Running Head: FAMILIAL FACTORS AND DEPRESSION

Familial Factors Associated with Symptoms of Depression in Preschool Children

by

MALKA ISMACH

A dissertation submitted to the Graduate Faculty in Educational Psychology in partial fulfimment of the degree of Doctor of Philosophy, The City University of New York

2009

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© 2009

MALKA ISMACH

All Rights Reserved

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This manuscript has been read and accepted for the

Graduate Faculty in Educational Psychology in satisfaction of the

dissertation requirement for the degree of Doctor of Philosophy.

Dr. Marian C. Fish

___________________________________

__________________ __________________________Date Chair of Examining Committee

Professor Dr. Mary Kopala _______________________________________

__________________ __________________________Date Executive Office

Dr. Ida Jeltova

Dr. Mary Kopala

Dr. Georgiana S. Tryon

Dr. Jay Verkuilen

Supervisory Committee

The City University of New York

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Abstract

FAMILIAL FACTORS ASSOCIATED WITH SYMPTOMS OF DEPRESSION IN

PRESCHOOL CHILDREN

By

Malka Ismach

Advisor: Professor Marian C. Fish

The purpose of this study was to investigate whether or not preschoolers can be identified

as at risk for depression, if there was agreement between parents and teachers regarding

the symptoms that children display and to identify the familial factors that impact the

development of depression in preschool children. Recent evidence suggests that

preschoolers have symptoms indicating possible feelings of depression.  In order to help

these preschoolers, it is important to ascertain the factors associated with the

development of depressive symptoms.  The research consistently shows that parenting

styles, discipline practices, and family functioning impact depression in school age

children and adolescents.  This study examined the relationship between these factors and

depressive symptomatology in preschoolers.  Low levels of flexibility and high levels of

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rigidity in the home were found to have a significant relationship with preschoolers who

show signs of depression. Additionally, when all the familial factors were plotted on an

ROC curve, they demonstrated the ability to make good predictions about preschoolers

who may be at risk for depression. Educational implications of the study as well as

limitations are discussed.

Dedicated to my mom,

Pess Epstein, may she rest in peace

whose presence and pride on this day

would have made my joy complete.

And to my husband Shmuel,

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with whom I share all of my joy,

without his love and support,

this day could not have been.

Acknowledgements

A sincere thank you is in order to my advisor, Dr. Marian C. Fish, for without her

endless support, encouragement and availability, I would not be where I am today. Dr.

Fish’s accessibility, speedy responses and positive outlook made the dissertation process

a very pleasant one, and for that I am grateful.

Thank you also to my other committee members, Dr. Jay Verkuilen and Dr. Ida

Jeltova whose assistance, skill and knowledge base as well as their availability, allowed

me to experience this process feeling supported and well guided. Thank you.

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Table of Contents

Chapter Page

I. Introduction 1

Research Questions 7

II. Literature Review 9\

Depressive Disorders 109

Depressive Symptoms in Preschool Children 14

Familial Factors and Depression 22

Risk Factors 41

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Agreement between Parents and Teachers 423

Summary 434

Rationale 44

Hypotheses 456

III. Methods 47

Participants 47

Measures 47

Procedure 55

Design 56

IV. Results 587

Demographics 598

Risk Factors 631

Hypothesis #1 632

Hypothesis #2 643

Hypothesis #3 675

Hypothesis #4 697

Hypothesis #5 7068

ROC Curve 710

V. Discussion 752

Depressive Symptoms in Preschoolers 753

Agreement between Parents and Teachers 764

Familial Factors Associated With Depression in Preschoolers 774

Erikson’s Stages of Psychosocial Development 83

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Risk Factors 8379

Limitations and Future Research 840

Educational Implications 862

Conclusion 873

Appendices 884

A. Informed Consent 884

B. Preschool Feelings Checklist 9086

C. FACES IV 9187

D. Parenting Scale 940

E. Parenting Styles and Dimensions Questionnaire 984

F. Table 15 - Table 14 – Definitions of At-Risk 10096

References 10196

List of Tables

Table 1 Crosstabulation of Gender and Age of Participants 598

Table 2 Gender of Preschool Children in Sample 6059

Table 3 Age of Preschool Children in Sample 6059

Table 4 Ethnic Makeup of Sample 6059

Table 5 Number of children in family 610

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Table 6 Income of Parents Completing Parenting Scale 621

Table 7 The Observation of Depressive Symptoms in

Preschool Children 643

Table 8 PFC – Means and Standard Deviations 64

Table 9 Crosstabulation of Parent and Teacher Reports of At Risk

Children According to the Clinical Definition 654

Table 10 Crosstabulation of Parent and Teacher Reports of At Risk

Children According to the Less Stringent Definition 665

Table 11 Logistic Regression Analysis for relationship between

Parenting Styles and Depressive Symptoms using the

Teacher Report and the Less Stringent Definition of

At Risk 687

Table 12 Logistic Regression Analysis for the relationship

between the centered Authoritarian Parenting

Style and Depressive Symptoms using the Teacher Report and

the Less Stringent Definition of At Risk 687

Table 13 Logistic Regression Analysis for the relationship

between Family Functioning and Depressive Symptoms

using the Teacher Report and the Less Stringent

Definition of At Risk 7169

Table 14 Logistic Regression Analysis for the relationship between the

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Centered Variable of Flexible Family Functioning and

Depressive Symptoms using the Teacher Report and

the Less Stringent Definition of At Risk 7169

Table 15 Definitions of At-Risk 10096

List of Figures

Figure 1 ROC Curve using the seven predictor (authoritarian

parenting, permissive parenting, laxness, over reactivity,

hostility, cohesive family functioning, and flexible family

functioning) logistic regression model with the teacher report

and the less stringent definition of at risk (TARLS) as the

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outcome variable 731

Figure 2 ROC Curve using the seven predictor (authoritarian

parenting, permissive parenting, laxness, over reactivity,

hostility, cohesive family functioning, and flexible family

functioning) logistic regression model with the teacher report

and the clinical definition of at risk (TARC) as the

outcome variable 743

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Chapter 1

Introduction

In recent decades, research (e.g., Kovacs, 1996; Stark, 1990; Stark et al., 1990)

has emerged regarding the existence of depression in school age children and

adolescents; yet research regarding preschool children who show signs of depression is

lagging behind despite studies (e.g., Luby, Heffelfinger, Mrakotsky, Hessler, & Brown,

2002; Luby et al., 2003) demonstrating that signs of depression can be detected during

the preschool years. In order to effectively help these preschoolers, a thorough

understanding of the factors impacting the development of depression at such a young

age is necessary. There is empirical evidence (e.g., Normura, 2002; Rodriguez, 2003;

Sander & McCarty, 2005) demonstrating that familial factors appear to affect the

development of depression in school-age children and adolescents, but no studies have

examined whether these factors affect the development of depression in preschool

children as well.

According to the Diagnostic and Statistical Manual of Mental Disorders – Fourth

Edition (DSM-IV) (1994) there are three diagnostic categories of depression, all of which

can occur at any age. These include Major Depressive Disorder (MDD), Dysthymic

Disorder (DD), and Depressive Disorder Not Otherwise Specified (DDNOS). While

many of the symptoms are shared between MDD and DD, these categories are

characterized by differences in severity, chronicity, and persistence. DDNOS is

diagnosed when an individual is suffering from depression, but the severity, frequency, or

number of symptoms is not sufficient enough to warrant a diagnosis of DD or MDD.

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The DSM-IV (1994) specifies some of the ways depression may manifest itself in

children. Symptoms of MDD that are seen more frequently in young children include

somatic complaints, irritability, and social withdrawal. Dysthymic Disorder often has an

early onset. It is not unusual for a child to develop DD early on in life and later on

develop MDD. In children, DD frequently results in poor school performance and

impaired social skills. Children with Dysthymic Disorder are often irritable and cranky

as well as depressed. Low self-esteem and pessimism are also observed in children with

DD.

Over the past two decades, the existence of depression in children has become

widely recognized and taken very seriously by practitioners as well as researchers.

According to Stark (1990) when both cases of MDD and DD are considered, between

five and seven percent of the general school population from fourth, fifth, sixth, and

seventh grades may be experiencing a depressive disorder at any given time. This figure

progressively increases through middle school and high school.

Due to the increasing prevalence of depression in children, it seems urgent to

identify and treat symptoms of the disorder while the children are in preschool, prior to

reaching the abovementioned age range so as to improve the prognosis and prevent more

severe problems from developing later on in life (Luby, Heffelfinger, Mrakotsky,

Hessler, & Brown, 2002; Luby et al., 2003; Zito et al, 2000).

Research exists demonstrating that depression does exist in the preschool

population (Kashani, Holcomb, & Orvaschel, 1986; Kashani, Ray, & Carlson, 1984;;

Zito, et al., 2000). It is important to collect data from multiple sources, such as parents

and teachers, regarding children who might be at risk for the disorder due to the

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discrepancies in observations by different individuals (Junttila, Voeten, Kaukianinen, &

Vauras, 2006; Kashani, Holcomb, & Orvaschel, 1986). We also know that depression in

preschoolers is characterized predominantly by typical symptoms such as sadness,

irritability, and vegetative states. Depressed preschool children also exhibit more

destructive and suicidal play themes than the comparison groups (Luby et al., 2003).

Additionally, depressed preschool children exhibit less symbolic play than non-depressed

peers as well as less coherence of play, as they tend to switch play behaviors more often

than non-depressed children (Mol, De Wit, & De Bruyn, 2000). An effective screening

tool has been developed to identify preschool children with depressive symptoms (Luby

et al., 2004). Psychotropic medications are being prescribed, perhaps irresponsibly (Zito

et al., 2000), as an intervention for the disorder, indicating that families are seeking

assistance for their children who are experiencing some symptoms of depression.

There are various family-related factors that have been demonstrated to be

important with regard to the development of children in general. Some of these factors

have been empirically demonstrated to be related to the development of depression in

children and may also play a role in depression in preschoolers. These factors include

parenting styles, parenting discipline practices, and family functioning.

The concept of parenting styles was developed by Baumrind (1971) and includes

three prototypes including authoritative, authoritarian, and permissive parenting.

Authoritative parents are described as controlling and demanding as well as warm,

encouraging, rational, and receptive to the child’s communication. Authoritarian parental

behavior refers to parents who are detached and controlling and somewhat less warm

than other parents. Permissive parents refer to parents who are not controlling or

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demanding and relatively warm. The research has consistently indicated that parents

utilizing the authoritative parenting style tend to raise children who are more socially

competent and independent (Robinson, Mandleco, Frost Olsen, & Hart, 1995).

While there are no direct studies of Baumrind’s three parenting typologies and

how they are associated specifically with depression in children, there are many studies

looking at characteristics of parenting styles that overlap with the authoritative typology

described by Baumrind. The results of these studies indicate that family environments

that are not emotionally supportive, are punitive, and are not democratic in decision-

making are more likely to raise depressed children. Conversely, parents who are

authoritative, firm, and value the opinions of their children are more likely to bring up

children who are content and well-adjusted (Arieti & Bemporad, 1980; Gallimore &

Kurdek, 1992; Sander & McCarty, 2005; Stark, Humphrey, Crooke & Lewis, 1990). The

only study looking at parental factors and depression in the preschool population was

conducted by Belden and Luby (2006) who investigated the relationship between

preschool depression severity and parent emotional support. They found that

preschoolers who demonstrated higher depression severity scores experienced parenting

strategies that were less emotionally supportive. Emotional support was viewed as a

mother’s expression of positive regard, encouragement on novel tasks, a sense of when

her child is in need of encouragement, and respecting the child’s need for autonomy.

While the authors did not refer to this as authoritative parenting, the descriptions are very

much similar to Baumrind’s authoritative prototype. Thus, parents with less authoritative

parenting styles yielded children with elevated depression severity scores.

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Parenting discipline practices refer to parents’ methods of training their children

to act according to a certain set of rules or guidelines. Discipline practices are the

strategies that parents use to manage their children’s behavior or misbehavior. There is

an empirically-established relationship between parenting discipline mistakes and the

behavior disorders of children. Less is known about the relationship of discipline

practices to childhood anxiety, fear, and depression (O’Leary, 1995).

O’Leary describes three potential mistakes that parents of young children can

make. The first mistake, referred to as laxness, is the tendency to give in to one’s

children and not enforce rules. The second mistake, overreactivity, involves frequent

displays of anger, irritability, and meanness. The third mistake, called hostility, involves

a parent’s use of physical punishment, cursing, and name-calling.

While there is only one study looking at parental discipline practices and

depression in children using the three discipline mistakes described by O’Leary (1995),

there are many studies looking at parenting discipline practices, utilizing different

definitions and variables. An attempt was made to connect the variables that exist in the

literature to O’Leary’s three discipline mistakes, thereby utilizing the existing studies as

evidence supporting the connection between parenting discipline mistakes and the

development of depression in children. These studies seem to indicate that there is an

association between the discipline mistake of overreactivity and the development of

depression in children (Asarnow, Goldstein, Tompson, & Guthrie, 1993; Leve, Kim, &

Pears, 2005; Rodriguez, 2003).

