-confidence or stress,

however, moderated adverse effects on behavior

problems (

p

= .03). Predictors explained 16% of

variance of behavior problems.

PRACTICE IMPLICATIONS.

Empathy was protective

when stress was high. Empathy training may

enhance high-risk parent education.

Search terms:

Child behavior disorders,

confidence, empathy, maternal behavior,

nursing practice, stress

Lorraine O. Walker, EdD, RN, FAAN, is a Professor, and Ching-Yu Cheng, PhD, RN, is a Research Associate, School of Nursing, The University of Texas at Austin.

Accepted for publication August 14, 2006

A

t its simplest, empathy is defined as resonatingwith what another is feeling and seeing things fromhis or her point of view (Gordon, 2003). The capacity formothers or other caregivers to be empathic may beparticularly important with young children who lackthe maturity and power to advocate for themselves,especially during times of family stress. In this study,we propose and test an integrative framework thatcombines the concept of empathy with those of maternalself-confidence and stress in understanding antecedentsof behavior problems in young children.

Conceptual Framework

The research literature shows that demographicfactors, which are inherently unchangeable, such asmaternal age at childbearing (e.g., Nagin & Tremblay,2001), and risk factors, such as maternal stress, areassociated with later problem behaviors (Aguilar,Sroufe, Egeland, & Carlson, 2000; Sourander et al., 2006).Rarely have protective psychosocial factors, such asmaternal empathy, that may moderate or alter riskfactors associated with children’s behavior problemsbeen examined. Thus, we proposed an integrativeframework in which maternal empathy, along withmaternal self-confidence and stress, serve as protectiveor risk factors for behavior problems in young children.

Maternal Empathy

Maternal empathy is a central concept in theory ofmaternal role development. It has been described byRubin (1984) as the “special empathy of mother withchild that is characteristic of maternal identity” (p. 9).Maternal empathy may help a mother to maintain abeneficent orientation and sensitivity to the child (Dix,

Note to Readers: Research on empathy spans a period of over 30years. Several key writings and studies occurred in the 1980s.These classic references are included in this manuscript toaccurately reflect the science. The same is true of foundationalresearch on children’s behavior problem measurement and maternalrole research. Thus, references in the paper span 1981–2006.

94 JSPN Vol. 12, No. 2, April, 2007


1992) and reduce aggression directed at the child(Letourneau, 1981). Maternal empathy also maymoderate the effect that competing demands andtensions have upon the mother–child relationship. Giventhe potential importance of maternal empathy, it islikely to be related to important maternal variables,such as maternal self-confidence and maternal stress,and later preschool child behavior outcomes.

Maternal Self-Confidence

Maternal self-confidence reflects a mother’sappraisal of her mastery of the maternal role and growswith experience in the mothering role (Walker, Crain,& Thompson, 1986). Developing maternal self-confidence is one of the defining aspects of negotiatingthe transition to motherhood (Mercer, 1981; Rubleet al., 1990) and is shown in confidence in caregivingskills and the broader responsibilities associatedwith being a mother. As a result, enhancing maternalself-confidence is an aim of programs to ease thetransition to motherhood (Hanna, Edgecombe, Jack-son, & Newman, 2002) and an outcome of programsor interventions targeting mothers of young children(e.g., Morawska & Sanders, 2006). Like maternalempathy, maternal self-confidence is proposed tohave a positive influence on the maternal–childrelationship and behavioral development of youngchildren.

Stress

In contrast, stress from external events or challengesin daily living may erode women’s perceived capabilitiesas mothers (Walker, 1989) and their internal resources.Consequently, maternal stress may spill over to care-giving (e.g., reducing maternal sensitivity) and placechildren at risk for problem behaviors (Aguilar et al.,2000; Sourander et al., 2006). Thus, maternal empathy,self-confidence, and stress may each affect youngchildren’s behavior problems, an important indicatorof early socio-emotional development.

Background

Cognitive and Affective Aspects of Empathy

Empathy is a construct with a long historical traditionbut diverse perspectives (Davis, 1996; Eisenberg &Strayer, 1987; Goldberg & Michaels, 1985; Hoffman,2000). Some of these have emphasized the cognitiveaspect of empathy (i.e., taking the perspective of anotherwho is typically experiencing some form of distress);others have emphasized its affective aspects (Davis,1996). The cognitive aspect fosters understanding asituation or mishap from the unfortunate’s point ofview, thereby facilitating a response that is congruentwith another’s situation rather than one’s own. Twodistinct affective aspects of empathy have been isolatedin studies of empathy-mediated helping: empa-thic concern and personal distress (Batson, Fultz, &Schoenrade, 1987). Responding with empathic concernto another’s plight involves having either a similaremotion or one congruent with the other’s situation (suchas sympathy or tenderness) (Davis, 1996). By contrast,responding to the distress of another with self-focusedemotions (such as anxiety or fear) may interfere withthe ability or desire to offer aid and comfort.

