Mothers with spinal cord injuries: Impact on marital, family, and children's adjustment☆☆☆★★★♢

Article Outline

• Abstract
• Methods
  • Participants
  • Procedures
• Results
• Discussion
• Conclusion
• Acknowledgements
• References
• Copyright

Abstract 

Alexander CJ, Hwang K, Sipski ML. Mothers with spinal cord injuries: impact on marital, family, and children's adjustment. Arch Phys Med Rehabil 2002;83:24-30. Objective: To evaluate how mothers with spinal cord injury (SCI) adjust to parenting, their marriages, and their families, and how their children adjust to their mothers' disability. Design: Randomized control study of mothers with SCI and their children, matched to able-bodied mothers and their children on key demographic variables. Setting: Subjects were selected from 7 regional Spinal Cord Injury Model Systems from across the United States. Participants: A total of 310 volunteers (experimental: 88 mothers with SCI, 46 partners, 31 children; matched controls: 84 able-bodied mothers, 33 partners, 28 children). Interventions: Not applicable. Main Outcome Measures: Children's adjustment, gender role identity; self-esteem; children's attitude toward mother and father; dyadic and family adjustment; parenting stress; and satisfaction. Results: No significant differences were found between mothers with SCI and able-bodied mothers. Moreover, there were no significant differences between children raised in families with mothers with SCI and children raised in families with able-bodied mothers. Also, no significant differences were found in dyadic or family functioning with mothers with SCI or able-bodied mothers. Conclusions: SCI in mothers does not appear to affect their children adversely in terms of individual adjustment, attitudes toward their parents, self-esteem, gender roles, and family functioning. Our results may challenge health care providers, social policy-makers, and the general public to end negative stereotyping of children, couples, and families with a disabled mother and wife. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Keywords:  Mothers, Parenting, Rehabilitation, Spinal cord injuries

The goals of rehabilitation are to promote the opportunities and abilities by which persons with disabilities can live independently in the community. Many facets of independent living have been researched from the perspectives of the functional skills, life activities, and adjustment of persons with disabilities, as have the environmental, social, medical, and financial needs of such persons. However, one important life activity of persons with disabilities has been largely ignored in research, or worse, merely considered within the realm of speculation and presumption: parenthood and family functioning.¹, ², ³

Results of a national survey conducted by the Resource and Training Center (RTC) on Families with Adults with Disabilities suggested that there are 6.9 million parents who describe themselves as having some type of disability.⁴ Most of the survey's respondents reported having a physical disability (diagnoses ranged from spinal cord injury [SCI] to stroke to diabetes), but some reported sensory, cognitive, and psychiatric disabilities. The RTC survey found that, despite the degree of within-group variability, parents with disabilities have many common concerns, including a demand for adaptive child care equipment; difficulties in receiving reliable basic services such as housing modifications, transportation, and personal assistants; lack of awareness and support from service providers; and negative social stereotypes that hamper the ability of disabled persons to be effective parents.

Research into the impact of parental disability on children's adjustment has been scarce, has mostly highlighted negative outcomes, and is often laden with stigmatizing language and assumptions.², ⁵, ⁶ A sampling of pre-1980 literature reflects this bias. Arnauld,⁷ investigating the psychologic adjustment of children whose parents had multiple sclerosis (MS), expressed concern that parent-child relationships might be tense and conflict-laden because of the disabled parent's “irritability and lability” and the child's resentment against the parent's “often petulant and inconsistent behavior.” Arnauld's⁷ findings supported predictions that children of parents with MS expressed higher levels of general anxiety, body concern, dysphoria, hostility, constrained interpersonal relations, dependency longings, and false maturity (as manifested by overcompliance, loss of emotional spontaneity). Note, however, that a projective, rather than objective, measure of personality was used in this research, and that the results of the assessment scores were not matched by clinical observations of the children. This led Arnauld⁷ to conclude that an environment of family love and support appeared to be sufficient for “normal—if not optimal—growth.” Similar reporting biases appeared in a study⁸ that compared body image development of children of parents with MS with that of children of nondisabled parents. Although, differences in body image distortion scores between the 2 groups were not statistically significant and no significant differences were found in scores on 2 of the 3 assessment measures for any of the hypotheses, the investigator nevertheless concluded that children of parents with MS were in fact at greater risk for developing body image distortion than were children of nondisabled parents.