Normal family functioning refers to basic patterns of interactions that sustain the

preservation of the family unit and its ability to facilitate the performance of certain tasks

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that foster the growth and well-being of its members (Walsh, 2003). One useful way of

looking at family functioning is using the Circumplex Model, which has its roots

grounded in systems theory. The model includes three dimensions of family functioning

including family cohesion, flexibility, and communication. Family cohesion refers to the

emotional bonds that couples and families have towards one another. Extreme levels of

either separateness or togetherness are considered dysfunctional. Family flexibility refers

to the amount of change that occurs in terms of its leadership, role relationships, and

relationship rules. The focus of flexibility is on the quality and expression of leadership

and organization, role relationship, and relationship rules and negotiations. As with

cohesion, a system that functions at the extremes of flexibility is more problematic than a

system that is more balanced between the two. The third dimension, communication, is

referred to as a facilitating dimension, as this dimension aids families in adapting their

cohesion and flexibility to meet the demands of changing circumstances.

Communication is measured by assessing a family’s listening skills, speaking skills,

continuity tracking, self-disclosure, respect, and regard (Olson, Gorall, & Tiesel, 2007).

There are no studies, to date, that look at the relationship between family

functioning and the development of depression in preschoolers. Yet, the studies done

with older children seem to indicate that families of depressed individuals do function

more poorly than families without depressed individuals. When viewed from the

Circumplex model, low cohesion and adaptability have been observed in families of

depressed patients (Kashani et al., 1995; Kashani, Suarez, & Jones, 1999; Shiner, 1998).

It is important to mention that there are two risk factors which appear to be related

to the development of depression in both school age as well as preschool children. These

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include a family history of mood disorders and stressful life events (Luby, Belden, &

Spitznagel, 2006).

Based on the literature reviewed, it appears that certain family factors identified

as related to childhood depression may also be associated with depression in preschool

children. The literature review leads to the following research questions:

1. Are depressive symptoms observable in the preschool population?

2. Will there be a lack of agreement between teacher and parent responses to a

behavior checklist regarding the child’s symptoms?

3. Is there a relationship between parenting styles and depressive

symptomatology in young children?

4. Are dysfunctional discipline practices related to depressive symptomatology

in young children?

5. Is family functioning related to depression in preschool children?

Data were gathered from preschools in Queens, Manhattan, and Long Island. The

data were analyzed using descriptive statistics, Cohens’s Kappa statistics, logistic

regression, and a receiver operating characteristic curve (ROC curve). Findings of the

study indicate that depressive symptoms were observable in the preschool population.

There was a lack of agreement between teacher and parent responses to a behavior

checklist regarding the child’s symptoms. The regression analyses yielded significant

findings only when the teacher report of symptoms was used. Findings indicate that there

was a relationship between the authoritarian parenting style and depressive symptoms.

Dysfunctional discipline practices were not significantly related to depressive

symptomatology. Rigid family functioning was related to signs of depression in

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preschool children. Finally, when all the familial factors were plotted on an ROC curve,

they demonstrated the ability to make good predictions about preschoolers who may be at

risk for depression.

The authoritarian parenting style and rigid family functioning are consistent in

many ways. Controlling parents who demand obedience and do not allow for negotiation

create a home environment that is rigid and inflexible. Such a parenting style fosters a

home environment that does not adapt to new situations and circumstances in a flexible

and functional way. Therefore, it is intuitive that those two variables were both

significant predictors for preschoolers who are at risk for developing depression. The

ROC curve indicated that familial factors can work together to predict preschoolers who

are at risk for depression. Based on this model, the true positive rate is counter-balanced

by the low false positive rate, which is desirable for good predictions. There are several

limitations to the study including objectivity of responses on the scales, size of the

sample, and homogeneity of the samples. Nevertheless, findings of the current study have

important implications for preschools. Prevention and intervention programs can be

developed for children, teachers, and families so that symptoms of depression are

prevented or decreased before they become severe enough to significantly impact daily

functioning.

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Chapter Two

Literature Review

Over the course of the past several decades, professionals have become

increasingly aware of the existence of depressive disorders in children. While children as

young as 6 years old have been diagnosed with Major Depressive Disorders, empirical

evidence and public awareness that the disorder exists at younger ages is lagging.

Recently, there has been some research indicating that symptoms of depression do exist

in preschool children. In order to effectively help them, a thorough understanding of the

factors impacting the development of depression at such a young age is necessary.

Research has demonstrated that there are familial factors that appear to affect the

development of depression in school-age children and adolescents. These factors might

be applicable to the development of depression in preschoolers as well.

In the following pages the research on children with depression as well as

preschool children with depressive symptoms will be discussed. That will be followed by

a review of the research on familial factors and depression in school age children and

adolescents, including parenting styles, discipline practices, and family functioning. Risk

factors for the development of depression in preschool children will be discussed as well

as agreement between teachers and parents regarding symptoms of depression. Finally, a

study is proposed which will investigate the association between these familial factors

and the development of depressive symptoms in preschool children.

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Depressive Disorders

According to the Diagnostic and Statistical Manual of Mental Disorders – Fourth

Edition (DSM-IV) (1994) there are three diagnostic categories of depression, all of which

can occur at any age. These are Major Depressive Disorder (MDD), Dysthymic Disorder

(DD), and Depressed Disorder Not Otherwise Specified (DDNOS). While many of the

symptoms are shared between MDD and DD, these categories are characterized by

differences in severity, chronicity, and persistence. DDNOS is diagnosed when an

individual is suffering from depression, but the severity, frequency, or number of systems

is not sufficient to warrant a diagnosis of DD or MDD. Each of these disorders are

defined and a description of what the disorders might look like in young children is

provided below.

Major Depressive Disorder

There are several subcategories of Major Depressive Disorders as per the

diagnostic categories of the DSM-IV (1994). The differentiation between categories is

based on the number of major depressive episodes that an individual experiences. The

critical characteristic of a major depressive episode is either depressed mood or the loss

of interest or pleasure in most activities for a period of at least two weeks. Additionally,

the individual must experience at least four of the following symptoms for a two week

period:

1. Considerable weight loss or gain or considerable increase or decrease

in appetite almost everyday.

2. Insomnia or hypersomnia almost daily

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3. Psychomotor agitation or retardation almost everyday that is visible to

others

4. Exhaustion or loss of energy almost daily

5. Feelings of worthlessness or extreme unjustifiable guilt nearly every

day

6. Reduced capacity to think/concentrate or inability to make decisions

every day

7. Repeated thoughts of death or suicidal ideation or a suicide attempt or

plan

There are two subtypes of Major Depressive Disorder. Major Depressive

Disorder, Single Episode involves the presence of a single Major Depressive Episode and

Major Depressive Disorder, Recurrent involves the presence of two or more major

depressive episodes with at least two months between episodes. While the onset of MDD

can occur at any age, the average age of onset is in the early 20s.

Dysthymic Disorder

Dysthymic Disorder involves a chronically depressed mood that happens most of

the day, for more days than not, and for at least two years. During the time period in

which the individual is depressed, two of the following symptoms must be present and

cannot be absent for more than two months at a time:

1. poor appetite or overeating

2. insomnia or hypersomnia

3. low energy or fatigue

4. low self-esteem

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5. poor concentration or difficulty making decisions

6. feelings of hopelessness

Major Depressive Disorder may have been present previously, but there must

have been full remission prior to the development of Dysthymic Disorder. Additionally,

after the initial two years of the disorder it is possible for there to be superimposed

episodes of Major Depressive Disorder in which case both diagnoses may be given. In

order to be diagnosed with Dysthymic Disorder, the symptoms must cause clinically

significant distress or impairment in social, occupational, or other important areas of life

functioning

Depressive Disorder Not Otherwise Specified

Individuals diagnosed with this disorder experience symptoms of depression but

do not meet the criteria for any of the other disorders.

Depression in Children

The DSM-IV (1994) specifies some of the different ways depression may

manifest itself in children. In children with Major Depressive Disorder, the mood may

look irritable rather than sad. Additionally, instead of considerable weight loss or weight

gain, children with MDD may experience a failure to make expected weight gain. There

may be psychomotor agitation, such as restlessness or excessive fidgeting or

psychomotor retardation such as lack of energy or lethargy almost every day. Symptoms

of MDD that are seen more frequently in young children include somatic complaints such

as frequent complaints of headaches or stomachaches, irritability, or the tendency to often

be “on edge” around others, and social withdrawal, such as a once social child who stops

hanging out with his or her friends outside of school. Psychomotor retardation,

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hypersomnia, and delusions are less common in young children. Additionally, young

children often experience major depressive episodes in combination with other mental

disorders such as disruptive behavior disorders, attention deficit disorders, and anxiety

disorders.

In children with Dysthymic Disorder, the mood may also seem irritable rather

than sad, and the minimum duration is one year rather than two. Dysthymic Disorder

often has an early onset. It is not unusual for a child to develop DD early on in life and

later on develop MDD. In children, DD frequently results in poor school performance

and impaired social skills. Examples of how impaired social skills may be exhibited in

children are through behaviors such as inappropriate touching, an inability to initiate a

successful social interaction with a peer, or social withdrawal. Children with dysthymic

disorder are often irritable and cranky as well as depressed. Low self-esteem and

pessimism are also observed in children with dysthymic disorder.

Over the past two decades, the existence of depression in children has become

widely recognized and of serious concern to practitioners and researchers. Since the

addition of the diagnostic criteria for Major Depressive Disorder in children in the

Diagnostic and Statistical Manual of Mental Disorders – Third Edition – Revised (APA,

1987) , it has been confirmed that childhood depression is an illness that is both chronic

and relapsing and does not develop spontaneously (Kovacs, 1996). According to Stark

(1990) when both cases of major depression and dysthymic disorder are considered,

between five and seven percent of the general school population from fourth, fifth, sixth,

and seventh grades may be experiencing a depressive disorder at any given time. This

figure progressively increases through middle school and high school.

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Due to the increasing prevalence of depression in children, it seems urgent to

identify and treat symptoms of the disorder while the children are in preschool, prior to

reaching the abovementioned age range so as to improve the prognosis and prevent more

severe problems from developing later (Luby, Heffelfinger, Mrakotsky, Hessler, &

Brown, 2002; ).

Depressive Symptoms in Preschool Children

In the past several decades, attention has been directed at whether depressive

symptoms occur in preschool children. Research indicates that symptoms of depression

do exist in preschoolers more so than was previously perceived.

Kashani and Ray (1983) conducted a preliminary study in which they utilized

parent reports to determine if depressive symptoms existed in preschool-age children.

They mailed parents a questionnaire about symptoms of major depression and found that

no depression was reported among these preschoolers. While there were many

shortcomings to this study, relying on only one source of information was a major flaw in

the research design. Additionally, including only questions regarding symptoms of

Major Depressive Disorder was considered a limitation. At the conclusion of the study,

the authors recommended a more comprehensive approach to identifying depressive

symptoms within this age group.

Subsequently, Kashani, Ray, and Carlson (1984) designed a study with the goal of

collecting data regarding the existence of depression in preschool children. The sample

consisted of 100 children ages 1 to 6 years old who were referred to a child development

unit for developmental, behavioral, or emotional problems. Following the referral, a two-

day evaluation took place by a child psychiatrist and a clinical child psychologist. All

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aspects of the children’s functioning were explored including emerging academics, motor

skills, speech and language, psychological functioning, and family functioning. Parents

were also interviewed regarding the functioning of the referred child. Additionally,

children and parents were observed interacting with each other and these interactions

were recorded. Out of the 100 referred children, 7 children reported frequent feelings of

sadness and all seven were confirmed by their parents as being unhappy most of the time.

Another 10% of parents reported that their children were unhappy most of the time, but

these children did not report feeling sad. Comprehensive evaluations indicated that only

four out of the 100 referred children met DSM-III criteria for one of the depressive

disorders. Three out of the four children would have been diagnosed with Dysthymic

Disorder and one with Major Depressive Disorder. Thus, while depression does exist in

preschool children, it is possible that young children experience more minor symptoms

characteristic of Dysthymic Disorder and these symptoms become more severe with time.

While these authors found that preschoolers do experience symptoms of depression, it is

less common than in older children and adolescents and it is also often less severe.

Kashani, Holcomb, and Orvaschel (1986) then set out to investigate whether or

not depressive symptoms exist in the general preschool population. They examined a

group of children ranging in age from two and a half to six years old, who had depressive

symptoms but did not meet DSM-III criteria for affective disorders. Additionally, they

wanted to compare the responses of parents and teachers with regard to the depressive

symptoms of preschool children. Finally, they wanted to investigate whether life events

had a correlation with depressive symptoms in preschool children.

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Participants in Kashani et al.’s (1986) study included 109 preschool children

enrolled in two community nursery schools. Data were collected from a variety of

sources; preschool children participated in a psychological assessment, and parents as

well as teachers completed several different checklists and questionnaires. Children

whose psychological testing or questionnaires demonstrated symptoms of Major

Depressive Disorder or Dysthymic Disorder were interviewed and observed in the

preschool setting. Based on the interview and observations, attempts were made to

identify those children who presented with depressive symptoms.