Because parenting is complex, parents are likely todraw on cognitive and affective aspects of empathy(Feshbach, 1987). Because nurturant parenting requiresthat parents be motivated to do what promotes thechild’s growth and comfort, an emotional response ofhigh empathic concern may promote such parenting.Thus, Rubin (1984) asserts: “It is empathy, not instinct,that makes a mother respond to a child in pain” (p. 75).By contrast, if the empathic experience leads to excessivearousal of self-focused emotions (i.e., personal distress),parental behavior is likely to be directed at egoisticgoals rather than altruistic ones (Batson et al., 1987)aimed at benefiting the child. Consequently, experienc-ing high perspective taking, high empathic concern, andlow personal distress is most likely to lead to child-centered parental responses and more favorable childmental health. Except for the pioneering research of


Feshbach, few studies have examined the relationshipbetween maternal empathy and children’s behaviorproblems. In her research, Feshbach reported thatmaternal empathy was related negatively to behaviorproblems in school-age children.

Maternal Self-Confidence

As a well-established indicator of mastery of thematernal role, maternal self-confidence is a contentfocus of programs to ease the transition to motherhood(Hanna et al., 2002) and an outcome in parentingprograms (e.g., Morawska & Sanders, 2006). Despitethe importance of maternal self-confidence in maternalrole development, to our knowledge no studies haveexamined its relation to later maternal empathy. Oneof the few studies of the relationship of early maternalself-confidence to later behavior outcomes of childrenfound no significant relationships (Walker &Montgomery, 1994). Still, whether effects of maternalself-confidence may be mediated (transmitted) ormoderated by (interact with) maternal empathy in regardto young children’s behavior problems is unstudiedand warrants consideration to better understand theformative aspects of the mother–child relationship.

Stress

Stress from life events or other demands experiencedby mothers of young children are frequent antecedentsof children’s behavior problems (Barry, Dunlap,Cotten, Lochman, & Wells, 2005; Calzada, Eyberg,Rich, & Querido, 2004). Letourneau (1981), writing inthe field of child abuse prevention, was among thefirst to propose that maternal empathy might interactwith stress to lessen the harmful effects of stress inchildren’s lives. Specifically, the configurations ofhigh stress and low empathy vs. low stress and highempathy were hypothesized to have markedly differingoutcomes. Although Letourneau’s study results wereinconclusive because of sampling issues and smallsample size, it provides a template for testing more

complex psychosocial relationships (such as protectiveinteractions) between empathy, stress, and children’sbehavior problems. To our knowledge, such protectiveinteractions have not been tested in relation topreschool children’s behavior problems.

Behavior Problems in Young Children

Two broad classes of behavior problems, externalizingand internalizing (Cicchetti & Toth, 1991), occur fromearly childhood to adolescence and are the basis forassessment measures such as the Child BehaviorChecklist (Achenbach, Edelbrock, & Howell, 1987).Understanding behavior problems during earlychildhood is important because of accumulating evidencethat certain externalizing problem behaviors, such asaggression, may start in late infancy and persist tolater developmental periods. Long-term continuity inchildren’s aggressive behavior, especially among boys,has been found in studies spanning the toddler toschool-age periods (Shaw, Gilliom, Ingoldsby, & Nagin,2003) and from preschool to adolescence (Broidy et al.,2003). It is noteworthy that Tremblay et al. (2004) reportedthat 14% of young children follow a trajectory of highand increasing aggression between 17 and 42 months,although a smaller study during this early periodshowed less clear-cut findings for boys than girls (Hay,Castle, & Davies, 2000). Although internalizing behaviorproblems, such as social withdrawal and depression,have demonstrated less continuity across time (Souranderet al., 2006), they remain important to the mentalhealth of children (Cicchetti & Toth).

Purpose

In this study, our focus was to test potentiallymodifiable psychosocial factors that may be antecedentsof preschool children’s behavior problems. We addressedthe following two hypotheses. First, maternal empathymediates the relationship between maternal self-confidence and child behavior problems. Second, whenstress is high, empathy moderates the relationship



between stress and child behavior problems. Inaddition, we explored whether maternal empathy andmaternal self-confidence interact as antecedents ofchild behavior problems.

