Parents of Children with Parents of Children with Emotional and Behavioral Emotional and Behavioral

Disorders: Stress and School Disorders: Stress and School Service SatisfactionService Satisfaction

Martha Ellen Wynne, Ph.D., Martha Ellen Wynne, Ph.D., Eva Kowalewicz, M.Ed., Kathy Kula, M.Ed., Eva Kowalewicz, M.Ed., Kathy Kula, M.Ed.,

Ruth Schumacher, M.Ed., Mary Satchwell, M.Ed. Ruth Schumacher, M.Ed., Mary Satchwell, M.Ed. & Laura Swanlund, M.Ed.& Laura Swanlund, M.Ed.

Children with EBD and their FamiliesChildren with EBD and their Families At Loyola University, we tend to view problems At Loyola University, we tend to view problems

through a lens of social justice as part of our mission.through a lens of social justice as part of our mission. Fewer than 1% of children are found eligible for Fewer than 1% of children are found eligible for

special education services as a child with an special education services as a child with an emotional or behavioral disability. emotional or behavioral disability. (U.S. Department of (U.S. Department of Education, 2005.)Education, 2005.)

At least 6 to 10% of students in elementary school At least 6 to 10% of students in elementary school have serious and persistent emotional/behavioral have serious and persistent emotional/behavioral problems.problems.

By adolescence, up to 22% of students have mental By adolescence, up to 22% of students have mental health problems serious enough to warrant a DSM health problems serious enough to warrant a DSM diagnosis diagnosis (U.S. Department of Education, 2004) .(U.S. Department of Education, 2004) .

Therefore, appropriately serving children with EBD is Therefore, appropriately serving children with EBD is an issue of social justice because this is such an an issue of social justice because this is such an underserved population. underserved population. 2

Types of Emotional and Behavioral Types of Emotional and Behavioral Disorders (EBD)Disorders (EBD)

School and clinical behavior classification systems School and clinical behavior classification systems operate independentlyoperate independently

It is difficult for parents to navigate multiple It is difficult for parents to navigate multiple systemssystems

Parenting a child with a disability is stressful and Parenting a child with a disability is stressful and interfacing with multiple professionals in schools interfacing with multiple professionals in schools and mental health agencies is also stressfuland mental health agencies is also stressful

Parents are often blamed for their child’s Parents are often blamed for their child’s behaviorsbehaviors

Blaming leads to difficulty in establishing parent-Blaming leads to difficulty in establishing parent-school partnershipsschool partnerships

Positive parent relationships lead to better Positive parent relationships lead to better outcomes for all students (Christenson, 2004) outcomes for all students (Christenson, 2004)

The Present StudyThe Present Study

Little research has investigated the relationships Little research has investigated the relationships among type and severity of student behavior among type and severity of student behavior problems, parental stress, and school services.problems, parental stress, and school services.

Research questions for the current study: Research questions for the current study: How does parent stress vary in relationship to the severity How does parent stress vary in relationship to the severity

of their child’s behavior problems?of their child’s behavior problems? Is there a relationship between the severity of the child’s Is there a relationship between the severity of the child’s

rated EBD problems and the presence or absence of an rated EBD problems and the presence or absence of an IEP?IEP?

Is there a relationship between parent stress and the Is there a relationship between parent stress and the presence or absence of an IEP?presence or absence of an IEP?

How does parent satisfaction with the adequacy of school How does parent satisfaction with the adequacy of school services vary whether or not the child has an IEP?services vary whether or not the child has an IEP?

How does parent satisfaction with the adequacy of school How does parent satisfaction with the adequacy of school services vary in relationship to their degree of reported services vary in relationship to their degree of reported stress?stress?

MethodologyMethodology

ParticipantsParticipants627 parents of children with EBD (ages 3-627 parents of children with EBD (ages 3-

21 )21 )97% female, 92% Caucasian, 65% middle 97% female, 92% Caucasian, 65% middle

class or aboveclass or aboveRecruited from an online support group for Recruited from an online support group for

parents of children with both internalizing parents of children with both internalizing and externalizing behavior problemsand externalizing behavior problems

See Table 1 in the handout for specific See Table 1 in the handout for specific demographic informationdemographic information

MethodologyMethodologyInstrumentsInstruments Online survey instrument included:Online survey instrument included:

Caregiver Strain Questionnaire (CSQ) (Brannan, Caregiver Strain Questionnaire (CSQ) (Brannan, Heflinger, Heflinger, & Bickman, 1997)

