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The Impact of TBI on Parenting

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Introduction to parenting by gays and lesbians. Review beliefs ... Greater level of synchronicity in parenting than het partners (Stacey and Biblarz, 2001) ... – PowerPoint PPT presentation

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Title: The Impact of TBI on Parenting


1
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

2
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

3
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

4
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

5
Parenting After TBI
  • Pezzar et al (1993)
  • Spousal report of own and mate with TBIs
    parenting abilities, impact of parenting on
    childrens 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


6
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

7
Parenting After TBI
  • Uysal, Hibbard, et al (1998)
  • Self report parenting skills parents with TBI
  • Self report parenting skills mates without TBI
  • Childrens 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

8
Parenting Measures (Uysal et al., 1998)
  • Parents Battery
  • Self rating of parenting abilities
  • Parent Behavior Form
  • Parent Practices Questionnaire
  • Parenting Dimension Inventory
  • Ratings of childrens behaviors
  • Childrens Problem Checklist
  • Behavior Rating Profile
  • Self report depression
  • BDI
  • Childs Battery
  • Parenting abilities of both parents
  • Parent Behavior Form
  • Parent Practices Questionnaire
  • Rating of own behavior
  • Behavior Rating Profile
  • Self report depression
  • CDI

9
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

10
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

11
Impact of Parental TBI on Children(Uysal et al,
1998)
  • Childrens 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

12
Impact of TBI on Familys 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

13
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 effectchildren downplay the
    impact of TBI on parents skills
  • A time effectchildren accept the parents
    current abilities as normal since it was now 9
    years on average post injury

14
Parenting challenges in other disability groups
  • Fathers with marked ADHD symptoms tended to be
    more over-reactive and use authoritarian
    discipline strategies (Arnold, OLeary 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)

15
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

16
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

17
Next steps???
  • Expanded evaluation
  • Broaden domains of inquiry
  • Prospective studies
  • Determine nature and scope of parental
    interventions needed

18
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)

19
Evaluating Parenting Impacts within the TBI
Family System
Potential Impacts
20
Parental Adjustment Post TBI
21
Parental Adjustment Post TBI
22
Child Adjustment Post TBI
23
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

24
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