Method

Design and Procedures

This study was a secondary analysis. Data for thisstudy were derived from a 3-time-point, 24-monthlongitudinal mail survey of mothers of infants. Surveyquestionnaires were sent to mothers whose namesappeared in birth announcements in a Midwesternnewspaper. At the first data collection point, motherswere recruited as two cohorts: Cohort 1 includedmothers of 12-month-old infants, and cohort 2contained mothers of 6-month-old infants. The secondand third data collection points occurred at 12 or 18months, and 30 or 36 months, respectively. This designhad the advantage of covering a wider span of earlydevelopment. Particularly at the third data collectionpoint, however, age differences between the cohortsbecame less distinct because questionnaires werereturned in varying lengths of time after being mailed.Each time point of data collection was reviewed andapproved for protection of human subjects.

This current study encompasses demographic dataand measures of maternal self-confidence and stresscollected at the first data collection point, maternalempathy at the second data collection point, and achild behavior assessment (Child Behavior Checklistfor ages 2–3 years) completed by mothers at the thirddata collection point. Findings from this sample havebeen previously published relating to the relationshipsof maternal health-promoting behaviors and maternalidentity to child behavior problems (Preski & Walker,1997). These findings indicated that maternal healthbehaviors and maternal age, but not maternal identity,made a small independent contribution in predictingchild behavior problems. The current study presentsfindings pertaining to previously unexamined

relationships and emphasizes proximal psychosocialinfluences on child behavior problems that may bemodifiable (i.e., maternal self-confidence, maternalempathy, and stress). In the current study, the analysisis enriched by testing for hypothesized moderatoreffects associated with maternal empathy.

Sample

In the first data collection point, 228 of 400 mothersreturned usable questionnaires. Subsequently, in thesecond and third data collection points, 157 and 129mothers, respectively, responded. Of these, 122provided usable reports of their children’s behaviorproblems. Of these 122 mothers, 99% were marriedand were white. Most of them (68%) had a collegeeducation, and 48% of them were employed. All motherswere under 40 years old with a mean age of 28.8 years(

SD

= 4.54). About 40% of mothers had only one child,and their mean parity was 1.90 (

SD

= .96). For morethan half (58%), the youngest child (focus of thesurvey) was a boy

.

No differences were found on most variables, suchas number of children, infant sex, employment status,or family income, between mothers who completed allthree surveys and those who either did not respond orwere unreachable after the first survey (Preski & Walker,1997). However, mothers who dropped out of thestudy were younger and had less education than thosewho completed all three data collection points in thestudy.

Instruments

The Stress Scale, comprised of 27 items and oneopen-ended item, was used to measure situationalstressors being experienced by mothers of youngchildren. The Stress Scale items were derived from anearlier content analysis of sources of stress reported bymothers of infants (Walker & Best, 1991). Its validity issupported by a significant correlation (

r

= .63,

N

= 121)in this study sample with the well-established Perceived


Stress Scale (Cohen, Kamarck, & Mermelstein, 1983).The Stress Scale has the benefit of being customized tothe context of mothers of young children. The Cronbachalpha for the Stress Scale (27 items) was .87 in this study.A high score indicates a high level of maternal stress.

Maternal self-confidence was measured by the 24-item Lips Maternal Self-Confidence Scale (Bloom & Lips,1988). The scale lists brief statements about women’sperceptions of themselves as mothers. The Lips Scalehas been used in other studies of parenting (e.g., Walker,Walker, & Walker, 1994). The scale has a reportedCronbach alpha of .88–.91 and a test–retest reliabilityof .88 (Bloom & Lips). Its validity is supported by asignificant association with child care experience (Bloom& Lips) and a significant correlation (

r

= .59) with ameasure of maternal identity in the present studysample. The Cronbach alpha of the Lips Scale was .87in this study. A high score indicates high maternalself-confidence.

Mothers’ empathy was measured by the 21-itemMaternal Empathy Scale (MES) developed for thisstudy. The MES uses a 5-point response format to measurethree of four components (personal distress, empathicconcern, and perspective taking) of empathy identifiedby Davis (1983). These three aspects reflect, respectively,cognitive aspects of empathy, emotional concern foranother’s distress, and concern with one’s own distress.To reflect the overall construct of empathy within thecontext of a structural equation model with multiplepaths (including interactions), we used a total compositeempathy score based on 17 of the 21 MES items. (Oneitem was omitted because of a printing error, andthree others were deleted because of low item–totalcorrelations with the composite score.) Coefficientalpha for the 17 item MES composite was .67. Constructvalidity of the composite MES score is supported byits significant and moderate correlation (

r

= .30,

N

=118) with a concurrent maternal rating of infantattachment security in the study sample. In this study,the MES items were coded so that a high compositescore reflected a combination of high perspectivetaking, high empathic concern, and low personal distress.