Modified version of the Achenbach Child Behavior Modified version of the Achenbach Child Behavior Checklist (Achenbach, 1991)Checklist (Achenbach, 1991)

Sample-specific survey questions addressing Sample-specific survey questions addressing adequacy of educational programmingadequacy of educational programming

Presence or absence of an IEP Presence or absence of an IEP

Three Online survey instrument included:Three Online survey instrument included: behavioral factors used in these analyses:behavioral factors used in these analyses: Externalizing problemsExternalizing problems Internalizing ProblemsInternalizing Problems Learning problems (including attention control/executive Learning problems (including attention control/executive

functioning)functioning)

ResultsResultsParent Rating of StressParent Rating of Stress

Parents were asked to complete the CSQ, which Parents were asked to complete the CSQ, which included rating 20 items on a 5-point scale measuring included rating 20 items on a 5-point scale measuring parent stress related to parenting a child with parent stress related to parenting a child with emotional and behavioral problems.emotional and behavioral problems.

Factor analysis yielded three clear factors: General Factor analysis yielded three clear factors: General Family Stress, Negative Emotional Stress, and Financial Family Stress, Negative Emotional Stress, and Financial Stress. Stress.

Parents reported highest means for General Family Parents reported highest means for General Family Stress, lowest for Financial Stress. Stress, lowest for Financial Stress. General Family Stress Mean = 3.72General Family Stress Mean = 3.72 Negative Emotional Stress Mean = 3.03Negative Emotional Stress Mean = 3.03 Financial Stress Mean = 2.34Financial Stress Mean = 2.34

See Table 2See Table 2

Combined ResultsCombined ResultsParent Rating of StressParent Rating of Stress

Combined Parental Stress Measures:Combined Parental Stress Measures:14% of parents reported low levels of combined stress14% of parents reported low levels of combined stress33% reported moderate levels of stress33% reported moderate levels of stress38% reported high levels of stress38% reported high levels of stress14% reported very high levels of stress14% reported very high levels of stressGrand Mean for combined stress = 3.02Grand Mean for combined stress = 3.02

(See Table 3)(See Table 3) Over half of parents reported high or very high stress in parenting Over half of parents reported high or very high stress in parenting

a child with EBD.a child with EBD.

ResultsResultsRating of Behavior ProblemsRating of Behavior Problems

Parents were asked to rate the severity of their child’s Parents were asked to rate the severity of their child’s behavior problems on 22 items from the Achenbach CBCL behavior problems on 22 items from the Achenbach CBCL using a 6-point scaleusing a 6-point scale

Factor analysis yielded three clear factors and each was Factor analysis yielded three clear factors and each was found to be reliable: Externalizing Behaviors, found to be reliable: Externalizing Behaviors, αα=.85=.85, , Internalizing Behaviors, Internalizing Behaviors, αα=.81=.81, and Learning Problems, , and Learning Problems, αα=.92.=.92.

Parents reported highest severity ratings for behavior on the Parents reported highest severity ratings for behavior on the Learning Problems scale (Mean = 3.92, SD = 1.49), but the Learning Problems scale (Mean = 3.92, SD = 1.49), but the highest single item was highest single item was Opposition/Defiance at Home Opposition/Defiance at Home on on the the Externalizing Scale (5.59)Externalizing Scale (5.59)

It is important to remember that although some of the It is important to remember that although some of the means for individual items are below the mid-point, all the means for individual items are below the mid-point, all the behaviors are undesirable, so even “sometimes a problem” behaviors are undesirable, so even “sometimes a problem” is not something that a parent would wish for. (See Table 4)is not something that a parent would wish for. (See Table 4)

Results Comparing Results Comparing Behavior Problems and Parent StressBehavior Problems and Parent Stress

Comparisons of all types of parental stress (General Family Comparisons of all types of parental stress (General Family Stress, Negative Emotional Stress, and Financial Stress) Stress, Negative Emotional Stress, and Financial Stress) and rated severity of children’s problem behaviors were and rated severity of children’s problem behaviors were significant (significant (FF(3,500)=42.423, (3,500)=42.423, pp<.0001), with higher stress <.0001), with higher stress associated with increased severity of behavior.associated with increased severity of behavior.

When all three types of stress were combined, parents When all three types of stress were combined, parents reported more stress as their children’s rated behavior reported more stress as their children’s rated behavior problems increased in severity.problems increased in severity.