There were several key findings of the Kashani et al. (1986) study. Earlier results

acknowledging the existence of depressive symptoms in preschool children in a clinic

were reportedly true for the general population as well. It was also found that although

preschool children did exhibit concerning depressive symptoms, the symptoms were

usually not sufficient to reach a diagnosis of clinical depression (only one child met

criteria for major depression). Comparisons of parent and teacher responses indicated no

correlation and at times, even a negative correlation leading to the conclusion that there is

a discrepancy between parents’ and teachers’ ratings of depressive symptoms in

preschoolers. An individual case study was investigated as part of the larger study and

demonstrated that the parent underreported her child’s symptoms while the teacher

responded more accurately. Thus, teachers serve as important sources of information, but

multiple sources of data should always be gathered. Results also indicated that parents

of preschool children with depressive symptoms report more stressful life events than

parents of preschool children without depressive symptoms.

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Luby et al. (2002) hypothesized that developmentally modified criteria of the

Diagnostic and Statistical Manual of Mental Disorders (DSM) are necessary in order to

identify and treat preschool children with depressive symptoms. One hundred and thirty

six preschool children ages 3-0 to 5-6 were assessed via a variety of scales and

observations to determine if they met criteria for a developmentally modified DSM

diagnosis of Major Depressive Disorder. The modified diagnosis was referred to as

“preschool diagnostic criteria for MDD”, or “P-DC-MDD.” Data demonstrated that

when age appropriate symptom manifestations were assessed, preschool children who

met the modified criteria for MDD exhibited elevated levels of “typical” depressive

symptoms. Seventy-six percent of these children would not have met standard DSM

guidelines. The authors concluded that as per their hypothesis, modified criteria are

required. It is noteworthy to mention that the children with depressive symptoms were

found to be significantly more socially impaired than normal children and, therefore,

should not merely be considered an at-risk group, but rather a clinically significant

population who require early identification and intervention.

The diagnostic criteria for Preschool Major Depressive Disorder, proposed by

Luby et al. (2002) included five or more of the following symptoms that have been

present but not necessarily persistent over a 2-week period and represent a change from

previous functioning. At least one of the symptoms is either depressed mood or loss of

interest or pleasure in activities or play. If both the above criteria are present, a total of

only four symptoms are needed. The symptoms include:

1. Observed or reported depressed mood for a portion of the day for

several days. The mood may be irritable instead of depressed.

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2. Noticeably diminished interest or pleasure in all, or almost all activities

or play for a portion of the day for several days (as indicated by either

subjective account or observation made by others).

3. Considerable weight loss when not dieting or weight gain or decrease

or increase in appetite almost every day.

4. Insomnia or hypersomnia almost daily.

5. Psychomotor agitation or retardation almost every day (observable by

others, not merely subjective feelings of restlessness or being slowed

down).

6. Fatigue or loss of energy nearly every day.

7. Feelings of worthlessness or extreme amounts of or inappropriate guilt

(which may be delusional) that may be evident in play themes.

8. Reduced ability to think or concentrate, or indecisiveness, for several

days (either by subjective account or as observed by others).

9. Repeated thoughts of death (not just fear of dying), repeated suicidal

ideation without a specific plan, or a suicide attempt or a specific plan

for committing suicide. Suicidal or self-destructive themes are

persistently evident in play.

Using these new diagnostic criteria for preschoolers, Luby et al. (2003)

investigated the clinical characteristics of depression in preschoolers. They found that

depression in this population is characterized predominantly by “typical symptoms” such

as sadness, irritability, and vegetative states. Depressed preschool children also exhibited

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Familial Factors

more destructive and suicidal play themes than the comparison groups. “Masked

symptoms,” such as somatic complaints were not as common as typical symptoms.

Mol, De Wit, Cees, and De Bruyn (2000) conducted an exploratory study

investigating the differences in the play behavior of depressed and nondepressed 3 to 6

year olds. More specifically, they looked at whether depressed and non depressed

children differed in the amount of play in which they engaged. They also investigated if

there was a difference in the level of coherence in their play and if affect regulation

problems influenced the play of young children. Finally, they explored whether inducing

positive or negative moods during play situations affected the play behavior of depressed

and nondepressed children.

The behavior of seven depressed and seven non depressed 3 to 6 year olds was

compared in three different play situations: solitary free play, interactive free play, and

play narratives. Each play situation was subdivided into a positive, negative, or neutral

mood. In each of the three play situations, nine behavior categories were coded. In order

to observe the amount of coherence in the behaviors of depressed and nondepressed

children, the number of behavior changes was computed for each child. A behavior

change was recorded each time the child’s behavior changed from any category of play or

nonplay behavior to another.

The findings of the Mol et al. (2000) study indicated that depressed 3 to 6 year old

children demonstrated less play behavior than their nondepressed peers during symbolic

play. In this situation, they also exhibited more nonplay behavior such as more

orientation towards the environment and towards the experimenter. The groups did not

differ with regard to manipulative play. Additionally, depressed children demonstrated

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Familial Factors

less coherence of play as they switched behaviors more often than nondepressed children.

Mood induction did not influence the play of depressed or nondepressed children.

These findings indicate that while there are differences in the play behavior of

depressed and nondepressed preschool children, the depressed children did not exhibit the

typical low level of activity or retardation that is often observed in adults with depression.

Instead, the play behavior of depressed preschool children appears to be different, but

still active, or “differently active.” These findings are similar to the findings of Kashani

et al. (1997) who found that young depressed children demonstrate psychomotor

agitation more often than they demonstrate decreased activity.

The results of Mol et al. (2000) and Kashani et al. (1997) shed additional light on

the screening and identification of preschoolers with depression. Teachers and parents

can observe play styles and preferences in order to gather evidence for diagnosis and

treatment. Additionally, counter to what one might automatically assume, depressed

preschoolers often do not appear withdrawn and lethargic, but rather they are irritable and

agitated. Teachers and clinicians may automatically assume the child has attention or

regulation difficulties characteristic of attention deficit hyperactivity disorder, without

even considering the possibility that the child is experiencing depression.

Frequency of use of antidepressants with preschool children is another indicator

of concern about depression in preschool children. The prevalence of psychotropic

medication as a treatment for children younger than five years old has not received much

attention in the literature until recently. Zito et al. (2000) used three large computerized

data sources to estimate the prevalence of psychotropic medications in 2 through 4 year

olds. They found that antidepressants were the second leading treatment among this age

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Familial Factors

group. Additionally, the rate of the use of psychotropic medications prescribed for

preschoolers increased significantly from 1991 to 1995. The increase was greatest for

three medications, antidepressants being one of them. These findings are somewhat

surprising in light of the limited knowledge base not only about the existence of

depression in preschool children but also about the use of psychotropic medications in

such young children. The findings of Zito et al. indicate that despite the limited

knowledge base in this area, families are recognizing depressive symptoms in preschool

children, to such an extent that antidepressants are being prescribed often. While the

practice of prescribing psychotropic medications with such limited amounts of research is

troubling, it alerts researchers that depression in preschool children is certainly occurring.

While we do not know a lot about preschoolers and depression, there have been

some important findings in this area. While the research regarding preschool children is

not at all extensive, it does demonstrate that the disorder exists in the population

(Kashani, Ray, & Carlson, 1984; Kashani, Holcomb, & Orvaschel, 1986; Zito et al.,

2000). The sources of information that are necessary in order to collect information

regarding the children at risk for the disorder are known (Kashani, Holcomb, &

Orvaschel, 1986) as well as what the symptoms look like (Luby et al., 2003; Mol et al.

2000). Psychotropic medications are being prescribed, perhaps irresponsibly as an

intervention for the disorder, indicating that families are seeking assistance for their

children who are experiencing some symptoms of depression. Additional data are needed

regarding factors that affect depression in such young children in order to develop

empirically supported interventions.

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Familial Factors

It seems clear that depressive disorders exist in the preschool population. It is

imperative that valid and effective prevention and intervention programs are developed to

address these symptoms. Due to the fact that symptoms can be apparent as early as

preschool, intervening then may be an ideal way of preventing the problem from

becoming more severe. In order to do this, we must investigate why increasing numbers

of preschool children are showing signs of chronic unhappiness.

Familial Factors and Depression

There are various family-related factors that have been demonstrated to be crucial

with regard to the development of children in general. Some of these factors have been

empirically demonstrated to be related to the development of depression in children.

These factors are parenting styles, parenting discipline practices, and family functioning

and are discussed below.

Parenting Styles

One family factor that has been established as crucial in many areas of child

development is the parenting styles of mothers and fathers. Baumrind (1971)

conceptualized three main prototypes of parenting styles that have lead to a plethora of

research regarding these styles and their effects on child-rearing outcomes. The three

typologies of parenting styles are authoritative, authoritarian, and permissive. The

research on these three typologies has been fairly consistent in its findings regarding the

effect that such parenting styles have on middle-class children. Children raised by

parents utilizing the authoritative parenting style tend to be more socially competent and

independent (Robinson, Mandleco, Frost Olsen, & Hart, 1995).

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Familial Factors

Authoritative parents are described as controlling and demanding as well as

warm, encouraging, rational, and receptive to the child’s communication. They value

both autonomy and conformity and demand that their children take part in family

functioning and household tasks. They respect their own rights as adults as well as the

rights of their children as individuals with unique interests. Children of authoritative

parents have been found to be self-reliant, self-controlled, explorative, and content.

Preschool children from authoritative homes were consistently found to be significantly

more competent than their peers. Girls were observed to be purposive, dominant, and

achievement-oriented, while boys were friendly and cooperative (Baumrind, 1989).

Authoritarian parental behavior refers to parents who are detached and controlling

and somewhat less warm than other parents. They attempt to shape, evaluate, and control

their children’s attitudes and behaviors according to a set standard of behavior, usually a

code of conduct that is theologically based or developed by a higher authority. There is

no negotiation between parents and children as parents are viewed as the absolute

authority. Obedience is considered a virtue and punishments are usually punitive and

forceful and are used when there is a conflict between the beliefs or actions of their child

and their standard of acceptable conduct. Children of authoritarian parents were found,

relative to others, to be unhappy, withdrawn, and distrustful. More specifically, boys

were found to be hostile and resistive, and girls were found to be lacking in independence

and dominance (Baumrind, 1989).

The third prototype, called permissive parenting, refers to parents who are

noncontrolling, nondemanding, and relatively warm. They give children autonomy.

They are accepting of their children’s impulses, demands, and desires and are

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Familial Factors

nonpunitive. They make few maturity demands. Permissive parents allow their children

to regulate their own activities. Parents are present as resources for their children to use

as they wish but are not there to alter their children’s current or future behavior. They do

not demand that the attitudes or behaviors of their children meet externally defined

standards. Children of such parents have been found to be the least self-reliant,

explorative, and self-controlled as well as quite immature. Compared with children of

authoritative parents, girls have been found to be less socially assertive and both girls and

boys were less achievement oriented (Baumrind, 1989).

While there are no direct studies of Baumrind’s three parenting typologies and

how they are associated specifically with depression in children, there are many studies

that examined characteristics of parenting styles that overlap with the authoritative

typology described by Baumrind.

Sander and McCarty (2005) reviewed some of the literature regarding familial

risk factors related to depression in youth. They came to several conclusions regarding

these risk factors. First, parental depression is clearly linked to childhood depression.

Second, relationships between parent and child, interactions between the child’s

temperament and the child’s ability to cope with the family environment, and the impact

of stress on the family system are all contributing factors to depression in youth.

Additionally, lack of parental warmth and availability have consistently been found to be

a risk for youth depression. “Affectionless control” was a term used by Nomura,

Wickramaratne, Warner, and Weissman (as cited in Sander and McCarty, 2005) to

describe a style of discipline that was characterized by a high level of control and little

warmth and was found to be highly predictive of depression in youth of nondepressed

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Familial Factors

parents. While the authors did not utilize Baumrind’s typologies, affectionless control

appears to be similar to elements of the authoritarian parenting style.

Gallimore and Kurdek (1992) looked at parenting style and how it relates to

depression in adolescents. More specifically, they hypothesized that the severity of the

adolescents’ depressive symptoms would be negatively related to the extent to which

fathers, mothers or both parents used authoritative discipline techniques. Thirty-five

eighth-grade and ninth-grade students who lived with both parents served as participants

of the study. Students filled out the Child Depression Inventory (Kovacs & Beck, 1977)

and the Authoritative Parenting: Adolescent Version, which is a modification of a

measure designed by Buri, Louiselle, Misukanis, and Mueller (1988) for college students.

Parents completed the Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979)

and the Authoritative Parenting: Parent Version. The results of the study indicate a

significant and negative correlation between the amount of authoritative discipline of the

father (as reported by the adolescent) and depression in the adolescent, that is, the more

authoritative discipline techniques used by the father, the less symptoms of depression

existed in the adolescent and vice versa. Moreover, it was found that a father’s

authoritative parenting mediated the effects of parental depression on child development:

when fathers utilized an authoritative parenting style, adolescents with depressed parents

were less depressed.