The Child Behavior Checklist for Ages 2–3 (CBCL/2–3) is a two-page questionnaire to measure parents’ratings of children ages 2–3 (Achenbach et al., 1987). Itcontains 99 structured items as well as several open-ended questions. Parents respond on a 3-point scale ofnot true (0) to often true (2). Subscales for behavioralsyndromes are based on factor analysis of CBCL/2–3items rated on 398 2- to 3-year-old children fromclinical and nonclinical samples (Achenbach et al.).The scale was normed on 273 respondents from thegeneral population. The scale has sound reliability andvalidity (Achenbach et al.; Crawford & Lee, 1991).Analyses reported here aggregated CBCL data asnormed

T

-scores for the broadband factors of externalizingand internalizing behavior problems. CBCL formswere scored by computer software from the checklistdeveloper.

Data Analysis

Means and standard deviations were computedfor study variables. Pearson correlations were used toexamine relationships among variables and to assessif the resulting correlations were consistent with theconditions required (Bennett, 2000) to test whethermaternal empathy mediated the relationship betweenmaternal self-confidence and child behavior problems.

Structural equation modeling (SEM) can be used to testinferentially a hypothesized model that incorporatedobserved and latent variables (unobserved variablesmeasured by multiple indicators), taking into accountmeasurement error (Byrne, 2001; Raykov & Marcoulides,2000). Because of these properties, SEM was used inthis study. The initial model was specified based onreview of literature and research hypotheses. Thelatent variable was child behavior problems, whichconsisted of internalizing and externalizing childbehaviors. Maternal stress and self-confidence measuredat the first data collection point were hypothesized aspredictors of child behavior problems measured at thethird data collection point, while maternal empathymeasured at the second data collection point was the



moderator. Two moderating terms used in the modelwere stress

×

empathy and self-confidence

×

empathy.The variable of child’s sex was controlled statisticallyby including it in the model. The hypothesized model(see Figure 1) was tested with

amos

5.0, a softwarepackage for SEM (Arbuckle, 2003).

All tested variables, except for the child’s sex, wereconsidered as continuous data. The only two missingvalues, one in maternal stress and the other in mater-nal self-confidence, were replaced with correspondingvariable means. Stress, self-confidence, and empathywere considered normally distributed based on skew-ness being within

−

1 and +1. All predicted variableswere centered to avoid multicollinearity (Cohen, Cohen,West, & Aiken, 2003).

There were 35 parameters and 36 distinct samplemoments that included regression weights, variances,and covariances in the model. Of the 35 parameters, 4were fixed, and 31 were free parameters that neededto be estimated. The sample to indicator ratio was 15.3in this study. The four fixed parameters were threeerror terms associated with endogenous variables and

with one of the latent variable indicators, internal-izing behaviors. The degrees of freedom for the modelwere 5.

There is no consensus on how large of a sample sizeis needed for testing a structural equation model thatincludes one latent variable as its outcome (e.g., childbehaviors in Figure 1). According to Tanaka (1987), totest a model with a latent variable and 4 measuredindicators, a sample size as small as 50 might besufficient. Olsson, Foss, Troye, and Howell (2000)recommended using both maximum likelihood (ML),which is more stable and accurate, and generalizedleast squares (GLS), which has a better estimation withsmall sample sizes, to estimate parameters in the model.On the other hand, in addition to the chi-square statistic,Fan, Thompson, and Wang (1999) recommended thatmodel fit be evaluated with the comparative fit index(CFI), non-normed fit index (NNFI), and root meansquare error of approximation (RMSEA) index becausethese indexes are less sensitive to variations in samplesizes. Thus, multiple indexes were used to evaluateparameter estimates and model fit in this study.

Figure 1. Psychosocial Model of Child Behavior Problems, Including Maternal Empathy, Stress, and Self-Confidence. Standardized Coefficients Were Shown in the Diagram


Results

Table 1 presents the means, standard deviations,and correlation coefficients of observed variables. Childbehavior problems did not differ by child’s sex (

t

(120) =–.363,

p

= .72 (two-tailed),

d

= .07 for internalizingbehaviors and

t

(120) = –.156,

p

= .88 (two-tailed),

d

= .03 for externalizing behaviors). The level of stresswas negatively correlated with maternal self-confidence(

r

(122) = –.52,

p

< .001) but positively correlated withchild behavior problems (

r

(122) = .20,

p

= .03 for inter-nalizing and

r

(122) = .25,

p

= .01 for externalizingbehaviors). Maternal self-confidence was positivelycorrelated with maternal empathy (

r

(122) = .34,

p

< .001)but was not significantly correlated with child behaviorproblems. Since the latter relationship must be significant(Bennett, 2000) to pursue meaningful tests of themediating effects of empathy between maternal self-confidence and child behavior problems, further testingof mediating effects was abandoned.