This finding was consistent for Externalizing Behavior, This finding was consistent for Externalizing Behavior, (Somer’s (Somer’s d d = .501, = .501, pp<.0001); <.0001); Internalizing Behavior, Internalizing Behavior, (Somer’s (Somer’s dd

= .46, = .46, pp<.0001)<.0001); and Learning Problems ; and Learning Problems (Somer’s (Somer’s d d = .22, = .22, pp<.0001).<.0001).

See Table 5 for combined contingency results. See Table 5 for combined contingency results.

Presence or Absence of an IEPPresence or Absence of an IEP

63% of children had an IEP63% of children had an IEP

The “right” students were identified – students with The “right” students were identified – students with more severe behaviors were more likely at a more severe behaviors were more likely at a statistically significant level to have an IEP (statistically significant level to have an IEP (pp<.001).<.001).

IEPs and Severity of BehaviorsIEPs and Severity of Behaviors Parents of students with IEPs rated their child’s behavior problems Parents of students with IEPs rated their child’s behavior problems

as more severe than did parents of children without IEPs.as more severe than did parents of children without IEPs. Contingency analyses showed a significant relationship between Contingency analyses showed a significant relationship between

severity of behaviors and presence or absence of an IEP (Somers’ severity of behaviors and presence or absence of an IEP (Somers’ d = -.213, d = -.213, p<.001).p<.001).

Presence or Absence of Presence or Absence of an IEPan IEP

TotalTotal

YesYes NoNo

Severity of Severity of BehaviorBehavior

Never a ProblemNever a Problem 1818 2121 7.9%7.9%

Very Infrequently a Very Infrequently a ProblemProblem 5050 5858 22.022.0

%%

Infrequently a Infrequently a ProblemProblem 120120 6363 37.337.3

%%

Sometimes a ProblemSometimes a Problem 9393 3535 26.126.1%%

Frequently a ProblemFrequently a Problem 2828 55 6.7%6.7%

TotalTotal 62.9%62.9% 37.1%37.1% 100.100.0%0%

IEPs and Mean of Parent StressIEPs and Mean of Parent Stress

Parents of students with IEPs Parents of students with IEPs reported more stress than parents of reported more stress than parents of students who did not receive special students who did not receive special education services.education services.

ANOVA comparing the grand mean of ANOVA comparing the grand mean of stress scores for parents whose child stress scores for parents whose child received special education services received special education services with those who did not was with those who did not was significant (significant (F, F, (1,455) = 7.08, (1,455) = 7.08, pp<.008.<.008.

Parent Rating of Adequacy of Parent Rating of Adequacy of Educational Programming Educational Programming

Parents were asked to rate the adequacy of Parents were asked to rate the adequacy of their child’s educational program in their child’s educational program in addressing their child’s needs. addressing their child’s needs.

Parents were most satisfied with the Parents were most satisfied with the academic aspects of their child’s academic aspects of their child’s educational program and least satisfied educational program and least satisfied with the degree to which the program with the degree to which the program addressed their child’s challenging addressed their child’s challenging behavior problems. behavior problems.

See Table 6 for means and SD for ratings.See Table 6 for means and SD for ratings.

Parent Rating of Program Parent Rating of Program Adequacy With and Without an IEPAdequacy With and Without an IEP In all areas of programming but one, there In all areas of programming but one, there

were no significant differences between were no significant differences between parental ratings of program adequacy and parental ratings of program adequacy and the presence or absence of an IEPthe presence or absence of an IEP

However, in the area of programming to However, in the area of programming to address challenging behavior problems, address challenging behavior problems, parents of students with IEPs were parents of students with IEPs were significantly more satisfied (significantly more satisfied (F F (1,463) (1,463) == 6.322, 6.322, p p < .012) than parents of students < .012) than parents of students without IEPs.without IEPs.

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Program Adequacy and Parent Program Adequacy and Parent Stress with IEPsStress with IEPs

There was a significant relationship There was a significant relationship between parental rating of educational between parental rating of educational program adequacy and stress when program adequacy and stress when children had IEPs.children had IEPs.

Within each cell, the relationship was Within each cell, the relationship was negative and linear, i.e., the higher the negative and linear, i.e., the higher the satisfaction with the adequacy of the satisfaction with the adequacy of the programming, the lower the stress programming, the lower the stress level.level.

Each of the six programming areas was Each of the six programming areas was significant at significant at p < p < .01 level..01 level.

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Program Adequacy and Parent Program Adequacy and Parent Stress without IEPsStress without IEPs

For students without IEPS, the relationship For students without IEPS, the relationship between rated program adequacy and between rated program adequacy and parental stress was similar and significant parental stress was similar and significant for 5 of 6 areas.for 5 of 6 areas.

