hibbard

The Impact of TBI on Parenting : 

The Impact of TBI on Parenting Mary R. Hibbard, Ph.D., ABPP (RP) Professor Department of Rehabilitation Medicine Mount Sinai School of Medicine New York New York Rehabilitation Research and Training Center on Traumatic Brain Injury Interventions Mount Sinai School of Medicine, New York NY Supported in part by Grant No. H133B040033, from the National Institute on Disability and Rehabilitation Research, U.S. Department of Education

Objectives: 

Objectives Review of research on parenting and TBI Highlight challenges identified in parenting for similar disability groups Challenges in assessing the impact of TBI on parenting and the family Suggested research agenda

Need for Parenting Research in TBI : 

Need for Parenting Research in TBI Majority of adult TBIs occur prior to the age of 35 Children with TBI become adults who marry and have children Many children are (or will be) raised in families where one parent has experienced a TBI TBI challenges may selectively impact cognitive and behavioral abilities needed for effective parenting

Parenting After TBI: 

Parenting After TBI Urbach and Culbert (1991) 3 case studies of impact of fathers’ TBI on children On interviews, children presented with: Increased emotional and conduct disturbances (somatic symptoms, levels of activity, increased dependence, school failure) Feelings of abandonment Difficulties adapting to changes in parent and family roles

Parenting After TBI: 

Parenting After TBI Pezzar et al (1993) Spousal report of own and mate with TBI’s parenting abilities, impact of parenting on children’s behaviors Findings: Negative changes - parent with TBI Decreased parental role fulfillment Increased frequency negative behaviors Fewer positive behaviors Negative changes - parent without TBI Increased feeling overwhelmed Increased impatience and arguing Decreased activities with children Negative changes for children Increased acting out behaviors Increased emotional problems Relationship problems with parent with TBI

Suggested impacts of TBI on Children : 

Suggested impacts of TBI on Children Children mirror or react to cognitive, emotional and behavioral styles of parent with TBI Higher risk of emotional, cognitive and behavioral problems in children Changing roles and expectations of child Lack of support in time of need Stigmatization of having a “different” parent Increased depression in children From Uysal, et al., 1998

Parenting After TBI: 

Parenting After TBI Uysal, Hibbard, et al (1998) Self report parenting skills: parents with TBI Self report parenting skills: mates without TBI Children’s ratings of parenting skills Impact parental TBI on family members’ levels of depression Comparison group of non-disabled families (16 families with TBI/16 families without TBI) Families equivalent in terms of age and sex of parents and children interviewed On average, parents with TBI 9 years post injury

Parenting Measures (Uysal et al., 1998): 

Parenting Measures (Uysal et al., 1998) Parent’s Battery Self rating of parenting abilities Parent Behavior Form Parent Practices Questionnaire Parenting Dimension Inventory Ratings of children’s behaviors Children’s Problem Checklist Behavior Rating Profile Self report depression BDI Child’s Battery Parenting abilities of both parents Parent Behavior Form Parent Practices Questionnaire Rating of own behavior Behavior Rating Profile Self report depression CDI

Impact of TBI on Parenting Skills(Uysal et al, l998): 

Impact of TBI on Parenting Skills (Uysal et al, l998) Parents with TBI and their spouses were similar to parents in the comparison group in: Egalitarian treatment Encourage of independent thinking Parental strictness Use of punishment and anger Demands for maturity Frequency of favorable and unfavorable parental practices Reports of stress related to child rearing

Impact of TBI on Parenting Skills(Uysal et al, 1998): 

Impact of TBI on Parenting Skills (Uysal et al, 1998) Parents with TBI reported less: Goal setting Encouragement of skill development Emphasis on obedience to rules and orderliness Promotion of work values Nurturance Involvement in activities with children Non-TBI parent reported less: Feelings of warmth for children Loving of children Accepting of children

Impact of Parental TBI on Children(Uysal et al, 1998): 