One drawback in much of the early literature is that disability was often accepted uncritically as an independent variable by researchers. That is, when a disabled person has problems, the physical impairment or medical condition itself is assumed to be the root cause.⁹ The social construction of disability—the myths, stereotypes, and assumptions surrounding a disabled person's role in society—has only recently come under scrutiny. Accordingly, more recent literature has considered not only the disabled parent's own individual strengths and weaknesses, but also his/her lack of adequate education, support, adaptive equipment and strategies when necessary, and available community resources.¹⁰ Other barriers that have been identified are a lack of role models, attitudinal discrimination,¹¹ and a lack of respect and understanding from medical professionals.⁵ Rather than seeking pathology, the focus of this research has shifted to identifying and addressing certain problem areas: for instance, parents' overdependence on the child, or expectations of the child to assume responsibilities that are not age-appropriate,¹⁰ or attachment breakdown resulting from adaptive stress—that is, distress that develops when a parent is unable or unwilling to adapt adequately parenting demands to physical functioning.⁵

Because 85% of SCIs occur in men, the research into long-term adjustment within the family context has focused primarily on fathers. Early research into disabled fathers shows a similar systematic bias toward pathology. Christopherson¹² discussed the impact of traumatic disability on the male sex role, primarily in terms of loss of breadwinner status and the resulting loss of income and benefits for the family. Another study¹³ examined the negative effect of a father's disability on the family as a whole. Besides issues around economic stress, loss of provider status, and disruption of traditional gender roles, Thomason and Clifford¹³ cited potential consequences such as “ego damages, personality damages, insecurity, fears and guilt”¹³ that could negatively impact marital and parenting functioning. In addition, there was speculation that a severe disability could result in a traumatized home environment that could potentially threaten family stability.

More recent empiric research studying the children of fathers with SCI has failed to support speculation that parental disability has a negative impact on parenting abilities.¹⁴, ¹⁵, ¹⁶, ¹⁷ Rather, results have shown that children of fathers with SCI were well-adjusted, emotionally stable persons who had attained normal sex role identities, and did not appear to be adversely affected in such areas as health patterns, body image, recreational interests, interpersonal relationships, or family relations.¹⁵ Moreover, few relationships were found between child adjustment and severity of paternal disability¹⁶ or between child adjustment and financial security of SCI fathers.¹⁷ (These latter 2 studies were conducted by using the retrospective accounts of adult children.) Rintala et al¹⁸ investigated the parenting styles and concerns of parents with SCI and parents without a disability who had children between the ages of 6 and 12 years. They found that parents with SCI were stricter with their children, but that the difference in strictness was not associated with children's social competence or behavioral outcome. The methodology, did not however, control for gender of the parent with SCI or for the child's age at the time of the parent's injury.

The literature on mothers with disabilities has been largely anecdotal and theoretical. First-hand accounts by disabled mothers show that despite the negative pressures surrounding their decisions to bear and raise children, they have generally adapted well to parental responsibilities and derive a great deal of fulfillment from the role.¹⁹, ²⁰, ²¹ Qualitative investigations²² have found that mothers with disabilities generally reported high levels of parenting satisfaction and personal competence. In addition, mothers frequently described the beneficial effects of maternal disability on their children's development, among them an increased sensitivity to the needs of others, increased self-sufficiency, and increased sense of social advocacy.¹¹, ²², ²³

Only 1 study²⁴ has addressed empirically the issues associated with practical questions and the effectiveness of parenting by mothers with SCI. Results of that study were generally favorable in terms of quality of family life, along such variables as interpersonal relationships, family relationships, social integration, recreational interests, and demand for external assistance. However, methodologic issues, such as small sample size, limitations of the questionnaire, and cultural and economic differences between Swedish and American societies, may restrict the generalizability of the results.

Further research is needed in this area for at least 2 reasons: (1) little research has been performed on women and SCI; and (2) research has documented the differing contributions of fathers and mothers to child development and adjustment,²⁵ as well as gender differences in parents' sense of confidence and control in the parenting role.²⁶ The need for such research is amply documented,¹, ², ³, ¹⁴, ¹⁶, ¹⁷ and methodologic paradigms and variables of importance in parenting by persons with disabilities have been identified.¹, ², ³ Any comprehensive and meaningful model of adjustment to disability must include family functioning as an outcome measure of rehabilitation or independent living.²⁷

This study examined parenting by mothers with SCI. In line with recent theoretical and methodologic directives in parental research,¹, ²⁸, ²⁹ parenting by mothers with disabilities was studied in the context of sociocultural status, family context variables, parent status and parenting process factors, and children's adjustment. Specifically, the study's purpose was to evaluate the impact of SCI on mothers' parenting, their marriages and their families, and on their children's adjustment to their mothers' disability.

In addition, we hypothesized that (1) children of SCI mothers would show no significant differences in psychologic adjustment when compared with children raised by a matched sample of able-bodied mothers; (2) parental adjustment and marital and family functioning would not significantly differ between families with SCI mothers and families with able-bodied mothers; (3) SCI mothers and their partners would not differ from a matched sample of able-bodied mothers and their partners in the degree of satisfaction received from parenting; and (4) mothers with SCI and their partners would not experience more stress from parenting than a matched sample of able-bodied mothers and their partners.