Thus, not only is authoritative parenting beneficial in the development of

emotionally healthy children, but it can reduce the powerful effects that parental

depression often has on a child’s emotional development. One hypothesis provided by

the authors to explain the significant correlation observed with regard to fathers’

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Familial Factors

parenting styles but not mothers’ is that during adolescence, conflicts between child and

parents typically increase, and mothers and fathers tend to react differently to the

increase. Mothers tend to back off and, therefore, adolescents usually confront them,

while fathers become more assertive and adolescents defer to them. Therefore, fathers

may be vital socialization agents during early adolescence.

Stark, Humphrey, Crook, and Lewis (1990) examined the perceived environments

of families with a depressed, depressed and anxious, anxious, or normal child from fourth

to seventh grade. Results of the study demonstrated that the child pathology could be

predicted based on knowledge of their perceived family environments. Children from the

pathological group as compared with the normal control children perceived their family

environments to be less supportive, less engaged in outside recreational, social, or

religious activities, and more enmeshed. Children felt less involved in decisions made

about them and their family. One of the most consistent findings of the study was that

families of depressed children were perceived to be significantly less democratic than all

the other families. In other words, depressed children consistently reported having less of

an impact in the family decision-making. Democratic families and a tendency to value

the opinions of the children is another important factor in authoritative parenting.

Arieti and Bemporad (1980) found that parents of depressed youngsters often

display a critical, punitive, and belittling or shaming parenting style that leads the child to

feel bad, worthless, unlovable, and depressed. Such parenting resembles Baumrind’s

descriptions of the authoritarian parenting style.

While the abovementioned studies of children did not all utilize Baumrind’s three

parenting styles, they all yield similar results. Family environments that are not

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Familial Factors

emotionally supportive, are punitive, and are not democratic in decision-making are more

likely to bring up children who are depressed. Parents who are authoritative, firm, and

value the opinions of their children are more likely to bring up children who are content

and well-adjusted.

Some research has studied parenting styles and preschoolers. Baumrind’s

observational studies of parenting styles and preschoolers’ behavior (Baumrind, 1968)

indicate that different parenting styles correlate with different behaviors in preschool

children. Mothers who were either very harsh (authoritarian prototype) or permissive

(permissive prototype) in their discipline tended to have children who were poorly

behaved or aggressive.

In one of her studies, Baumrind (1967) set out to identify the parent attitudes and

behaviors that are associated with competent behavior in nursery school for both boys

and girls. The goal of the study was to empirically examine a mainstream preschool

population to determine the relationship between parent behaviors, parent attitudes, and

child behaviors. Ninety-five families and their preschool children (ages 3 and 4)

participated in the study. The behavior of the children was observed and rated by

psychologists over a 3-month period of time. The domains of behavior that were rated

included neurotic symptoms, mood and energy characteristics, and interpersonal

behaviors such as self-control, perseverance, self-reliance, self-assertiveness, friendliness,

and cooperativeness. They also attempted to assess dominance and independence in the

children. An analysis of the items observed yielded an eight-cluster structure for the boys

and a different eight-cluster structure for the girls. The eight clusters for boys included

unlikable-likeable, hostile-friendly, impetuous-self-controlled, rebellious-dependable,

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Familial Factors

autonomous-compliant, imaginative-stereotyped, adaptive-regressive, and confident-

fearful. The eight clusters for the girls included hostile-friendly, unsocialized-well

socialized, obstructive-helpful, rebellious-dependable, domineering-tractable,

autonomous-compliant, at ease-ill at ease, confident-fearful, and adaptive-regressive. A

second set of clusters were also developed that were the same for both boys and girls

including clusters such as independent-dependent, assertive-withdrawn, irresponsible-

responsible, and nonconforming-conforming.

Data regarding parenting styles were obtained by assessing parental behavior in

the home. The observations took place from before dinner until after the child’s bedtime.

Parent-child interactions were recorded during the observation and coded after the visit

was over. The coded information was later used as the basis for defining theoretically

relevant variables. The parents were also interviewed regarding their attitudes as parents

and their child rearing practices.

Results of the study indicated several key findings. First, parental warmth was

not found to be an important predictor of child behavior. Second, punitive attitudes of

the parents were not found to be associated with fearful or compliant behavior. Third,

paternal consistent discipline (authoritative parenting) was associated with independence

and assertiveness in boys and with affiliativeness in girls. Maternal maturity demands

were also correlated with independence and assertiveness for boys. For girls, maternal

socialization demands were correlated with independence and assertiveness.

Additionally, parental willingness to offer justification for directives and to listen to the

child (authoritative parenting) was associated with competent behavior on the part of the

child. Restrictiveness and refusal to grant enough independence (authoritarian parenting)

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Familial Factors

were correlated with dependent and passive behavior in boys. In sum, parents of mature

children were less authoritarian, but just as firm and more loving.

In 1971, Baumrind set out to replicate parent-child relationships found in two

previous studies and to differentiate further among patterns of parental authority as well

as to measure their effects on the behavior of preschool children. One hundred and forty-

six preschool children and their families participated in the study. Child behavior in

school was observed over a period of 3 to 5 months. A cluster structure similar to the

previous one was developed. Home visits were made which lasted from before dinner to

after bedtime. Additionally, parents were interviewed regarding attitudes and child-

rearing practices.

There were several key findings to this study. First, authoritative parental

behavior was strongly associated with independent, purposive behavior for girls. The

same was true for boys only when the parents were nonconforming. Additionally,

authoritative parental control was associated with social responsibility in boys and with

high achievement in girls when compared to authoritarian and permissive control in boys.

Baumrind summarized her findings by saying that authoritative parents are more likely to

foster the development of competence in children through responsible and independent

behavior.

The only study that examined parental factors and depression in the preschool

population was conducted by Belden and Luby (2006) who investigated the relationship

between preschool depression severity and parental emotional support in 150 three, four,

and five year olds. Child and parent behaviors during challenging structured dyadic tasks

were observed and coded. Children belonged to one of three diagnostic groups –

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Familial Factors

depression, disruptive, and healthy preschoolers. Preschoolers who demonstrated higher

depression severity scores experienced parenting strategies that were less emotionally

supportive. The authors viewed emotional support as a mother’s expression of positive

regard, encouragement on novel tasks, a sense of when her child was in need of

encouragement, and respecting the child’s need for autonomy. While the authors did not

refer to this as authoritative parenting, the descriptions are similar to Baumrind’s

authoritative prototype.

Parenting Discipline Practices

Parenting discipline practices refers to parents’ methods of training their children

to act according to a certain set of rules or guidelines. Discipline practices are the

strategies that parents use to manage their children’s misbehavior. Parents have

significant impact on their children’s behavior and misbehavior. The younger a child is,

the greater the influence that parents have on them. There is an empirically established

relationship between parenting discipline mistakes and the behavior disorders of children.

Less is known about the relationship of discipline practices to childhood anxiety, fear and

depression (O’ Leary, 1995).

One example of a discipline practice is parents’ use of reprimands for their child’s

misbehavior. Pfiffner and O’Leary (1989) looked at the effects of immediate, short, firm

(ISF) reprimands and delayed, long, gentle (DLG) reprimands delivered in high and low

nurturant environments. The authors predicted that ISF reprimands would result in less

misbehavior than DLG reprimands and that the presence of nurturing interactions would

result in fewer misbehaviors. Results indicated that immediate, short, firm reprimands

were clearly more effective than delayed, long, gentle reprimands in controlling the

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Familial Factors

misbehavior of children. Children transgressed less often, and when they did, they

stopped misbehaving sooner after an ISF reprimand was issued.

Arnold, O’Leary, Wolff, and Acker (1993) investigated specific dimensions of

parental discipline that might be setting the stage for children’s disruptive behavior.

Studies of noncompliant preschoolers indicated that when parents were taught to replace

maladaptive discipline practices with clear, firm, consistent, and appropriate

consequences, their children became more compliant (Webster-Stratton, Kolpacoff, &

Hollinsworth, 1988).

O’Leary (1995) described three potential discipline mistakes that parents of

young children can make. The three mistakes are referred to as laxness, overreactivity

and hostility. Laxness refers to a tendency to give in to one’s children, not enforce rules,

and positively reinforce negative behaviors. Overeactivity involves frequent displays of

anger, irritability, and meanness. Hostility is the tendency of a parent to engage in

physical punishment, cursing, and name-calling.

While there is only one study that looked at parental discipline practices and

depression in children using the three discipline mistakes described by O’Leary (1995)

there are many studies that examined parenting discipline practices utilizing a variety of

definitions and variables. An attempt was made to connect the variables that exist in the

literature to O’Leary’s three discipline mistakes, thereby utilizing the existing studies as

evidence supporting the connection between parenting discipline mistakes and the

development of depression in children.

Leve, Kim, and Pears (2005) looked at childhood temperament and family

environments and how they predicted internalizing and externalizing problems in

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Familial Factors

children. Harsh parental discipline was one of the factors investigated as part of the

family environment. They found that harsh discipline techniques predicted internalizing

problems for boys at age 17. Harsh discipline techniques are a component of O’Leary’s

overreactivity.

Rodriguez (2003) investigated whether children receiving physical discipline have

difficulties with internalizing problems. Forty-two children between the ages of eight

and twelve and their parents were recruited for the study. Two measures were

administered to parents. The first was the Child Abuse Potential Inventory (Millner,

1986) and the second was an unpublished measure called Discipline Scenarios, where

parents read several scenarios involving physical discipline and were asked to rate on a 7-

point Likert scale how frequently they use similar physical punishment on their own

children. Child Measures included The Children’s Attributional Style Questionnaire

(Kaslow, Tannenbaum, & Seligman, 1978), The Children’s Depression Inventory

(Kovacs, 1983, 1985) and The Children’s Manifest Anxiety Scale – Revised (Reynolds &

Richmond, 1985). The research was done in the homes of the families. Parents

completed instruments on a computer while children were taken to a quiet room in the

home to complete the measures. Results of the study indicated that parents who held

more physically abusive attitudes as well as parents who were practicing harsher

discipline techniques had children with elevated depression scores.

Rodriguez (2006) examined parents’ potential to physically abuse children which

had been found to correlate with dysfunctional discipline practices and the use of

corporal punishment. Part of her study looked at the relationship between the frequency

of physical discipline/dysfunctional parenting practices and symptoms of depression in

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Familial Factors

children. Participants of the study included seventy-five parent-child dyads with children

between the ages of 8 and 12. The Parenting Scale, developed by Arnold et al. (1993),

was used to identify dysfunctional parenting practices, and the Children’s Depression

Inventory (Kovacs, 1983, 1985) was used to assess childhood depressive symptoms.

There was a significant positive correlation at the .001 level between children’s scores on

the Children’s Depression Inventory and scores on the Parenting Scale, that is, there was

a positive correlation between the number of depressive symptoms reported by children

and the level of dysfunctional discipline practices exhibited in the home.

Garber, Robinson, and Valentiner (1997) looked at the relationship between

depression and three components of parenting in young adolescents, (a) emotional

connectedness or caring, warmth, acceptance and affection, as opposed to hostility and

rejection (overreactivity), (b) psychological autonomy, or individuation versus

overcontrol and intrusiveness (overreactivity), and (c) behavior regulation, or

supervision, monitoring, limit-setting, and firm control in comparison to lax and

inconsistent control (laxness). The authors also explored the relationship between

management strategies and depressive symptoms. They hypothesized that low levels of

parental acceptance and high levels of psychological control would predict depressive

symptoms.

Two hundred and forty sixth-grade children and their mothers participated in the

study. Interviews were conducted with the mothers regarding their mental health history

and current psychiatric disorders. Several months later, each mother was interviewed by

a different interviewer regarding her child and her parenting practices. Assessments were

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Familial Factors

conducted with the children as well regarding depressive symptoms and parenting

practices exhibited by their parents.

Results of the study indicated a significant negative relationship between

psychological acceptance and depression as well as a significant positive relationship

between psychological control and depression. Therefore, parents who are warm and

accepting raise children who are less likely to develop depression. Additionally, parents

who are over controlling and intrusive are more likely to raise children with depression.

Parents who are hostile and rejecting as well as those who are overcontrolling and

intrusive are similar to the overreactive discipline mistake described by O’Leary (1995).

Laxness did not yield significant results with respect to its relationship with depressive

symptoms.

Asarnow, Goldstein, Tompson, and Guthrie (1993) looked at depressed children

who had been hospitalized and what their 1-year post hospitalization outcome was. More

specifically, they looked at the association between the 1-year outcome and homes with

high levels of expressed emotion, which resembles the discipline mistake of

overreactivity. Expressed emotion refers to criticism, hostility, and emotional over

involvement, and was hypothesized to be a predictor of outcomes for depressed children.

The authors hypothesized that during the first year after discharge, higher rates of

continuing mood disorder and/or relapse will be observed among children returning to

homes with higher levels of expressed emotion when compared to children returning to

homes with less expressed emotion.

Participants of the study included 26 child psychiatric inpatients between the ages of

7 and 14 with diagnoses of Major Depression or Dysthymic Disorder and their parents.