Standardized path coefficients of the model testedby ML estimation are shown in Figure 1, and theunstandardized estimates are shown in Table 2. Thechi-square statistic (

χ

2

(5,

N

= 122) = 1.21,

p

= .94), CFI(= 1.00), NNFI (= 1.14), and RMSEA (< .001) indexesshowed a fit of the model to the data. Among maternalstress, self-confidence, and empathy, only maternalstress had direct effects on child behavior problems(standardized path coefficient = .23,

p

= .05). Both

moderating terms, stress

×

empathy and self-confidence

×

empathy, were significant predictors of child behaviorproblems (standardized path coefficients = –.25 and–.23,

p

= .03 and .03, respectively). A total of 16% ofthe variance in child behavior problems was explainedby variables in the model. The parameter estimationresults were the same using GLS: maternal stressand the two interaction terms accounted for 16% ofthe variance of child behavior problems with the samepath coefficients as in ML estimation. The chi-squarestatistic (

χ

2

(5,

N

= 122) = 1.19,

p

= .95), CFI (= 1.00),NNFI (= 1.27), and RMSEA (< .001) indexes showed afit of the model to the data.

The model fit was also tested with nested modelsby fixing one parameter to 0 (Raykov & Marcoulides,

Table 1. Pearson Correlation Between Observed Variables

Stress Self-confidence

Empathy Internalizing behaviors

Externalizing behaviors

Stress 44.92 ± 15.29Self-confidence –.52** 115.79 ± 12.60Empathy –.06 .34** 46.43 ± 6.52Internalizing behaviors .20* –.11 –.13 49.49 ± 9.61Externalizing behaviors .25** –.15 –.14 .65** 50.33 ± 9.27

Note. Variable means and standard deviations were presented on the diagonal.*p < .05, **p < .001.

Table 2. Unstandardized Path Coefficients of Variables in the Model of Child Behavior Problems

Variables Path coefficient t p

Child sex –.26 −0.22 .83Stress .10 1.98 .05Self-confidence –.01 −0.26 .79Empathy –.09 −0.92 .36Self-confidence × empathy –.02 −2.14 .03Stress × empathy –.02 −2.17 .03R2 .16

Note. Fit indexes: χ2 = 1.21, df = 5, p = .94; CFI = 1.00, NFI = .99, RMSEA < .001.

100 JSPN Vol. 12, No. 2, April, 2007


2000). This permitted paths to be tested individuallyfor their contribution to the overall model. The chi-squarevalues for the differences between the hypothesizedfull model and nested models are listed in Table 3.Results showed that when setting the parameters ofstress, stress

×

empathy, and self-confidence

×

empathyto 0, the changes of chi-square values for the modelwere significant. These results support the fit of thehypothesized full model.

To better interpret the moderating influencesassociated with maternal empathy found in the structuralequation modeling, scores on maternal stress, self-confidence, and maternal empathy were dichotomizedat their medians to form groups of mothers scoringhigh and low on each of these variables. Figure 2shows children’s behavior problem scores (as

z

-scores)for the four groups that resulted from cross-classifyinghigh and low stress and empathy groups. The CBCL

Table 3. Model Fit of the Initial Model Tested With Nested Models

Variable Model fit indexes Difference from initial model

χ2 df p χ2 df pChild sex = 0 1.25 6 .97 .04 1 >.10Stress = 0 6.13 6 .41 4.92 1 <.05Self-confidence = 0 1.28 6 .97 .07 1 >.10Empathy = 0 2.07 6 .91 .86 1 >.10Self-confidence × empathy = 0 7.22 6 .30 6.01 1 <.05Stress × empathy = 0 7.56 6 .27 6.35 1 <.05

Note. Fit indexes for initial model: χ2 = 1.21, df = 5, p = .94.

Figure 2. Mean Scores of Child Behavior Problems Based on Maternal Empathy and Maternal Stress Category

JSPN Vol. 12, No. 2, April, 2007 101

scores of the children in the high maternal stress-low maternal empathy group showed the most inter-nalizing and externalizing behavior problems, whereasthe remaining three stress-empathy groups all hadmean CBCL scores below the sample

z

-score mean of0. Figure 3 shows children’s behavior problem scoresfor the four groups that resulted from cross-classifyinghigh and low maternal self-confidence and empathygroups. In the high maternal self-confidence groups,children’s behavior problems differed widely based onwhether mothers were high or low in empathy, withthe high confidence-low empathy group having thehighest behavior problems and the high confidence-high empathy group having the least.