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Methods 

Participants 

To obtain a sufficiently large sample, mothers with SCI were recruited through 7 different regional Spinal Cord Injury Model Systems centers. They were: the Northern New Jersey Spinal Cord Injury System, Regional SCI System of Delaware Valley, Georgia Regional SCI System, Texas Regional SCI System, University of Michigan Regional SCI System, Northern California SCI System, and the Northwest Regional SCI System.

Inclusion criteria were: (1) mothers were 18 years of age or older; (2) they were able to read and understand English; (3) they were the mother of a child without a disability (if the mother had more than 1 child, for this study, only the oldest child was included; (4) the designated child was less than 2 years of age (or not yet born) at the time of the mother's SCI (for experimental group subjects only, to allow for sufficient time whereby the child was raised by a disabled mother); (5) the child lived with the parents at least half the time; (6) the spouse or partner did not have a disability; and (7) the mother had a female friend or relative who lived nearby and was willing to serve as a matching control subject.

Inclusion criteria for mothers in the control group were the same except that they were able-bodied and met the following matching criteria with their experimental group counterparts: they had at least 1 child of the same sex who was within 1 year of age of their friend's child who was selected for the study. Because subjects were obtained nationally, matching was important to reduce potential heterogeneity owing to cultural differences, socioeconomic factors, and age differences. Data were also collected directly from all designated children aged 12 and older, and from spouses or partners who agreed to participate.

A total of 310 subjects participated. Eighty-eight mothers with SCI, 46 of their partners, and 31 of their children comprised the experimental group. The control group was composed of 84 able-bodied mothers, 33 partners, and 28 of their children. Participation from partners and children was optional. This accounts for the discrepancy in numbers of participants among the mothers, their partners, and their children.

Procedures 

Approval was given by each institutional review board for human subjects and all experimental procedures used in the study conformed to the ethical considerations of the Helsinki Declaration. All eligible subjects signed informed consent documents. Disability in mothers was examined in relation to marital and family functioning, parental stress, and to children's adjustment. Mothers in both the experimental and control groups completed a series of questionnaires. Their partners were invited to complete the same questionnaires. Depending on the age of the participating child, questionnaires were either completed by the mother or the child. All adults were paid $50 for their participation.

The McMaster Family Assessment Device³⁰ (FAD) was used to assess family functioning. It is a 60-item questionnaire that evaluates family functioning along 6 dimensions: problem solving, communication, roles, affective responsiveness, affective involvement, and behavior control. A seventh scale, assessing general functioning, was also included. Test-retest reliability coefficients on the FAD scales range from .66 to .76, and scores are not significantly affected by social desirability. The FAD correlates well with other family assessment measures, and is reliable and valid for use with families with a medically disabled member.³¹ The FAD was completed by mothers, partners, and children ages 12 and older.

Parenting satisfaction was assessed with the Kansas Parenting Satisfaction Scale³² (KPSS), a 3-item scale of self-reported satisfaction with their child(ren)'s behavior, with self as a parent, and with the parent-child relationship. The KPSS has a moderate to high reliability and correlates significantly with self-esteem.

Parenting stress was measured by the Parenting Stress Index³³, ³⁴ (PSI), a 101-item questionnaire that identifies stressful parent-child systems in terms of child characteristics, parent characteristics, family contexts, and life stress events. The child domain is divided into 6 subscales: distractibility and hyperactivity, adaptability, reinforces parent, dependence, mood, and acceptability. The parent domain is divided into 7 subscales: competence, isolation, attachment, health, role restriction, depression, and spouse. The 2 domains add up to a measure of total stress. There is also an additional life stress scale, which measures environmental stressors. The PSI has a high internal consistency (range of α coefficients: in child domain, .70-.83; in parent domain, .70-.84; total stress, ≥.90) and test-retest reliability that is significant at 3 weeks, 3 months, and 1 year. The PSI has been used extensively with families with disabled, chronically ill, or behaviorally at-risk children, and as a screening device for predicting child-abuse situations. High scores on both domains have been associated with maternal illness,³⁵ maternal neglect,³⁶ and various child behavior problems. Both scales were completed by all parents.

Marital adjustment was assessed with the Dyadic Adjustment Scale³⁷ (DAS), a 32-item instrument designed to assess the quality of the relationship as perceived by a couple. It measures 4 aspects of the relationship: dyadic satisfaction, dyadic cohesion, dyadic consensus, and affectional expression. It is used as a general measure of satisfaction in the marriage, and it was completed by all parents who were married or living with a partner. Internal consistency reliabilities for the various subscales within the DAS range from .58 to .94, to .96 for the total scale. Test-retest correlations show that the DAS is relatively stable over time, and its validity has been well established in numerous clinical and experimental research studies.