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Familial Factors

DSM-III diagnoses were made at intake based on several different sources. A five

minute speech sample of expressed emotion was obtained in an individual session with

the parent during the first month of the child’s hospitalization. Parents were told to speak

for five minutes about their child and how they got along. High expressed emotion is

defined based on high score on either criticism or emotional over involvement.

Children’s outcomes at one year after discharge were classified as either recovered

or persistent mood disorder. Results of the study indicate a highly significant association

between mother’s expressed emotion and child outcome. While none of the children in

the high expressed emotion homes recovered, 53% of the children who went back to

homes with low expressed emotion did recover. Thus, a brief measure of expressed

emotion was highly predictive of 1-year post discharge outcome for the present sample of

child psychiatric inpatients with diagnoses of Major Depression or Dysthymic Disorder.

Mothers with high levels of expressed emotion share strong similarities to the over

reactive parenting practice described by O’Leary.

Many of the characteristics of parenting practices that were investigated share

similarities with over reactivity and hostility. One study which did specifically address

the three abovementioned discipline mistakes as it utilized the Parenting Scale developed

by Arnold et al. (1993) found that elevated levels of dysfunctional discipline practices

were associated with depression in children. Additionally, the literature is lacking

research regarding the relationship between the parenting discipline practices and the

development of depression in preschool children. While there are many studies

examining parental discipline and externalizing disorders in preschool children, the

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Familial Factors

connection between discipline and internalizing disorders in preschoolers has not been

investigated thus far in the literature.

Family Functioning

Normal family functioning refers to basic patterns of interactions which sustain the

preservation of the family unit and its ability to facilitate the performance of certain tasks

that foster the growth and well-being of its members (Walsh, 2003). Nurturing and

protecting children and taking care of elders and other vulnerable members are examples

of such tasks. Every family develops its own set of norms which are communicated

through rules that are explicitly stated as well as those that are unspoken. Each family’s

set of rules is communicated through repeated and ongoing interactions and sets

expectations about roles of members, actions, and consequences of actions. There are

many models of family functioning including the Beavers Systems Model, The McMaster

Model, and the Circumplex Model (Walsh, 2003).

A useful way of looking at family functioning is using the Circumplex Model, which

has its roots grounded in systems theory. The model includes three dimensions of family

functioning including family cohesion, flexibility, and communication. Family cohesion

refers to the emotional bonds that couples and families have towards one another. The

focus is on the balance that family systems find between being separate and being

together. Extreme levels of either separateness or togetherness are considered

dysfunctional. Family flexibility refers to the amount of change that occurs in terms of

its leadership, role relationships, and relationship rules. The focus of flexibility is the

quality and expression of leadership and organization, role relationship, and relationship

rules and negotiations. As with cohesion, a system that functions at the extremes of

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Familial Factors

flexibility (i.e., being too rigid or overly flexible) is more problematic than a system that

is more balanced between the two. The third dimension, communication, is referred to as

a facilitating dimension, as this dimension aids families in adapting their cohesion and

flexibility to meet the demands of changing circumstances. Communication is measured

by assessing a family’s listening skills, speaking skills, continuity tracking, self-

disclosure, respect, and regard (Olson, Gorall & Tiesel, 2007).

There are several hypotheses that have been derived regarding the circumplex model

and family functioning. The first hypothesis is that balanced families will function more

adequately overall than unbalanced families. Balanced families can function at extreme

levels, at times, but they do not typically function at these extremes for extended periods

of time. It is possible for there to be cultural exceptions to his hypothesis, where a

family’s expectations or cultural norms are that families should function at extreme

patterns. Families can function well in this way as long as all family members are

comfortable with that pattern of functioning. The second hypothesis is that positive

communication skills will facilitate and assist balanced families to change their levels of

cohesion and flexibility when necessary. The third hypothesis is that families will alter

their levels of cohesion and flexibility to adapt to changes and stressors that take place

throughout the life cycle (Olson & Gorall, 2003).

Kashani et al. (1995) set out to examine the relationship between childhood

depression and family functioning of psychiatrically hospitalized depressed and non

depressed children on the dimensions of cohesion and adaptability. They also analyzed

the circumplex model for use with childhood depression. The authors hypothesized that

families of children with depression will generally fall within the extreme ranges of the

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Familial Factors

circumplex model as opposed to within the balanced ranges. More specifically, they

hypothesized that children with depression would report less cohesive and less adaptive

family functioning than children without depression. Additionally, the authors

hypothesized that children with and without depression would differ when compared on

group placement (i.e., balanced, midrange, and extreme) on the circumplex model of

family functioning.

To test their hypotheses, 22 boys (ages 10-12) were chosen from an inpatient

unit, 11 of whom were depressed and 11 of whom were not depressed. The 11 depressed

boys were matched with the 11 non-depressed boys and no significant differences were

found with regard to demographic characteristics such as SES, race and family structure.

A modification of the Family Adaptability and Cohesion Evaluation Scale-III (FACES-

III-K) was used to assess family functioning. FACES-III was modified for use with

young children and was administered to each of the 22 children. Results of the study

indicate that depressed children report a less cohesive family environment than children

without depression. The two groups did not differ significantly with regard to the

adaptability dimension. The hypothesis regarding family cohesion was confirmed and

families of depressed children appear to be less cohesive and more disengaged than

families of children without depression. Thus, low family cohesion, according to the

results of this study appears to be the crucial factor between adverse family functioning

and childhood depression.

In another study, Kashani et al. (1999) compared anxious and depressed

children and adolescents with respect to their perceptions of their family environments.

Specifically, they looked at the differences in perceived family adaptability and cohesion

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Familial Factors

of an inpatient sample of depressed and anxious children. They also investigated whether

these two clinical samples differ in their level of perceived family support. Twenty-one

depressed (mean age of 14) and 18 anxious children (mean age of 11) participated in the

study and were administered several questionnaires including Family Strengths (assesses

the positive attributes of a child’s family), Family Adaptability and Cohesion Scales-II

(FACES II), the Social Support Questionnaire – revised (SSQS-R), and the Children’s

Interview for Psychiatric Syndromes (ChIPS). Findings of the study indicated that

youngsters diagnosed with a depressive disorder differed from those diagnosed with an

anxiety disorder in several key aspects. Depressed youngsters reported less trust, respect,

and loyalty between members of their families, viewed their families as less adaptable in

stressful situations, and indicated being less satisfied with the amount of support they

received from their family members. Thus, Kashani et al. supports the findings that

family characteristics are different between children diagnosed with depression and those

diagnosed with anxiety as measured by the child’s perception. This study lends further

support to the connection between poor family functioning and depression in children. In

this case, low adaptability was observed in families of depressed children.

Shiner (1998) investigated the family functioning of adolescents with a history of

depression, taking into account maternal history of depression. Family characteristics of

adolescents with lifetime major depression and a control group of adolescents with no

history of significant depressive symptoms were assessed. Family functioning of three

types of families was assessed including (a) families that have an adolescent and a mother

with lifetime major depression, (b) families with an adolescent with major depression and

a never-depressed mother, and (c) families with never depressed adolescents. These three

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Familial Factors

groups of families were compared in terms of overall family cohesion and flexibility,

relationships between adolescents and mother and adolescents and father, and the rate of

divorce in the families. Both adolescents and their parents provided reports of family

functioning. The author hypothesized that of the three groups of families compared, the

families with adolescents and mothers with lifetime depression would be reported to be

functioning the most poorly.

Seventy-nine males and females with a diagnosis of major depression and 82

never-depressed control subjects were included in the sample. Parents of depressed and

control adolescents were also included in the study. The Family Adaptability and

Cohesion Scale 3rd edition (FACES-III) was used to assess family members’ perceptions

of the family’s overall functioning, specifically cohesion and adaptability. The Parental

Environment Questionnaire was also used to assess relationships between each of the

parents and the adolescents. The SCID was utilized to assess each family member in

terms of past and present symptoms of depression. Results of the study indicate that a

higher proportion of depressed adolescents had mothers with lifetime depression than did

the never-depressed controls. Families with depressed adolescents and depressed

mothers reported significantly poorer family functioning than did the other groups.

Additionally, depressed adolescents, regardless of their mothers’ depression history came

disproportionately from divorced families relative to control adolescents. Only the subset

of depressed adolescents with depressed mothers described disturbed family relationships

relative to the control adolescents. Thus, when looking at the family functioning of

individuals with depression, it is important to take into account a history of depression in

the family.

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Familial Factors

There have been no studies to date that examined the relationship between family

functioning and the development of depression in preschoolers. Yet, the studies with

children have indicated that families of depressed individuals do function more poorly

than families without depressed individuals. When viewed from the Circumplex Model,

low cohesion and adaptability have been observed in families of depressed patients.

When considering family functioning, it is important to take family history of depression

into account as that could be an important factor in the poor functioning of the family.

Risk Factors for Preschool Depression

Key risk factors in the development of major depressive disorder in older

individuals are a family history of mood disorders and stressful life events (Jaffee et al.,

2002). Moreover, Jaffee et al. (2002) established that juvenile onset depression was

associated with a higher frequency of psychosocial risk factors than the adult onset

disorder. The only study to date to examine the mediating relationships between risk

factors and very early onset depression in preschool children was done by Luby, Belden,

and Spitznagel (2006). Luby et al. (2006) considered the current research indicating that

depression can occur in preschoolers as young as 3 years old and thought it necessary to

consider potential mediators for depression in this population. Specifically, the authors

used regression analyses to investigate the roles of family history of psychiatric disorders

or behaviors such as mood disorders, suicidality and stressful life events as risk factors of

early onset depressive symptoms in preschool children ages 3.0 to 5.6. The authors

hypothesized that a family history of mood disorders and a history of stressful life events

that were reported at baseline would serve as risk factors for depression and would be

associated with higher depression severity sum scores 6 months later.

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Familial Factors

Results of the study confirmed both hypotheses. A family history of mood

disorders was significantly associated with higher depression severity sum scores 6

months later. Approximately 5% of the variance in the depression severity of preschool

children was accounted for by its linear relationship with family history of mood

disorders in first and second degree relatives. Additionally, stressful life events ranging

from mild (birth of a sibling) to more severe (death of a parent) events during the past

year prior to baseline was a significant predictor of the depression severity of preschool

children 6 months later. Stressful life events accounted for 10% of the total variance in

preschoolers’ depression severity score 6 months later. Thus, a family history of mood

disorders and stressful life events are crucial in a child’s development and are risk factors

for the development of depression even in the preschool period of development.

Agreement between Parents and Teachers

In 1987, Achenbach, McConaughty and Howell conducted a meta-analyses

looking at the reports of various informants including parents and teachers. The

correlation between ratings of parents and teachers (.27) represented a small degree of

association according to Cohen’s criteria. Kashani, Holcomb, and Orvaschel (1986)

looked at depressive symptoms in the general preschool population and as part of their

study had both parents and teachers complete checklists regarding each participating

child. Results of comparisons between parent and teacher responses indicated no

correlation, and at times, even a negative correlation, leading to the conclusion that there

is a discrepancy between parents’ and teachers’ ratings of depressive symptoms in

preschool children. When an individual case study of one of the participants was

investigated, it was found that the parent underreported the child’s symptoms while the

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Familial Factors

teacher responded more accurately. This finding indicates that while multiple sources of

respondents should always be gathered, teachers serve as important resources when

gathering data regarding symptoms.

Correlations between reports of parents and teachers have also been found to be

low for ratings of adolescent personality (Laidra et al, 2006), social competence of

children (Juntiltila, Voeten, Kaukiainen, & Vauras, 2006), and attention deficit

hyperactivity disorder (Hartman, Rhee, Willcutt, & Pennington, 2007). Hartman et al.

(2007) also found that parents may be more biased than teachers in their ADHD ratings.

Thus, disagreement or low levels of agreement seem to occur between parents’ and

teachers’ reports of children across various aspects of the child’s functioning. It is

possible that the ratings of teachers are more accurate and less biased descriptions of the

child’s behaviors.

Summary

The literature appears to support the fact that while the symptoms might be

milder, depression does exist in preschool children. Research also supports the fact that

there is often little agreement between teachers’ and parents’ reports of symptoms

(Achenbach, McConaughty & Howell, 1987; Juntiltila et al., 2006; Laidra et al., 2006).

Additionally, there are several familial factors associated with the development of

depression in children that might be applicable to preschool children. Baumrind’s (1971)

three typologies of parenting styles are important predictors in child outcomes. The

authoritarian parenting style is associated with the development of depression in children.

Additionally, dysfunctional discipline practices, as described by O’Leary (1995) can

include three discipline mistakes including laxness, verbosity, and over reactivity. High

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frequencies of these mistakes, especially over reactivity, are associated with the

development of depression in children. Family functioning is an important factor of

family life. Low cohesion and adaptability, in families, as described by Olson and Gorall

(2003) are associated with depression in children. Finally, there are several important

risk factors that have been demonstrated as crucial in the development of depression in

children and preschool children. These risk factors include a family history of mood

disorders and stressful life events.