Impact of Parental TBI on Children (Uysal et al, 1998) Children’s reports did not support differences reported by their parents in TBI households Children in TBI households did report: both parents using lax control more frequently non-TBI parent was less actively involved in parenting roles The frequency of self reported behavioral problems were equivalent in children from TBI and non-TBI families

Impact of TBI on Family’s Mood(Uysal, et al, 1998): 

Impact of TBI on Family’s Mood (Uysal, et al, 1998) Parents with TBI reported: higher frequency of depressive symptoms greater % met criteria for depression (BDI >15) Spouses of mates with TBI endorsed more symptoms of depression Children in TBI families reported more depressive symptoms

Lack of congruence: Parents and children reports?(Uysal, et al, 1998): 

Lack of congruence: Parents and children reports? (Uysal, et al, 1998) Parents in TBI families overly critical of their parenting abilities A “halo effect” ….children rate parents as doing well despite TBI A “minimization effect”…children downplay the impact of TBI on parents skills A “time effect”…children accept the parent’s current abilities as “normal” since it was now 9 years on average post injury

Parenting challenges in other disability groups: 

Parenting challenges in other disability groups Fathers with marked ADHD symptoms tended to be more over-reactive and use authoritarian discipline strategies (Arnold, O’Leary & Edwards (1997) Mothers with ADHD were poorer at monitoring child behaviors and less consistent disciplinarians (Murray & Johnson, 2006) Children of fathers with alcoholism display increasing levels of externalizing behavior problems from an early age leading to antisocial behavior in later years (Eiden, Edwards & Leonard, 2006; Puttler,Zucker, Fitzgerald & Bingham, l998, Wong, Zucker, Fitzgerald & Puttler, 1999)

Parenting challenges in other disability groups: 

Parenting challenges in other disability groups Parents with co-morbid Axis I and II disorders (Johnson, Cohen, Kasen et al, 2006) Parental depression associated with Low parental affection Low parental assistance Low parental time with child Parental anxiety associated with Low parental possessiveness Low parental affection Low parental assistance

Parenting challenges in other disability groups: 

Parenting challenges in other disability groups Parents with co-morbid Axis I and II disorders (Johnson, Cohen, Kasen et al, 2006) When effects of parent and offspring gender and co-occurring Axis II conditions controlled for: Only Axis I association remaining: Parental anxiety disorder associated with high parental possessiveness Parental personality disorders were associated with: Parental possessiveness Inconsistent parental discipline Low parental communication Low parental praise and encouragement Parents with personality disorders were 3x more likely to engage in problematic child rearing behaviors

Next steps???: 

Next steps??? Expanded evaluation Broaden domains of inquiry Prospective studies Determine nature and scope of parental interventions needed

Assessment of Family Functioning Post TBI (Wade, et al, 1995): 

Assessment of Family Functioning Post TBI (Wade, et al, 1995) Avoid observations based on a single individual in the family to draw conclusions about the functioning of the family Integrate self report measures with direct observation of family interactions Differentiate generic family impact and stressors from changes unique to TBI ? construct structured interviews of family stress and adaptation geared to specific stresses of TBI which combine, open-ended and structured probes, e.g., Family Interview Rating Scale (Rivera et al, 1992) Family Burden of Injury Interview (Taylor, in press)

Evaluating Parenting Impacts within the TBI Family System : 

Evaluating Parenting Impacts within the TBI Family System Potential Impacts

Parental Adjustment Post TBI: 

Parental Adjustment Post TBI

Parental Adjustment Post TBI: 

Parental Adjustment Post TBI

Child Adjustment Post TBI: 

Child Adjustment Post TBI

Design Considerations: 

Design Considerations Discrepancies = extent of potential discord within members of the family Discrepancies will highlight needed intervention for parents and children Prospective studies will identify: Shifts in family adjustment and adaptation Time periods when interventions are most critical

Thank you : 

Thank you