Discussion

Maternal Empathy, Stress, and Self-confidence as Predictors of Behavior Problems

Our focus in this study was to test a model of theproximal psychosocial factors—especially the protective

effects of maternal empathy—that might be associatedwith preschool children’s behavior problems. Findingsdid not support hypothesis one because the necessaryrelationship between maternal self-confidence andchild behavior problems was not significant. The modeltesting showed that maternal stress directly and positivelypredicted child behavior problems. Furthermore,maternal empathy was a moderator of the relationshipof maternal stress to child behavior problems (hypothesistwo), and also a moderator of the relationship betweenmaternal self-confidence and child behavior problems(exploratory question).

Stress as a predictor of child behavior problemshas been found in earlier research (Aguilar et al., 2000;Barry et al., 2005; Calzada et al., 2004). Contrary to thefindings of Feshbach (1987), who measured empathyand behavior problems concurrently, in this study,empathy was not directly related to child behaviorproblems measured 18 months later. Maternal empathyin combination with stress or maternal self-confidence,however, was a significant predictor of child behaviorproblems. The most behavior problems occurred when

Figure 3. Mean Scores of Child Behavior Problems Based on Maternal Empathy and Maternal Self-Confidence Category

102 JSPN Vol. 12, No. 2, April, 2007


maternal empathy was low and stress was high orempathy was low and maternal self-confidence washigh. The combination of low empathy and high stressbeing associated with the most behavior problems isin line with the proposal set forth previously byLetourneau (1981) in the field of child abuse. Wespeculate that the combination of low empathy andhigh stress may limit a mother’s capabilities to providenurturant parenting, which in turn increases thelikelihood of child aggression and other behaviorproblems.

The finding that the combination of low maternalempathy and high maternal confidence was associatedwith higher behavior problems supports the idea thatconfidence in the maternal role needs to be temperedby an emotional and cognitive openness to the child’sexperience. That is, maternal self-confidence is associatedwith the least behavior problems when mothers’confidence in the maternal role and their empathicresponse to their children are both high.

Whether viewed within the context of high stress ormaternal self-confidence, the findings of this studygive some support to the protective effects of maternalempathy in regard to young children’s behavior andmental health. Although on reflection our findingsmay seem intuitive, they provide a potential evidencebase for strengthening the content and relevance ofparent education programs. For example, the NurturingCurriculum in the Parenting Project for Teen Mothersis one example of a program that has as one of itscomponents building “empathic understanding of chil-dren’s needs” (Woods et al., 2003) and that measuresmaternal empathy as one of its outcomes. An empathy-building component may be especially important inprograms for parents who are under high stress.

Strengths and Limitations

The key strength of this study is its longitudinaldesign. The temporal sequence of data collection permittedus to measure psychosocial predictors of child beha-vior problems prior to measuring child outcomes and

thus avoided the ambiguity of the direction of influencefound in cross-sectional (“one-shot”) studies. Limita-tions of the study include a small sample size thatlimited the number of background variables we couldinclude in the statistical modeling; the fact that alldata were derived from one source, maternal report; apossible sample bias related to attrition of youngermothers and those with less education; and the ethnichomogeneity of the sample. Although relatively newmeasures of stress and empathy were used, each wastailored to the context of early parenting and had sup-porting validity evidence. Repeated measures of thesetwo variables and self-confidence, although not done inthis study, would have enabled us to determine if theychanged over time. In view of these limitations, findingsof this study must be viewed as preliminary. Furthertesting in larger samples, with more diverse participants,and with multiple data sources are warranted.

How Do I Apply This Information to Nursing Practice?

Keeping in mind its limitations indicated above,this study contributes to increasing the relevance ofeducational and supportive programs for parents ofyoung children, especially among parents under highstress. In such situations, the study findings providesupport for including a component aimed at buildingparental empathy in parenting programs. An exampleof such programs is the Nurturing Curriculum (Woodset al., 2003). Because empathy may sometimes be easier“caught than taught,” in parent–nurse interactionsnurses may find role modeling of empathic emotionalresponses and expressing child-oriented perspectivesto be helpful to parents under stress. Explaining howa child’s developmental level affects how he or sheviews the world and responds to it is another toolnurses may use to begin to foster parental empathy.

Acknowledgment.