Rationale

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Based on the literature reviewed, it appears that certain family factors identified

as related to childhood depression may also be associated with depression in preschool

children. These factors include parenting styles, parenting practices, and family

functioning. While this has been established with parents of older children with

depression, this has not been studied with preschoolers. However, we do know that

depression occurs in preschool children, and there are screening measures and

observation methods which have been demonstrated to be good diagnostic tools for this

population. Modified criteria for depression in preschool children have been proposed to

aid in the identification and diagnostic process (Luby et al., 2002). It is not yet known

what factors are associated with the development of depression in preschool children.

Since familial factors such as parenting styles and practices as well as family functioning

have been demonstrated to be associated with the disorder in older children, it is

hypothesized that the same would be true for preschoolers. Obtaining this knowledge

would aid in developing effective prevention and intervention programs when children

are still quite young, and when prevention and intervention are most effective. The

literature review leads to the following research questions. First, are depressive

symptoms observable in the preschool population? Second, will there be a lack of

agreement between teacher and parent responses to a behavior checklist regarding the

child’s symptoms? Third, is there a relationship between parenting styles and depressive

symptomatology in young children? Fourth, are dysfunctional discipline practices related

to depressive symtomatology in young children? Fifth, is family functioning related to

depression in preschool children?

Hypotheses

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This investigated the relationship among parenting styles, parenting discipline practices,

family functioning and depressive symptomatology in young children. There were

several hypotheses of the study:

H1 Depressive symptoms are observable in preschool children.

H2 There will be a lack of agreement between teacher and parent responses to

a behavior checklist regarding the child’s symptoms.

H3 There is a relationship between parenting styles and depressive

symptomatology in preschool children. Authoritarian or permissive

parenting styles will be related to depressive symptomatology in preschool

children.

H4 Dysfunctional discipline practices will be related to depressive

symptomatology in preschool children.

H5 Family functioning will be related to depression in preschool children.

Families who are less cohesive will have children who show more signs of

depression. Less cohesiveness is associated with depression in

preschoolers. Less adaptability is associated with depression in

preschoolers.

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Chapter Three

Method

Participants

Sixty parents of typically developing children in preschools were recruited from

six private preschools in Queens, Manhattan and Long Island, New York, comprised of

mostly Caucasian children from middle and upper class families. Twenty preschools

were contacted to ask permission to recruit participants from their parent bodies and six

(30%) agreed. Three schools were located in Great Neck, Long Island; two schools were

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Familial Factors

located in Queens, NY, and one school was located in Manhattan. The Manhattan

preschool only consisted of 20 children while all the other preschools had between 90 and

120 children. Parents with preschool children between the ages of 3 and 5 were invited

to participate. Consent forms were sent home to parents with their children. Parents who

agreed to participate sent back signed consent forms and indicated whether they preferred

the questionnaires in paper and pencil format or via e-mail. Fifty-five out of the sixty

participating parents completed the questionnaires and checklists online while five

preferred using the paper and pencil format. Parents who agreed to participate

completed questionnaires in one of the two formats. Teachers of the children whose

parents agreed to participate also completed surveys. None of the teachers completed the

checklists online. They all preferred the paper and pencil format.

Measures

Several instruments were utilized for this study including the Parenting Styles and

Dimensions Questionnaire, the Parenting Scale, the Family Adaptability and Cohesion

Evaluation Scale and the Preschool Feelings Checklist. The instruments are described

below.

Parenting Styles and Dimensions Questionnaire. The Parenting Styles and

Dimensions Questionaire (PSDQ) can be found in Appendix E. The PSDQ was

completed by one of the parents or a legal guardian of the child. Robinson, Mandleco,

Frost Olsen, and Hart (1995) developed a 32-item parenting scale using Baumrind’s three

major typologies which assesses whether the parenting style is authoritative,

authoritarian, or permissive. This scale was originally developed as a 62-item parenting

instrument which yields three global dimensions consistent with Baumrind’s three major

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Familial Factors

typologies of parenting styles: authoritative, authoritarian, and permissive. These 62

items correlated significantly with the total factor score. There are 27 authoritative items

with a reliability of .91, 20 authoritarian items with a reliability of .86, and 15 permissive

items with a reliability of .75.

Once the reliability of the factors was established, the authors set out to determine

the dimensions and internal structures within the three factors that may reflect specific

parenting practices. In order to do this, each set of items within the three global

typologies were analyzed using principal axes factor analysis followed by oblimin

rotation.

As a result, four factors were identified within the authoritative factor accounting for

47.4% of the variance–(a) warmth and involvement–11 items (b) reasoning/induction–7

items (c) democratic participation–5 items (d) good natured/easy going–4 items. Four

factors were extracted from the authoritarian items accounting for 46.8% of the variance,

that is, (a)verbal hostility – 4 items, (b) corporal punishment–6 items (c) nonreasoning

punitive strategies – 6 items, and (d) directiveness – 4 items. Three factors were

extracted from the permissive items accounting for 40.3% of the variance. These factors

were labeled–(a) lack of follow through–6 items (b) ignoring misbehavior – 4 items, and

(c) self-confidence–5 items. The results of this study indicated that parenting questions

consistent with Baumrind’s three major typologies can be derived.

Additionally, within each typology additional factors have been identified which may

prove to be useful in predicting outcomes. A 32-item version was later developed using

confirmatory factor analysis/structural equation modeling, which is the scale that was

used for the current study. The scoring key of the PSDQ was used to classify parents into

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one of three parenting styles. The scoring key yielded an overall mean score in each

category of parenting style, and based on this score the parents’ particular style was

determined.

Parenting Scale. The Parenting Scale (see Appendix D) was completed by one of

the parents of a preschool child or by a legal guardian of the child. Arnold et al. (1993)

designed a rating scale comprised of 30 items measuring dysfunctional discipline

practices in parents of young children. The authors identified three stable factors of

dysfunctional discipline, or three primary types of mistakes made by mothers of two to

four year old children: (a) laxness (b) overreactivity, and (c) hostility.

O’Leary (1995) described these three mistakes as follows. Laxness refers to a

tendency to give in to one’s children, not enforce rules, and positively reinforce negative

behaviors. Overeactivity involves frequent displays of anger, irritability, and meanness.

Hostility refers to a parent’s use of physical or verbal force when disciplining, such as

physical punishment, cursing, and name-calling

Item responses utilize 7-point Likert scales and higher scores indicate

dysfunctional discipline practices. Thus, for each of the three mistakes factor scores were

computed based on the average of the responses on the items on that factor. Higher

factor scores indicated more lax, overreactive, or hostile parenting, depending on the

factor being examined. Scores range from 1 to 7 for each of the different factors.

A recent study conducted by Rhoades and O’Leary (2007) looked at confirmatory

analyses based on the scoring derived from 5 previous studies of the Parenting Scale. In

all, 453 parents of 3 to 7 year olds comprised the sample. The three factor scores of lax,

overreactive, and hostile disciplining practices correlated significantly with several

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Familial Factors

validity measures, including child behavior problems. The validities of the Parenting

Scale factors were supported by meaningfully strong correlations between the factors and

a variety of other measures for both parents. Therefore, the Parenting Scale is a cost-

effective self-report measure of parental discipline. In addition, Coefficient alphas of

factor scores were as follows: (a) Lax, .85 and .82; (b) Overreactive, .80 and .80; and (c)

Hostile, .78 and .83. These scores demonstrate strong internal consistency of the scale.

Family Adaptability and Cohesion Scales (FACES IV). The FACES-IV (see

Appendix C) was completed by one of the parents or by the legal guardian of a preschool

child. Olson, Gorall, and Tiesel (2007) developed this paper and pencil questionnaire

that is self-administered and contains 62 items that are measured on a 5-point Likert-type

scale. The scale includes two balanced scales called balanced cohesion and balanced

flexibility. It also includes four unbalanced scales called disengaged and enmeshed for

the cohesion dimension and rigid and chaotic for the flexibility dimension. Additionally,

there is a family communication scale and a family satisfaction scale.

Scoring consists of taking each item response and summing up the item responses

for each of the six FACES IV scales, creating a total raw score. Then the total raw score

is converted into percentage scores. A percentile score for the following six scales are

provided: (a) Balanced Cohesion, (b) Balanced Flexibility, (c) Disengaged, (d)

Enmeshed, (e) Rigid and (f) Chaotic. One can also create Cohesion Ratio, Flexibility

Ratio, and Total Circumplex Ratio scores that indicate the level of functional versus

dysfunctional behavior perceived in the family system. The ratio score is obtained by

assessing the Balanced/Average Unbalanced score for each dimension. The lower the

ratio score, the more unbalanced the system. Conversely, the higher the ratio score, the

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Familial Factors

more balanced the system. There are also dimension scores for cohesion and flexibility

which are used for plotting the one location of the family onto the updated graphic

representation of the Circumplex Model of Couples and Family Systems. Both ratio

scores and dimension scores will be used in the current study.

To assess the validity of the FACES-IV scale, Olson, Gorall, and Tiesel (2007)

administered a FACES IV item pool (84 items) to 487 individuals. These 87 items were

obtained from earlier versions of FACES as well as 24 new items that were developed to

identify the high and low extremes of cohesion and flexibility. To assess the criterion

validity of the FACES IV scales, three other family assessment measures were used

including the Self-Report Family Inventory, Family Assessment Device, and Family

Satisfaction Scale.

First, an exploratory factor analysis of all 84 items was conducted. Items loading

below .30 and those with cross-loading were removed from future analysis. Five factors

were identified including (a) balanced cohesion/disengaged, (b) balanced flexibility, (c)

enmeshed, (d) rigid and (e) chaos. Subsequently, six scales ((a) balanced cohesion, (b)

balanced flexibility, (c) disengaged, (d) enmeshed, (e) rigid, and (f) chaotic) with seven

items each (42 items in total) were subjected to confirmatory factor analysis. Results of

the confirmatory analysis indicated an acceptable and well-fitted model. Additionally,

factor loadings for all 42 items on their respective scales indicated high loadings and a

fairly even loading pattern. A differential pattern was revealed for each proposed

dimension. For example, balanced cohesion was strongly and negatively correlated with

the low unbalanced form of cohesion. Additionally, the balanced scales were very highly

correlated with each other.

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An alpha reliability analysis was conducted to examine the internal consistency of

the six scales. Reliability of the six scales are all acceptable and are as follows:

Enmeshed = .77, Disengaged = .87, Balanced Cohesion = .89, Chaotic = .86, Balanced

Flexibility = .84, Rigid = .82.

An additional confirmatory factor analysis was conducted with FACES IV and

each of the three validation scales. Results of this analysis indicated that the balanced

FACES scales of cohesion and flexibility had large positive correlations with the

validation scales, while the unbalanced FACES scales of disengaged and chaotic had

large negative correlations with the validation scales.

In order to determine whether the FACES IV scales can distinguish between

problem family systems and non-problem family systems, Olson, Gorall, and Tiesel

(2007) ran a discriminant analysis. Analyses that were run demonstrate the discriminant

validity of the FACES-IV scales.

Craddock (2001) conducted a study with the goal of testing out the predictions of

Tiesel and Olson’s (1997) FACES-IV and the Circumplex model using an Australian

sample. Results of this investigation indicate that, as Tiesel and Olson predicted, the

three measures of family quality on the FACES-IV, namely, family strength, satisfaction,

and communication have high positive correlations with each other. Additionally,

family strengths, satisfaction, and communication were negatively and significantly

correlated with disengagement, rigidity, and chaos. Families classified as generally

extreme in their family system type were significantly lower in family quality and higher

in family stress than families classified as balanced. The strongest predictors of family

quality were family disengagement and family rigidity, and family chaos was the

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Familial Factors

strongest predictor of family stress. Thus, FACES-IV has good internal consistency

reliability. Validity is demonstrated by the fact that the measure differentiates between

functional and dysfunctional families.

Preschool Feelings Checklist (PFC). The PFC (see Appendix B) was completed

by one of the parents or legal guardian of a preschool child as well as by the teacher of

the children whose parents consented to participate in the study. The Preschool Feelings

Checklist, developed by Luby, Koenig-McNaught, Brown, and Spitznagel (2004), is a

brief and valid screening measure of the child’s behaviors and can be used in a variety of

different settings. It consists of sixteen yes/no items about the existence of depressive

symptoms in preschool children. The items cover a range of internalizing and

externalizing symptoms that show strong associations with independent diagnostic

measures of internalizing symptoms and major depressive disorder.

The PFC is designed to be scored in a symptom present/absent fashion. If the

respondent indicates “Yes,” the child should be given a score of 1 for that item; if the

respondent indicates “No,” the child should be given a score of 0 for that item, resulting

in a total possible score of 16. A total score of 3 or more indicates the need for a clinical

evaluation (Luby et al., 2004).

Luby, Heffelfinger, Koenig-McNaught, Brown, and Spitznagel (2004)

administered the Preschool Feelings Checklist (PFC) to 174 parents of preschool

children. Once all inclusion and exclusion criteria were met, children and their caretakers

participated in a 2-to-3 hour assessment in which caregivers were administered a

comprehensive structured interview resulting in a diagnosis of either Major Depressive

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Disorder, a psychiatric disorder, or no disorder. The Childhood Behavior Checklist

(CBCL) was completed prior to the interview.