Children's adjustment patterns were examined in light of a number of variables, including general adjustment, gender role orientation, self-concept and esteem, and perceptions of and attitudes toward parents. Mothers rated their children aged 3 to 16 years by using part 1 of the Personality Inventory for Children³⁸ (PIC). The PIC provides comprehensive and clinically relevant descriptions of child behavior, affect, and cognitive status. Part 1 is a 131-item scale that yields a measure of informant defensiveness (the lie scale) and 4 factor scales: undisciplined and poor self-control; social incompetence; internalization and somatic complaints; and cognitive development. Extensive literature supports the reliability and validity of the PIC.³⁹, ⁴⁰ Adult children (age, ≥17yr) completed the Brief Symptom Inventory⁴¹ (BSI), a 53-item self-report measure designed to reflect primary psychologic symptom patterns: somatization; obsessive-compulsiveness; interpersonal sensitivity; depression; anxiety; hostility; phobic anxiety; paranoid ideation; and psychoticism. The BSI also yields 3 global scales of psychologic distress: the Global Severity Index, the Positive Symptom Total, and the Positive Symptom Distress Index. The BSI shows good internal consistency and reliability, and was chosen for this study because of its brevity and its high convergence with longer measures such as the Minnesota Multiphasic Personality Inventory.

Children aged 12 and over also completed the Child's Attitude Towards Mother (CAM) and Father (CAF) Scales.⁴² These are 25-item scales that measure the extent, degree, or severity of problems children have with their fathers or mothers. The instruments are identical, except for use of the word “father” or “mother.” These are 2 of the few instruments available for assessing parent-child relationships from the child's viewpoint. The CAF and CAM have excellent internal consistency and test-retest reliability (CAF, .96; CAM, .95), and both measures have good predictive validity for parent-child relationship problems.

All parents and all children over the age of 16 completed the Bem Sex Role Inventory⁴³, ⁴⁴ (BSRI), which contains both masculinity and femininity scales, each of which contains 20 personality characteristics and 20 filler items. A person taking the BSRI is asked to indicate on a 7-point scale how well each of his/her personality characteristics are described. The BSRI identifies masculine, feminine, and psychologic androgynous characteristics. Androgyny denotes the integration of both masculinity and femininity within a single individual. Research has shown that a more androgynous view of one's self is associated with greater maturity, self-esteem, and gender-role flexibility and comfort. The 2 scales are logically and empirically independent, and show a high test-retest reliability (≥.70).

Self-esteem was assessed with the Index of Self-Esteem⁴² (ISE), a 25-item scale that measures the degree, severity, or magnitude of problems with self-esteem. Because problems with self-esteem are often central to social and psychologic difficulties, all parents and children who were 12 and older were asked to complete the questionnaire. The ISE has excellent internal consistency and test-retest reliability, good construct validity, and correlates well with other measures such as depression, sense of identity, and general contentment. Total participation time for any subject was dependent on age and the number of instruments participants were asked to complete. In families with more than 1 child, information was collected only on the oldest child who fell within the exclusions of the SCI mother and her matching control subject.

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Results 

All data entry and statistical analyses were performed by using SPSS, version 10.0.^a Preliminary analyses compared mothers in the control and experimental groups to determine the success of the matching procedures. Mothers with SCI had a mean age of 40.36 years whereas able-bodied mothers had a mean age of 40.14 years (F_1,170 = .046, P > .05). Sixty-one SCI mothers were currently married, compared with 68 control mothers (X²₄ = 4.65, P > .05). Eighty-eight percent of mothers in both groups were white, with the remaining mothers being African American, Hispanic, Asian, and Native American (X²₆ = 6.14, P > .05). Eighty-five percent of mothers with SCI had some college education, compared with 87% of mothers in the control group (X²₆ = 8.56, P > .05). Regarding employment, 38 SCI mothers were employed either full- or part-time and 45 were unemployed. Of the mothers in the control group, 60 were employed full- or part-time and 24 were unemployed. There was a significant difference between SCI mothers and control group mothers on this employment variable (X²₄ = 15.88, P = .003). Of the mothers who were employed, there were no differences in individual income between the control and SCI groups (X²₁₁ = 11.89, P > .05). Both groups had similar household incomes, with the modal value being $75,000 and more (X²₁₁ = 10.99, P > .05). Thus, overall, the matching procedure for mothers was successful, yielding no significant differences between the 2 groups in age, marital status, race, education, and income.

Fifty-nine children participated in this study—31 from SCI mothers and 28 from able-bodied mothers in the control group. The mean age of children in the experimental (SCI) group was 15.74 years. The mean age of children in the control group was 15.71 years (F_1,57 = .002, P > .05). In the experimental group, there were 19 men and 12 women; in the control group, 17 men and 11 women. The 2 groups did not significantly differ on the children's gender variable (X²₁ = .002, P > .05).