The authors wish to acknowledgethe contributions of the following to this study:

JSPN Vol. 12, No. 2, April, 2007 103

Eileen Fowles, Sally Preski, Mary Ann Zellelmeier,Teresa Dobrzykowski, Mary Olszewski, Misha Vaughan,Sofia Martinez, Lee Wayman, and Ellen Montgomery.This study was supported in part by the Luci B.Johnson Centennial Professorship in Nursing atthe University of Texas at Austin.

Author contact: [email protected], with a copy to the Editor: [email protected]

References

Achenbach, T. M., Edelbrock, C., & Howell, C. T. (1987). Empiricallybased assessment of the behavioral/emotional problems of2- and 3-year-old children.

Journal of Abnormal Child Psychology

,

15

, 629–650.Aguilar, B., Sroufe, L. A., Egeland, B., & Carlson, E. (2000). Distin-

guishing the early-onset/persistent and adolescence-onsetantisocial behavior types: From birth to 16 years.

Development andPsychopathology

,

12, 109–132.Arbuckle, J. L. (2003). amos (Version 5.0.1.) [Computer software].

Spring House, PA: Amos Development Corporation.Barry, T. D., Dunlap, S. T., Cotten, S. J., Lochman, J. E., & Wells, K.

C. (2005). The influence of maternal stress and distress ondisruptive behavior problems in boys. Journal of the AmericanAcademy of Child and Adolescent Psychiatry, 44, 265–273.

Batson, C. D., Fultz, J., & Schoenrade, P. A. (1987). Distress andempathy: Two qualitatively distinct vicarious emotions withdifferent motivational consequences. Journal of Personality, 55, 19–39.

Bennett, J. A. (2000). Mediator and moderator variables in nursingresearch: Conceptual and statistical differences. Research inNursing and Health, 23, 415–420.

Bloom, K., & Lips, H. M. (1988, April). New scale of maternal self-confidence. Poster session presented at the InternationalConference on Infant Studies, Washington, DC.

Broidy, L. M., Nagin, D. S., Tremblay, R. E., Bates, J. E., Brame,B., Dodge, K. A., et al. (2003). Developmental trajectories ofchildhood disruptive behaviors and adolescent delinquency:A six-site, cross-national study. Developmental Psychology, 39, 222–245.

Byrne, B. M. (2001). Structural equation modeling with AMOS: Basicconcepts, applications, and programming. Mahwah, NJ: LawrenceErlbaum Associates.

Calzada, E. J., Eyberg, S. M., Rich, B., & Querido, J. G. (2004).Parenting disruptive preschoolers: Experiences of mothers andfathers. Journal of Abnormal Child Psychology, 32, 203–213.

Cicchetti, D., & Toth, S. L. (1991). A developmental perspective oninternalizing and externalizing disorders. In D. Cicchetti & S. L.Toth (Eds.), Internalizing and externalizing expressions of dysfunction:Rochester symposium on developmental psychopathology, Vol. 2,(pp. 1–19). Hillsdale, NJ: Lawrence Erlbaum Associates.

Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Appliedmultiple regression/correlation analysis for the behavioral sciences(3rd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.

Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measureof perceived stress. Journal of Health and Social Behavior, 24, 385–396.

Crawford, L., & Lee, S. W. (1991). Test–retest reliability of the ChildBehavior Checklist Ages 2–3. Psychological Reports, 69, 496–498.

Davis, M. H. (1983). Measuring individual differences in empathy:Evidence for a multidimensional approach. Journal of Personalityand Social Psychology, 44, 113–126.

Davis, M. H. (1996). Empathy: A social psychological approach. Boulder,CO: Westview Press.

Dix, T. (1992). Parenting on behalf of the child: Empathic goals inthe regulation of responsive parenting. In I. E. Sigel, A. V.,McGillicuddy-DeLisi, & J. J. Goodnow (Eds.), Parental belief systems:The psychological consequences for children (2nd ed.) (pp. 319–346).Hillsdale, NJ: Lawrence Erlbaum Associates.

Eisenberg, N., & Strayer, J. (1987). Empathy and its development. NewYork: Cambridge University Press.

Fan, X., Thompson, B., & Wang, L. (1999). Effects of sample size,estimation methods, and model specification on structuralequation modeling fit indexes. Structural Equation Modeling, 6,56–83.

Feshbach, N. D. (1987). Parental empathy and child adjustment/maladjustment. In N. Eisenberg & J. Strayer (Eds.), Empathy andits development (pp. 271–291). New York: Cambridge UniversityPress.