However, for students without IEPs, there However, for students without IEPs, there was no relationship between adequacy of was no relationship between adequacy of programming to reduce challenging programming to reduce challenging behavior problems and parental stress.behavior problems and parental stress.

Regardless of stress level, parents rated Regardless of stress level, parents rated behavioral programming adequacy as low.behavioral programming adequacy as low.

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DiscussionDiscussion

Overall, what do these data tell us Overall, what do these data tell us and what are the implications for and what are the implications for socially just practice in school socially just practice in school psychology?psychology?

A summary of the major points will A summary of the major points will precede considering the implications precede considering the implications for practice.for practice.

SummarySummary

First, there is a strong and consistent First, there is a strong and consistent relationship between the severity of the relationship between the severity of the child’s behavioral problems and all types child’s behavioral problems and all types of parental stress.of parental stress.

Cross-sectional research cannot Cross-sectional research cannot establish causality, but looking at the establish causality, but looking at the content of the stress items, it is unlikely content of the stress items, it is unlikely that the types of parental stress that the types of parental stress assessed would precede the child’s assessed would precede the child’s behavior problems.behavior problems.

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SummarySummary

Second, the students with the most Second, the students with the most severe problems are more likely to severe problems are more likely to have IEPs.have IEPs.

Parents of students with IEPs are more Parents of students with IEPs are more stressed, but probably due to the stressed, but probably due to the severity of the children behavioral severity of the children behavioral problems rather than the presence of problems rather than the presence of an IEPan IEP

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SummarySummary In general, parents are more satisfied In general, parents are more satisfied

with the adequacy of academic with the adequacy of academic programming than behavioral programming than behavioral programming.programming.

Parents of students with IEPs are less Parents of students with IEPs are less stressed when programming in all 6 stressed when programming in all 6 educational areas is more adequate. educational areas is more adequate.

Parents of students without IEPs are Parents of students without IEPs are equally stressed regardless of their equally stressed regardless of their rating of the adequacy of their child’s rating of the adequacy of their child’s behavioral programming. behavioral programming. 21

Implications As indicated, even in this underserved population,

the “right” students have IEPs because students with more severe behavioral problems have IEPs at a higher rate.

However, we know that over 1/3 were unserved despite the overall presence of problematic behavior and 84% of the sample having DSM diagnoses

Schools should strengthen interventions for behavioral needs of students in this population while continuing to address academic needs.

ImplicationsImplications

More connection between home and school may be More connection between home and school may be possible because parents tend to rate academic programs possible because parents tend to rate academic programs positively, countering the stereotype that parents of EBD positively, countering the stereotype that parents of EBD students do not care about education.students do not care about education.

Rather than being in denial about their child’s behavior, Rather than being in denial about their child’s behavior, parents in this population are in distress, and clearly would parents in this population are in distress, and clearly would like to receive more help with their very difficult-to-parent like to receive more help with their very difficult-to-parent children.children.

School personnel should guard against negative stereotyping parents of students with EBD

Recognition of the difficulty in parenting a child with Recognition of the difficulty in parenting a child with serious behavioral and emotional problems will help serious behavioral and emotional problems will help professionals work more effectively with parents.professionals work more effectively with parents.

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Limitations of the SampleLimitations of the Sample The use of on-line parent samples, which are The use of on-line parent samples, which are

more educated and affluent than the underlying more educated and affluent than the underlying population of parents of children with EBD in population of parents of children with EBD in general, possibly positively skewed the results, general, possibly positively skewed the results, and we acknowledge this.and we acknowledge this.

However, it is unlikely that less educated or However, it is unlikely that less educated or economically disadvantaged parents would fare economically disadvantaged parents would fare better in managing stress in their families while better in managing stress in their families while attempting to obtain help for their children.attempting to obtain help for their children.

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Closing & QuestionsClosing & Questions

Thank you for attending our presentation. Thank you for attending our presentation. The Power Point presentation and handout The Power Point presentation and handout

will be available on NASP’s website. will be available on NASP’s website. Questions?Questions?

Parents of Children with Emotional and Behavioral

Disorders: Stress and School Service Satisfaction

Martha Ellen Wynne, Ph.D., Eva Kowalewicz, M.Ed., Kathy Kula, M.Ed.,

Ruth Schumacher, M.Ed., Mary Satchwell, M.Ed.& Laura Swanlund