Data were analyzed by using 1-way analysis of variance (ANOVA) for each of the following comparisons: (1) SCI mothers versus able-bodied mothers; (2) children of SCI mothers versus children of able-bodied mothers; (3) SCI mothers versus their partners; (4) able-bodied mothers versus their partners; and (5) partners of SCI mothers versus partners of able-bodied mothers.

In the first analysis, no significant differences were found between SCI mothers and their matched able-bodied counterparts on the 5 subscales of the DAS (P > .05), the 3 subscales of the BSRI (P > .05), the ISE (P >.05), the 7 subscales of the FAD (P > .05), and the 3 subscales of the KPSS (P > .05). On the PSI, able-bodied mothers scored significantly higher (M = 57.32) on the adaptability subscale than did SCI mothers (M = 46.87; F_1,117 = 4.332, P = .040). No other significant differences were found on the remaining 17 subscales (P > .05).

The second analysis compared the children of SCI mothers and matched able-bodied mothers. On measures of adjustment for children between the ages of 3 to 16 years, the PIC was completed by the mother. ANOVA showed no significant difference on any of the PIC 5 subscales for children raised by SCI mothers versus children raised by able-bodied mothers (P > .05). Children ages 17 years and older completed the BSI. Again, no significant differences were found on any of its 12 subscales. No significant differences were found on the ISE, the CAM, the CAF, the 3 subscales of the BSRI, and the 7 subscales of the FAD (all P > .05). In summary, no significant differences were found on any of the dependent measures between children raised by their SCI mothers and children raised by able-bodied mothers.

The third analysis compared the adjustment of SCI mothers with their partners. On the DAS, no significant differences were found on any of its 5 subscales (P > .05). In addition, no significant difference was found between the mother and partner on the ISE (P > .05). On the FAD, partners scored significantly higher (M = 1.91) than did the SCI mothers (M = 1.73) on the affective responsiveness subscale (F_1,131 = 4.301, P = .040). Partners scored significantly higher (M = 6.17) than SCI mothers (M = 5.56) on the KPSS behavior of children subscale (F_1,132 = 7.978, P = .005). On the PSI, SCI mothers scored significantly higher (M = 59.84) than did their partners (M = 47.47) on the spouse subscale (F_1,90 = 4.477, P = .037). Finally, on the BSRI, partners scored significantly higher (M = 55.067) than SCI mothers (M = 47.966) on the masculine identity measure (F_1,131 = 10.701, P = .001). SCI mothers scored significantly higher (M = 57.557) than their partners (M = 49.364) on the feminine identity measure (F_1,130 = 32.802, P = .0001), and they also scored significantly higher (M = 55.773) than their partners (M = 45.556) on the androgyny measure (F_1,131 = 44.497, P = .0001).

The fourth analysis compared able-bodied mothers with their partners on the same measures described earlier. No significant differences were found on any of the subscales of the DAS or the ISE (all P > .05). On the PSI, partners scored significantly higher (M = 66.95) than able-bodied mothers (M = 41.42) on the attachment subscale (F_1,75 = 13.742, P = .0001); however, mothers scored significantly higher (M = 63.30) than their partners (M = 45.85) on the health subscale (F_1,75 = 8.052, P = .006). On the KPSS, able-bodied mothers scored significantly higher (M = 6.08) than their partners (M = 5.69) on the relationship with children subscale (F_1,114 = 3.653, P = .05). On the FAD, partners scored significantly higher (M = 2.1006) than able-bodied mothers (M = 1.7871) on the affective responsiveness subscale (F_1,115 = 9.498, P = .003). Partners also scored significantly higher (M = 1.7609 vs M = 1.5396) on the behavior control subscale (F_1,115 = 7.961, P = .006). On the BSRI, partners scored significantly higher (M = 55.3030) than able-bodied mothers (M = 49.8929) on the masculine identity measure (F_1,115 = 6.083, P = .015). Able-bodied mothers, however, scored significantly higher (M = 57.5476) than their partners (M = 49.4242) on the feminine identity measure (F_1,115 = 25.755, P = .001). Able-bodied mothers also scored significantly higher (M = 55.0952 vs M = 46.1818) on the androgyny measure (F_1,115 = 23.226, P = .0001).

The last analysis compared the partners of SCI mothers with the partners of able-bodied mothers on individual, couples, and family adjustment measures. For the FAD, the DAS, the KPSS, the BSRI, and the ISE, no significant differences were found (all P > .05). Three subscale differences were found on the PSI. On the mood subscale, partners of able-bodied mothers scored significantly higher (M = 67.90) than partners of SCI mothers (M = 48.50) (F_1,48 = 9.853, P = .003). Partners of able-bodied mothers also scored significantly higher (M = 59.40) than partners of SCI mothers (M = 41.57) on the child domain subscale (F_1,48 = 4.993, P = .030). Partners of SCI mothers, however, scored significantly higher (M = 51.90) than partners of able-bodied mothers (M = 30.45) on the life stress subscale (F_1,48 = 4.816, P = .033). Table 1 summarizes all of the statistically significant results.