Goldberg, A. P., & Michaels, G. Y. (1985). Empathy: Development,training, and consequences. Hillsdale, NJ: Lawrence ErlbaumAssociates.

Gordon, M. (2003). Roots of empathy: Responsive parenting, caringsocieties. Keio Journal of Medicine, 52, 236–243.

Hanna, B. A., Edgecombe, G., Jackson, C. A., & Newman, S. (2002).The importance of first-time parent groups for new parents.Nursing and Health Sciences, 4, 209–214.

Hay, D. F., Castle, J., & Davies, L. (2000). Toddlers’ use of forceagainst familiar peers: A precursor of serious aggression? ChildDevelopment, 71, 457–467.

Hoffman, M. L. (2000). Empathy and moral development: Implicationsfor caring and justice. New York: Cambridge University Press.

Letourneau, C. (1981). Empathy and stress: How they affect parentalaggression. Social Work, 26, 383–389.

Mercer, R. T. (1981). A theoretical framework for studying factorsthat impact on the maternal role. Nursing Research, 30, 73–77.

Morawska, A., & Sanders, M. R. (2006). Self-administered behavi-oural family intervention for parents of toddlers: Effectivenessand dissemination. Behaviour Research and Therapy, 74, 10–19.

Nagin, D. S., & Tremblay, R. E. (2001). Parental and early childhoodpredictors of persistent physical aggression in boys fromkindergarten to high school. Archives of General Psychiatry, 58,389–394.

Olsson, U. H., Foss, T., Troye, S. V., & Howell, R. D. (2000). Theperformance of ML, GLS, and WLS estimation in structuralequation modeling under conditions of misspecification andnonnormality. Structural Equation Modeling, 7, 557–595.

104 JSPN Vol. 12, No. 2, April, 2007


Preski, S., & Walker, L. O. (1997). Contributions of maternal identityand lifestyle to young children’s adjustment. Research in Nursingand Health, 20, 107–117.

Raykov, T., & Marcoulides, G. A. (2000). A first course in structuralequation modeling. Mahwah, NJ: Lawrence Erlbaum Associates.

Rubin, R. (1984). Maternal identity and the maternal experience. NewYork: Springer.

Ruble, D. N., Brooks-Gunn, J., Fleming, A. S., Fitzmaurice, G.,Stangor, C., & Deutsch, F. (1990). Transition to motherhood andthe self: Measurement, stability, and change. Journal of Personalityand Social Psychology, 58, 450–463.

Shaw, D. S., Gilliom, M., Ingoldsby, E. M., & Nagin, D. S. (2003). Tra-jectories leading to school-age conduct problems. DevelopmentalPsychology, 39, 189–200.

Sourander, A., Pihlakoski, L., Aromaa, M., Rautava, P., Helenius, H.,& Sillanpaa, M. (2006). Early predictors of parent- and self-reported perceived global psychological difficulties amongadolescents: A prospective cohort study from age 3 to age 15.Social Psychiatry and Psychiatric Epidemiology, 40, 1–10.

Tanaka, J. S. (1987). “How big is big enough?” Sample size andgoodness of fit in structural equation models with latent vari-ables. Child Development, 58, 134–146.

Tremblay, R. E., Nagin, D. S., Seguin, J. R., Zoccolillo, M.,Zelazo, P. D., Boivin, M., et al. (2004). Physical aggression duringearly childhood: Trajectories and predictors. Pediatrics, 114, e43–e50.

Walker, L. O. (1989). Stress process among mothers of infants:Preliminary model testing. Nursing Research, 38, 10–16.

Walker, L. O., & Best, M. A. (1991). Well-being of mothers withinfant children: A preliminary comparison of employed womenand homemakers. Women and Health, 17(1), 71–89.

Walker, L. O., Crain, H., & Thompson, E. (1986). Maternal roleattainment and identity in the postpartum period: Stability andchange. Nursing Research, 35, 68–71.

Walker, L. O., & Montgomery, E. (1994). Maternal identity and roleattainment: Long-term relations to children’s development.Nursing Research, 43, 105–110.

Walker, L. O., Walker, M. L., & Walker, M. E. (1994). Health andwell-being of childbearing women in rural and urban contexts.Journal of Rural Health, 10, 168–172.

Woods, E. R., Obeidallah-Davis, D., Sherry, M. K., Ettinger, S. L.,Simms, E. U., Dixon, R. R., et al. (2003). The Parenting Project forTeen Mothers: The impact of a Nurturing Curriculum on adoles-cent parenting skills and life hassles. Ambulatory Pediatrics, 3,240–245.

maternal empathy, self-confidence, and stress as antecedents of preschool children's behavior...

Documents