Results indicated significant correlations between the PFC and the diagnosis of

MDD based on the interview as well as between the PFC and the Internalizing T score on

the CBCL. Such findings indicate that the PFC is a valid screening measure. Excellent

internal consistency was found and scores on the PFC significantly differentiated

depressed preschoolers from those with other psychiatric disorders. The measure

contained a cutoff point that maintained a high level of sensitivity, which could be used

to identify preschoolers who are in need of a more in-depth clinical evaluation.

Web based surveys.

In recent years there has been rapid development of technology and its ability to

offer convenience and efficiency in many different realms of daily life, including

conducting research. Administering surveys and questionnaires via the internet is

becoming increasingly popular for a variety of different reasons.

Denscombe (2006) investigated whether or not people provide different

information on a survey depending on the mode of administration. This was done by

administering a survey to two near-equal groups who responded to two near-identical

questionnaires. One questionnaire was web-based and one was paper-based. Contents of

data as well as completion rates were considered. It was concluded that there are no

essential differences between responses or completion rates between the different modes

of administration. In fact, the completion rate was slightly higher for web-based

questionnaires than for paper-based. The indications from this study are that web-based

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questionnaires provide a reliable data collection method as compared to paper based

versions.

Procedure

Preschools listed in the yellow pages were contacted and asked permission to

recruit participants from their population of parents. While many schools were contacted,

six granted permission recruit participants from the parent body. A faculty member in

each school was designated as the one responsible for the distribution of forms. A letter

explaining the project and seeking participants was distributed to all parents in the

preschool facility. A consent form (see Appendix A) was attached and parents were

asked to send back the signed consent form if they agree to participate. A designated box

was set up in the main office of each preschool that served as the drop off location for

completed forms. In the consent forms, parents were offered the option of completing

the surveys on the internet. Those who chose this option were asked to provide their e-

mail address, and the survey was e-mailed to them.

Once the signed consent forms were collected, those parents who agreed were

given or e-mailed a brief questionnaire to complete, called the Preschool Feelings

Checklist (PFC). Two weeks later, they were given or e-mailed a set of three

questionnaires to complete; the Parenting Styles and Dimensions Questionnaire (PSDQ),

the Parenting Scale, and the Family Adaptability and Cohesion Scales (FACES-IV). All

questionnaires were coded before they were distributed to the parents, so that their name

did not appear anywhere on the questionnaire. Those that were done via e-mail were

coded when the completed questionnaire was printed from the computer.

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At the same time, teachers of the participants’ children were given or e-mailed the

Preschool Feelings Checklist (PFC). The names of the students were written on an

attached sheet of paper and only a number code was on the actual checklist. Teachers

were instructed to tear off the first page before returning the checklist so that the child’s

name was not located on the actual checklist. Parents and teachers returned completed

questionnaires and checklists in sealed envelopes and left them in the designated box in

the main office. If it was done via e-mail, the name of the child was coded once the

completed questionnaire was printed from the computer.

Design

Several statistical analyses were utilized. Descriptive statistics were used to

determine whether or not depressive symptoms were observable in preschool children.

Cohen’s Kappa statistics were used to evaluate inter-rater agreement between parent and

teacher responses on the PFC. This statistic compares observed and expected agreement

to find if the observed agreement is beyond the chance level. Logistic Regression

analyses were utilized to determine the relationships between the three independent

variables and depressive symptoms in preschool children. Additionally, a receiver

operating characteristic curve (ROC curve) was plotted to evaluate the predictive power

of the logistic regression model

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Chapter Four

Results

This chapter describes the results obtained. Descriptive statistics, Cohen’s Kappa

statistics, logistic regression analyses and Receiver Operating Characteristic Curves

(ROC Curves) were used to address the five hypotheses in this study.

The dependent variable in this study was the presence or absence of certain

symptoms that characterize a preschool child as either at risk or not at risk for developing

depression. These symptoms are represented by the parent and teacher scores on the

Preschool Feelings Checklist (PFC) (Luby, Koenig-McNaught, Brown, &

Spitznagel,2004), a 16 item screening measure used to identify whether or not preschool

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children are at risk for developing depression. The items cover a range of internalizing

and externalizing symptoms that show strong associations with independent diagnostic

measures of internalizing symptoms and major depressive disorder.

Four categorical variables were created based on parent and teacher PFC scores.

Two variables were created based on a clinical definition of at risk as is described by the

scoring instructions of the PFC. Using this definition, a score of 3 or more indicates that

the child is at risk for developing depression. Two variables were created using a less

stringent definition of at risk. The less stringent definition is such that the child is

considered at risk for developing depression if he/she exhibits one or more symptoms

depicted on the PFC.

The two definitions of at risk were created due to the expectation that the clinical

definition suggested in the scoring instructions of the PFC would occur too infrequently.

Because the N in logistic regression depends on the minimum number of events and the

number of events is relatively small using the clinical definition, the power is reduced.

One way to address low power is to lower the standard for the number of events. This is

what was done by creating the less stringent definition of at risk.

As explained above, four categorical variables were created (See Table 15). The

Parent At-Risk Clinical (PARC) variable indicates whether or not the parent reported the

child to be at risk according to the clinical definition of at risk. The Teacher At-Risk

Clinical (TARC) variable indicates whether or not the teacher reported the child to be at

risk according to the clinical definition of at risk. The Parent At-Risk Less Stringent

(PARLS) variable indicates whether or not the parent reported the child to be at risk

according to the less stringent definition of at risk. The Teacher At-Risk Less Stringent

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(TARLS) variable indicates whether or not the parent reported the child to be at risk

according to the less stringent definition of at risk.

Demographics

Age and gender of preschool children.

The sample consisted of 35 (58.3 %) girls and 25 (41.7 %) boys. The age of the

preschool children ranged from 3 to 5 with a mean of 3.8 years old. One participant in

the sample did not report the age of her presschool child.

Table 1

Crosstabulation of Gender and Age of Participants Gender Age 3 Age 4 Age 5 Total

Female 15 12 8 35

Male 9 12 3 24

Total 24 24 11 59

Table 2

Gender of Preschool Children in SampleGender Frequency Percent

Female 35 58.3

Male 25 41.7

Table 3

Age of Preschool Children in Sample Age Frequency Percent

3 24 40.7

4 24 40.7

5 11 18.6

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Ethnicity.

For those parents responding to a question on ethnicity there were 4 Asian-Americans

(7.1%), 2 Hispanic/Latinos( 3.6 %), 2 respondents of mixed race(.6%) and 48 Caucasians

(85.7%).

Table 4

Ethnic Makeup of SampleEthnicity Frequency Percent

Asian American 4 7.1

Hispanic/Latino 2 3.6

Mixed Race 2 3.6

White/Caucasian 48 85.7

Family makeup of children in sample.

Fifty-seven (96.6 %) of the children in the sample were living with both their

biological parents. One (1.7 %) child was living with adoptive parents, and 1 (1.7 %) was

living in a single parent home due to divorce.

The number of children in the participating families range from 1 to 6 with 2.5 being

the average number of children in the family. The mode number of children was 2, with

22 families having 2 children.

Table 5

Number of Children in FamilyNumber of Children in Family Frequency Percent

1 9 15

2 22 36.7

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3 18 30

4 9 15

5 1 1.7

6 1 1.7

Of the children in the sample, 31 were the oldest, 11 were the youngest and 17

were middle children.

Role of PFC respondents.

The respondents of the Parent PFC consisted of both mothers and fathers. Fifty-

five of the 60 respondents were mothers (91.7%) and 5 (8.3%) were fathers.

Age of parent completing parenting scales.

The age of the parent completing the Parenting Scales ranged from 25 to 53 with

a mean age of 35.7.

Education of parent completing parenting scales.

Of the parents who completed the parenting scales, 2 parents (3.3%) completed

some college, 11 parents (18.3%) completed college and 47 parents (or 78.3%) hold an

advanced degree.

Income of parents.

The income of the parents completing the scale ranged from less than $10,000.00 (3

families) to more than $100,000 (17 families) as is depicted in Table 9.

Table 6

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Income of Parents Completing Parenting ScaleIncome Frequency Percent

Less than $10,000 3 5.6

$10,000 - $20,000 3 5.6

$20,000 - $30,000 1 1.9

$30,000 - $40,000 2 3.7

$40,000 - $50,000 5 9.3

$50,000 - $60,000 7 13

$60,000 - $80,000 8 14.8

$80,000 - $100,000 8 14.8

$100,000 or more 17 31.5

Risk Factors

The two risk factors that have been found to be significant in the development of

depression in children are a history of mood disorders in the family as well as the

occurrence of a stressful life event in the past year. Of the respondents in the sample, 27

parents (45.8%) reported that there was a history of mood disorders in the family. Thirty-

two (54.2%) respondents reported that there is no history of mood disorders in the family.

Twenty-nine respondents (50%) reported that the family experienced a stressful life event

within the past year, while 29 respondents (50%) reported that there was no stressful life

event experienced within the past year. Logistic regression analyses were conducted with

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the two risk factors as the independent variables and the four outcome variables (PARC,

PARLS, TARC, TARLS) as the dependent variables. The risk factors were not found to

be significant predictors of preschoolers who show signs for being at risk for developing

depression in this study.

Hypothesis #1

The first hypothesis addressed whether or not depressive symptoms are

observable in preschool children. It was hypothesized that depressive symptoms are

observable in preschool children. Descriptive statistics were calculated for each of the

four definitions of at risk and are depicted in Table 7. According to the parent report and

the less stringent definition (PARLS) of at risk, 35.1% of the children in the sample were

found to be at risk. According to the parent report and the clinical definition (PARC) of at

risk, 9.1% of the children in the sample were found to be at risk. According to the

teacher report and the less stringent definition, 33.8% of the sample was found to be at

risk. According to the teacher report and the clinical definition of at risk, 16.9% of the

children in the sample were found to be at risk. The data described above and depicted in

Table 7 below support the hypothesis that symptoms of depression are observable in

preschool children.

Table 7

The Observation of Depressive Symptoms in Preschool Children Reporter Definition of At Risk N At Risk Percent At Risk

Parent Less Stringent 59 27 35.1

Parent Clinical 59 7 9.1

Teacher Less Stringent 60 26 33.8

Teacher Clinical 60 13 16.9

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The responses on the parent PFC yielded a mean score of .88 and a standard deviation

of 1.18. In other words, the mean number of symptoms observed by parents is .88. The

responses on the Teacher PFC yielded a mean score of 1.3 and a standard deviation of

1.758. In other words, the average number of symptoms observed by teachers is 1.3.

Table 8

Preschool Feelings Checklist – Means and Standard Deviations

Scale Mean Score Standard Deviation

Parent PFC .88 1.18

Teacher PFC 1.3 1.758

Hypothesis #2

The second hypothesis in this study stated that there will be a lack of agreement

between teacher and parent responses to a behavior checklist regarding the child’s

symptoms. Cohen’s kappa statistics were used to evaluate inter-rater agreement. This

statistic compares observed and expected agreement to find if the observed agreement is

beyond the chance level.

The range of scores for the parent-completed PFCs was from zero to four, indicating

that the largest number of symptoms reported by parents was four. The range of scores

for the teacher-completed PFCs was zero to seven, with seven being the maximum

number of symptoms reported.

According to the clinical definition of at risk, both parent and teachers agreed

regarding 43 out of the 51 children, or 84.3% of the children. Parents reported that 5

children exhibited symptoms of being at risk while teachers reported that 9 children

exhibited symptoms of being at risk for developing depression. There were 6 cases in

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which the teacher reported the child to be at risk while the parent did not and 2 cases

where the parent reported the child to be at risk and the teacher did not. The magnitude

of the kappa value is .346, and there was a significant difference from chance at the .009

significance level. While parents and teachers agree more than chance, they are not

seeing the same symptoms.

Table 9

Crosstabulation of Parent and Teacher Reports of At Risk Children According to the Clinical Definition

Teacher Not At Risk Teacher At Risk Total

Parent Not At Risk 40 6 46

Parent At Risk 2 3 5

Total 42 9 51

According to the less stringent definition of at risk, both parent and teachers agreed

regarding 33 out of the 51 children, or 64.7% of the children. Parents reported that 23

children exhibited symptoms of being at risk while teachers reported that 21 children

exhibited symptoms of being at risk for developing depression. There were 8 cases in

which the teacher reported the child to be at risk while the parent did not and 10 cases

where the parent reported the child to be at risk and the teacher did not. The magnitude

of the kappa value is .282 and this indicates that there was a significant difference from

chance at the .044 significance level.

Table 10

Crosstabulation of Parent and Teacher Reports of At Risk Children According to the Less Stringent Definition

Teacher Not At Risk Teacher At Risk Total

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Parent Not At Risk 20 8 28

Parent At Risk 10 13 23

Total 30 21 51

The data described above support the hypothesis that there will be a lack of

agreement between teacher and parent responses on the PFC.