Table 1. Summary of significant findings

Dependent Measures and Subscales	Significant Findings
BSRI
Masculine identity	B > A, C > D
Feminine identity	A > B, D > C
Androgyny	A > B, D > C
FAD
Affective responsiveness	B > A, C > D
Behavior control	C > D
KPSS
Behavior of children	B > A
Relationship with children	D > C
PSI
Adaptability	D > A
Mood	C > B
Child domain	C > B
Attachment	C > D
Health	D > C
Spouse	A > B
Life stress	B > C

Note. P < .05.

Abbreviations: B, partner of SCI mother; A, SCI mother; C, partner of able-bodied mother; D, able-bodied mother.

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Discussion 

Our results support the hypothesis that physical disability in mothers, specifically SCI, does not appear to affect adversely their children in terms of individual adjustment, attitudes toward their parents, self-esteem, gender roles, and family functioning. Differences were few between SCI mothers and able-bodied mothers. No differences were found on measures of marital and family functioning, self-esteem, parental satisfaction, and gender role identity. Able-bodied mothers, however, scored high on the adaptability scale of the PSI. This fact is associated with characteristics that make the parenting task more difficult because of their child's inability to adjust to his/her social and physical environment. Another way to look at this finding is that SCI mothers see their children as being less rigid and more comfortable in adjusting to novel situations in their environment.

We examined differences in response patterns between SCI mothers and their partners and how well these patterns correlated with those found between able-bodied mothers and their partners. Results showed no differences in self-esteem or various measures of dyadic adjustment for either group. The FAD³⁰ revealed that partners of women with SCI perceived their family's affective responsiveness as more limited, that is, SCI mothers perceived their family members as being more capable of experiencing and expressing an appropriate range of affect than did their partners. Because the same response difference was found for able-bodied women and their partners, this issue seems to relate more to gender rather than to physical disability. Partners of able-bodied mothers also scored higher on the behavior control dimension of the FAD.³⁰ This suggests that the able-bodied mothers were more likely than their partners to believe that the standards for appropriate expression of behavior within the family were clear.

In the domain of parental satisfaction, the SCI mothers reported lower levels of satisfaction with the behavior of their children than did their partners. This suggests that the SCI mothers were more strict with their children, or had higher expectations for their children's behavior. Able-bodied mothers expressed having a higher quality relationship with their children than did their partners. This discrepancy did not exist with SCI mothers and their partners.

Although SCI mothers did not show any more stress from parenting than did able-bodied mothers, they were more likely than able-bodied mothers to report feeling a lack of emotional and active support from their partners in the area of child management. The deficits and difficulties resulting from disability undoubtedly make parenting more difficult, and thus places a greater burden on the partner to help manage a child's activities. In addition, partners of able-bodied mothers expressed a lack of emotional closeness to their children, as compared with those feelings expressed by the mothers. Interestingly, able-bodied mothers expressed feelings that their health was deteriorating; this may be the result of parenting stress not felt by their partners. It is surprising that no such trend appeared with SCI mothers, given their potential for greater vulnerability to SCI-related complications.

Finally, the partners of SCI mothers showed no differences in self-esteem, parental satisfaction, gender role identities, and perceptions of dyadic or family functioning than partners of able-bodied mothers. There is some evidence, however, to suggest that parenting leads to greater stress in certain areas for partners of able-bodied mothers than it does for partners of SCI mothers. Specifically, partners of able-bodied mothers indicated that the behavior of their children made it difficult for the parents to fulfill their parenting roles. These partners were also more likely to report signs of unhappiness and, at times, depression in their children. Understandably, partners of spinal-injured mothers expressed more life stress than did partners of able-bodied mothers. Specifically, this stress was associated with situational circumstances beyond their control (such as disability) and contributed to stress outside the parent-child relationship.

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Conclusion 

This study showed that differences between families with SCI mothers and able-bodied mothers were minor, at most. Our findings suggest that just the presence of maternal SCI does not predict difficulties in children's psychologic adjustment, nor does it lead to problems in areas of parenting satisfaction, parenting stress, marital adjustment, or family functioning. In fact, some evidence suggests that SCI mothers and their partners experience less stress in certain areas of parenting than do their able-bodied counterparts. Partners of SCI mothers, in particular, seem to enjoy more satisfying relationships with their children. Future research might examine the emotional and physical coping techniques used by SCI mothers and their partners that help them succeed in the parenting process.

Our sample of SCI mothers shows a demographic profile that may not be representative of the SCI population as a whole. Specifically, our participants had higher than median levels of education, employment, and household income. This suggests that these SCI mothers may have had more resources to help them cope with the demands of parenting, which might facilitate positive adjustment. Because of the strict criteria governing inclusion in our sample, there were not enough mothers in the sample to permit study of the impact of such factors as level of injury, marital status, or other demographic variables. In addition, we had some difficulty in recruiting partners and children, resulting in unequal numbers of participants. This might have resulted in a potential biasing factor. Further research into these factors could further our insights into the concerns of mothers with SCI, their partners, and their children. However, the difficulty in obtaining sufficient sample sizes would make this a challenging project.

Our results have clear implications for both clinical rehabilitation and for wider social policy. They suggest that there is no empiric basis for believing that SCI has a deleterious effect on parenting satisfaction, parenting stress, family functioning, or children's adjustment. This is encouraging for all women with SCI who are considering becoming a parent. We hope that our results will lead health care providers and social policy-makers to reconsider their assumptions about disability and parenting, so that mothers with disabilities can be given the support and encouragement that they deserve.

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Acknowledgements 

This collaborative project could not have been completed without the assistance of many people. The authors thank the following individuals for their cooperation, support, and efforts throughout the data collection process: Charles Bombardier, PhD, Francis M. Buck, PhD, Catherine Clubb-Foley, PhD, Michelle Cohen, PhD, Joel DeLisa, MD, Karyl Hall, PhD, Don Kewman, PhD, J. Stuart Krause, PhD, Margaret Nosek, PhD, Karen Orchard, MA, Diana Rintala, PhD, and Denise Tate, PhD.

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References 

1. Buck FM. Parenting by fathers with physical disabilities. In:  Haseltine FP,  Cole SS,  Gray DB editor. Reproductive issues for persons with physical disabilities. Baltimore: : Brooks; 1993;p. 163–186
   • View In Article
2. Buck F, Hohmann G. Parental disability and children's adjustment. In:  Pan E,  Backer T,  Vash C editor. Annual review of rehabilitation. Vol 3:New York: : Springer-Verlag; 1983;p. 203–241
   • View In Article
3. In:  Thurman SK editors. Children of handicapped parents: research and clinical perspectives. Orlando (FL): : Academic Pr; 1985;
   • View In Article
4. Barker LT, Maralani V. Challenges and strategies of disabled parents: findings from a national survey of parents with disabilities. Oakland (CA): : Berkeley Planning Associates; 1997;
   • View In Article
5. Kirshbaum M. Parents with physical disabilities and their babies. Zero to Three. 1988;8:8–15
   • View In Article
6. Smith NJ, Bland R, Grey C. Handicapped parents with non-handicapped dependents. Int J Rehabil Res. 1993;16:157–159
   • View In Article
   • MEDLINE
   • CrossRef
7. Arnauld SH. Some psychological characteristics of children of multiple sclerotics. Psychosomatic Med. 1959;21:8–22
   • View In Article
8. Olgas M. The relationship between parents' health status and body image of their children. Nurs Res. 1974;23:319–324
   • View In Article
   • MEDLINE
9. Asch A, Fine M. Disability beyond stigma: social interaction, discrimination, and activism. J Soc Iss. 1988;44:3–21
   • View In Article
10. Kopala B, Egenes KH. The physically disabled parent: assessment and intervention. Top Clin Nurs. 1984;6:10–18
    • View In Article
    • MEDLINE
11. Hanna DV, Edwards PA. Physically disabled parents and their normal children: assessment, diagnosis, and intervention. Holistic Nurs Pract. 1988;2:38–47
    • View In Article
12. Christopherson VA. Role modifications of the disabled male. Am J Nurs. 1968;68:290–293
    • View In Article
    • MEDLINE
    • CrossRef
13. Thomason B, Clifford K. The disabled person and family dynamics. Accent on Living. 1972;17:20–25
    • View In Article
14. Buck FM. The influence of parental disability on children: an exploratory investigation of the adult children of spinal cord injured fathers [dissertation]. Tucson (AZ): : Univ Arizona; 1980;
    • View In Article
15. Buck FM, Hohmann G. Personality, behavior, values, and family relations of children of fathers with spinal cord injury. Arch Phys Med Rehabil. 1981;62:432–438
    • View In Article
    • MEDLINE
16. Buck FM, Hohmann G. Child adjustment as related to severity of paternal disability. Arch Phys Med Rehabil. 1982;63:249–253
    • View In Article
    • MEDLINE
17. Buck FM, Hohmann G. Child adjustment as related to financial security and employment status of fathers with spinal cord injuries. Arch Phys Med Rehabil. 1984;65:327–333
    • View In Article
    • MEDLINE
18. Rintala DH, Herson L, Hudler-Hull T. Comparison of parenting styles of persons with and without spinal cord injury and their children's social competence and behavior problems. J Spinal Cord Med. 2000;23:244–256
    • View In Article
    • MEDLINE
19. Pischke ME. Parenting with a disability. Sexuality Disabil. 1993;11:207–210
    • View In Article
20. Killoran C. Woman with disabilities having children: it's our right too. Sexuality and Disability. 1994;12:121–126
    • View In Article
21. Kocher M. Mothers with disabilities. Sexuality Disabil. 1994;12:127–134
    • View In Article
22. Kopala B. Mothers with impaired mobility speak out. Am J Maternal Child Nurs. 1989;14:115–119
    • View In Article
23. Reinelt C, Fried M. “I am this child's mother:” a feminist perspective on mothering with a disability. Proceedings of the Society for Disability Studies Meeting. 1991 June; Oakland (CA)
    • View In Article
24. Westgren N, Levi R. Motherhood after traumatic spinal cord injury. Paraplegia. 1994;32:517–523
    • View In Article
    • MEDLINE
    • CrossRef
25. Grotevant H, Cooper C. Patterns of interaction in family relationships and the development of identity exploration in adolescence. Child Dev. 1985;56:415–428
    • View In Article
    • MEDLINE
    • CrossRef
26. Frank S, Jacobson S, Hole C, Justkowski R, Huyck M. Psychological predictors of parents' sense of confidence and control and self versus child-focused gratifications. Dev Psychol. 1986;22:348–355
    • View In Article
    • CrossRef
27. Trieschmann R. Spinal cord injuries: psychological, social, and vocational rehabilitation. 2nd ed. New York: : Demos; 1988;
    • View In Article
28. Coates D, Vietze P, Gray D. Methodological issues in studying children of disabled parents. In:  Thurman SK editors. Children of handicapped parents: research and clinical perspectives. Orlando (FL): : Academic Pr; 1985;p. 155–180
    • View In Article
29. Greer G. Children of physically disabled parents: some thoughts, facts, and hypotheses. In:  Thurman SK editors. Children of handicapped parents: research and clinical perspectives. Orlando (FL): : Academic Pr; 1985;p. 131–144
    • View In Article
30. Epstein NB, Baldwin LM, Bishop DS. The McMaster Family Assessment Device. J Marital Fam Ther. 1983;9:171–180
    • View In Article
    • CrossRef
31. Kabacoff RI, Miller IW, Bishop DS, Epstein NB, Keitner GI. A psychometric study of the McMaster Family Assessment Device in psychiatric, medical, and nonclinical samples. J Fam Psychol. 1990;3:431–439
    • View In Article
    • CrossRef
32. James DE, Schumm WR, Kennedy CE, Grigsby CC, Shectman KL. Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychol Rep. 1985;57:163–169
    • View In Article
    • CrossRef
33. Lloyd BH, Abidin RR. Revision of the Parenting Stress Index. J Pediatr Psychol. 1985;10:169–177
    • View In Article
    • MEDLINE
34. Abidin RR. The Parenting Stress Index. Odessa (FL): : Psychological Assessment Resources; 1995;
    • View In Article
35. Abidin RR, Wilfong E. Parenting stress and its relationship to child health care. Child Health Care. 1989;18:114–117
    • View In Article
    • MEDLINE
    • CrossRef
36. Ethier LS, La Freniere PJ. Les stress des meres monoparentales en relation avec l'aggressivité de l'enfant d'age precolaire. J Int Psychol. 1993;28:273–289
    • View In Article
37. Spanier GB. Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marriage Fam. 1976;38:15–28
    • View In Article
38. Lachar D. Personality Inventory for Children (PIC): revised format supplement. Los Angeles: : Western Psychological Services; 1982;
    • View In Article
39. Pearson DA, Lachar D. Using behavioral questionnaires to identify adaptive deficits in elementary school children. J School Psychol. 1994;32:33–52
    • View In Article
40. Kline R, Lachar D, Boersma D. Identification of special education needs with the Personality Inventory for Children (PIC): a hierarchical classification model. Psychol Assess. 1993;5:307–316
    • View In Article
    • CrossRef
41. Derogatis LR, Spencer PM. The Brief Symptom Inventory manual I: administration, scoring, and procedures for the BSI. Baltimore: : Clinical Psychometrics Research; 1982;
    • View In Article
42. Hudson WW. The clinical measurement package: a field manual. Chicago: : Dorsey; 1982;
    • View In Article
43. Bem SL. Measurement of psychological androgyny. J Consult Clin Psychol. 1974;42:155–162
    • View In Article
    • MEDLINE
    • CrossRef
44. Bem SL. On utility of alternative procedures for assessing psychological androgyny. J Consult Clin Psychol. 1977;45:196–205
    • View In Article
    • MEDLINE
    • CrossRef