Following up on the above findings, the author investigated which items on the

PFC were the greatest source of disagreement between parents and teachers. Items 1, 3, 7

and 10 were the greatest sources of disagreement, and all had more than 10 instances

where the teacher and parent disagreed regarding the item. Item #1 and item #7 are

related to playing with other children while item #3 is about following rules. These 3

items may be particularly observable in a school setting. Item # 10 is about lacking

confidence. In general, the teachers reported symptoms more readily than parents did.

Hypothesis #3

The third hypothesis in this study was about the relationship between parenting styles

and depressive symptomatology in preschool children. More specifically, it was

hypothesized that authoritarian and permissive parenting styles would be related to

depressive symptomatology in preschool children. Logistic regression analyses were

computed on SPSS with the four categorical variables (PARC, PARLS, TARC, TARLS)

entered as outcome variables, and authoritarian and permissive parenting entered into the

equation as predictors.

Using the parent report and clinical definition of at risk as the outcome variable, there

was no significant relationship between parenting styles and depressive symptomatology.

With PARC as outcome variable and authoritarian parenting as the independent variable,

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the logistic regression analysis yielded a p-value of .365. Using PARC as the outome

variable and permissive parenting as the independent variable, the logistic regression

analysis yielded a p-value of .248.

Using the parent report and the less stringent definition of at risk as the outcome

variable, there was no significant relationship between parenting styles and depressive

symptomatology. Using PARLS as the outcome variable and authoritarian parenting as

the independent variable, the logistic regression analysis yielded a p-value of .865. Using

PARLS as the outcome variable and permissive parenting as the independent variable,

the logistic regression analysis yielded a p-value of .182.

Using the teacher report and the clinical definition of at risk, there was no significant

relationship between parenting styles and depressive symptomatology. The logistic

regression analysis with TARC as the outcome variable and authoritarian parenting as the

independent variable yielded a p-value of .244. The logistic regression analysis with

TARC as the outcome variable and permissive parenting as the independent variable

yielded a p-value of .879.

Using the teacher report and the less stringent definition of at risk, the relationship

between authoritarian parenting styles and the observation of depressive symptoms yields

an a p-value of .053 (<.1) which indicates that there is a significant relationship between

the two variables. Taking permissive parenting out of the analysis and centering the

authoritarian variable at 1 (as scale responses go from 1 to 5 so 1 becomes 0) the results

change somewhat. When this is done, authoritarian parenting yields a p-value of .048

(< .05) which indicates that there is a significant relationship between the two variables.

Since the constant is .028 and the exponent, or odds are .236, the probability is .19. In

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other words, a child with authoritarian parenting has a 19% chance of being at risk for

depression.

Table 11

Logistic Regression Analysis for Relationship between Parenting Styles and Depressive Symptoms using the Teacher Report and the Less Stringent Definition of At Risk

Predictor B S.E. Df P Value Exp (B)

Authoritarian Parenting 2.090 1.079 1 .053 8.801

Permissive Parenting -.165 .608 1 .786 .848

Table 12Logistic Regression Analysis for the Relationship between the Centered Authoritarian Parenting Style and Depressive Symptoms using the Teacher Report and the Less Stringent Definition of At Risk

Predictor B S.E. df P Value Exp (B)

Authoritarian Parenting Centered 1.995 1.009 1 .048 7.353

The data described above partially supported the hypothesis that there was a

relationship between parenting styles and depressive symptomatology in preschool

children. Teacher reports regarding symptoms of depression yielded results indicating

that authoritarian parenting was related to the existence of symptoms of depression in

preschool children. However, parent reports of symptoms did not indicate a significant

relationship.

Hypothesis #4

The fourth hypothesis in this study examines the relationship between dysfunctional

discipline practices and depressive symptomatology in preschool children. The

dysfunctional discipline practices included laxness, overreactivity and hostility. Logistic

regression analyses were conducted to determine the significance of these predictors.

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The analyses were computed on SPSS using the dysfunctional discipline practices as

predictor variables in the regression equation and the four categorical variables (PARC,

PARLS, TARC, TARLS) as outcome variables in the equation. None of the

abovementioned predictors yielded significant results.

Using PARC as the outcome variable and laxness, overreactivity and hostility as the

predictors, the regression analysis yielded p-values of .287, .924, and .987, respectively.

Using PARLS as the outcome variable and laxness overreactivity and hostility ast the

predictors, the regression analysis yielded p-values of .558, .383, and .285, respectively.

Using TARC as the outcome variable and laxness, overreactivity and hostility as the

predictors, the regression analysis yielded p-values of .690, .314, and .440, respectively.

Using TARLS as the outcome variable and laxness, overreactivity and hostility as

predictors, the regression analysis yielded p-values of .546, .354, and .370, respectively.

The data do not support the hypothesis that there is a relationship between dysfunctional

discipline practices and depressive symptomatology in preschool children.

Hypothesis #5

The fifth hypothesis in this research study addressed the relationship between family

functioning and symptoms of depression in preschool children. It was hypothesized that

families who are less cohesive and less adaptable (more rigid) will have preschool

children who show more symptoms of depression. Using PARC, PARLS, and TARC as

predictors, neither family cohesion nor adaptability were significant predictors. Using

PARC as the outcome variable and family cohesion and flexibility as the independent

variables, the logistic regression analysis yielded p-values of .168 and .941, respectively.

Using PARLS as the outcome variable and family cohesion and flexibility as the

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independent variables, the regression anaysis yielded p-values of .130 and .656,

respectively. Using TARC as the outcome variable and family cohesion and flexibility as

the independent variables, the regression analysis yielded p-values of .126 and .136,

respectively.

Using the teacher report of symptoms and the less stringent definition of at risk

(TARLS), flexibility was a significant predictor with a p-value of .063 <.1. This

indicates that more rigidity in families is a significant predictor of preschool children who

show signs of being at risk for depression.

Taking cohesive family functioning out of the equation and centering the flexibility

score at 1, the results changed somewhat as the regression equation now yields a p value

of .003 (<.01). This further supported the hypothesis that more rigidity in family

functioning was a significant predictor of preschool children who show signs of being at

risk for depression.

Table 13

Logistic Regression Analysis for the relationship between Family Functioning and Depressive Symptoms using the Teacher Report and the Less Stringent Definition of At Risk

Predictor B S.E. Df P Value Exp (B)

Cohesive Family Functioning -.295 .188 1 .117 .745

Flexible Family Functioning -.242 .130 1 .063 .785

Table 14Logistic Regression Analysis for the relationship between the Centered Variable of Flexible Family Functioning and Depressive Symptoms using the Teacher Report and the Less Stringent Definition of At Risk

Predictor B S.E. df P Value Exp (B)

Flexible Family Functioning (Centered) -.365 .122 1 .003 .694

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The data from this study partially supported the hypothesis that family

functioning was related to depression in preschool children. Using the teacher report of

symptoms, less flexibility in family functioning was a significant predictor of symptoms

of depression in preschool children.

ROC Curve

A Receiver Operating Characteristic curve (ROC curve) is a graphical way to

evaluate the predictive power of the logistic regression model. It summarizes proportions

of correctly classified cases (true positives) versus the rate of misclassified events (false

positives), informing about the overall model value (Peng & So, 2002, Understanding

Statistics). An ROC curve was plotted to determine how well a combination of seven

independent variables (authoritarian parenting, permissive parenting, laxness, over

reactivity, hostility, cohesive family functioning, and flexible family functioning)

predicted the “at risk of depression” status of preschoolers, which was determined

according to the teacher report with the less stringent “at risk” definition. According to

Figure 1, this logistic regression model performed fairly well in classifying students to

their “at risk” category, judging by the separation between the model solid line and the

no-predictors-model dotted line. The model dotted line indicates what the curve would

look like if there was no prediction. The more separation there is between the model

solid line and the no predictor dash line, the stronger the predictive power of the model.

At the point where the false positive rate was at 20%, the true positive rate exceeded

80%. Thus, based on this model with seven predictors, for every five students classified

as “at risk”, four would be classified correctly, whereas one would be falsely

misdiagnosed with “at risk of depression.”

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In contrast, when the ROC curve was plotted using the seven predictors and the

TARC (teacher report and more clinical definition of at risk) the regression model does

not perform as well in classifying students as at-risk or not at-risk. One can see from

Figure 2, that there is more of a separation between the no predictor dotted line and the

model solid line. In order to achieve the true positive rate of 80%, there will be more

than 30% of false positives. This curve indicates less predictive power than the curve

depicting the full model with with TARLS definition.

Figure 1

ROC Curve using the seven predictor (authoritarian parenting, permissive parenting,

laxness, over reactivity, hostility, cohesive family functioning, and flexible family

functioning) logistic regression model with the teacher report and the less stringent

definition of at risk (TARLS) as the outcome variable

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False positive rate

Tru

e p

osi

tive

ra

te

0.0 0.2 0.4 0.6 0.8 1.0

0.0

0.2

0.4

0.6

0.8

1.0

Figure 2

ROC Curve using the seven predictor (authoritarian parenting, permissive parenting,

laxness, over reactivity, hostility, cohesive family functioning, and flexible family

functioning) logistic regression model with the teacher report and the clinical definition

of at risk (TARC) as the outcome variable

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False positive rate

Tru

e p

ositiv

e rate

0.0 0.2 0.4 0.6 0.8 1.0

0.0

0.2

0.4

0.6

0.8

1.0

Chapter 5

Discussion

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This chapter discusses the implications of the results obtained from the statistical

analyses. Potential reasons for the findings and limitations of the study are presented.

Educational implications for preschools are discussed.

This study examined whether depressive symptoms exist in the preschool

population and whether teachers and parents agree regarding the existence of the

symptoms. It also examined the relationship between certain family-related factors and

the existence of depressive symptoms in preschool children. The current study supports

and extends existing research on preschoolers and depression by examining the variables

associated with preschoolers who show signs of depression.

Depressive Symptoms in Preschoolers

Prior work, notably by Luby et al. (2002, 2003, 2004) found that preschool

children show signs of being at risk for depression, describe what the disorder looks like

in young children, and developed a brief and valid screening measure for detecting signs

of depression in preschool children. The results from the current study show consistent

findings with regard to the observation of symptoms of depression in preschool children.

The screening measure developed by Luby et al. was administered to teachers and parents

in a mainstream preschool. Parents reported that 35.1% of the sample displayed at least

one symptom while teachers reported that 33.8% of the sample displayed at least one

symptom of depression. Thus, parents and teachers can identify whether or not preschool

students are at risk for developing depression by carefully observing and monitoring their

behaviors. The ability to screen students in this way at such an early age is crucial and

will have significant impact on treatment effectiveness. The earlier children can be

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identified as depressed, or even at risk for depression, the sooner they can be treated and

the greater the likelihood of the treatment being effective.

The abovementioned finding is significant because it is often difficult to identify

internalizing disorders in young children; more often young children tend to “act out”

their symptoms and so those externalizing disorders are reported more frequently.

(Webster-Stratton, Kolpacoff, & Hollinsworth, 1998). This study indicates that it is

possible to detect signs of internalizing disorders in young children.

Agreement between Parents and Teachers

The current study confirms previous findings of Achenbach, McConaughty and

Howell (1987), Kashani, Holcomb, and Orvaschel (1986) and others that there is limited

agreement between parents and teachers reports of symptoms. While parents and

teachers agree more than chance, they are not reporting the same behaviors. The range of

scores for the parent-completed PFCs was from zero to four, indicating that the largest

number of symptoms reported by parents was four. The range of scores for the teacher-

completed PFCs was zero to seven, with seven being the maximum number of symptoms

reported. In the current study, many of the items on which parents and teachers disagreed

were items regarding following rules and playing with other children which may be

behaviors that are more readily observable in school. Additionally, parents may have

difficulty objectively rating the child’s behavior and might be hesitant to report

difficulties that their children are experiencing.

This finding is important as it demonstrates that it is never sufficient to collect

data regarding symptoms from only one source. We know that there is little agreement

between parents and teachers regarding symptoms. Therefore, when assessing preschool

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children, it is important to collect information from multiple sources and recognize that

there may be discrepancies between teacher and parent perspectives.

Familial Factors Associated With Depression in Preschoolers

There were no significant findings with regard to familial factors associated with

the development of depression using the parent report (either clinical or less stringent

definition of at risk) as the outcome variable. There were also no significant findings

using teacher report and the clinical definition of at risk. The only analysis that yielded

significant findings involved the teacher report and the less stringent definition of at risk

(TARLS). The less stringent definition of at risk yielded the largest number of

preschoolers who are at risk. In the parent report and less stringent definition of at risk

(PARLS), 27 preschool children were considered at risk while 26 were considered at risk

using the TARLS definition. This is compared to 7 and 13 preschoolers who were

considered at risk according to the clinical definition. There were simply not enough data

regarding children who are at risk using the clinical definition for any of the findings to

have been significant.

It is unclear why the analyses involving PARLS as the outcome variable did not

yield significant findings despite the stronger power. It is possible that the subjectivity of

the parents completing both the PFC as well as the parenting scales compromised the

findings to some degree. While parents may have been somewhat comfortable reporting

that their children display certain symptoms, they may not have been comfortable

reporting on their own shortcomings as parents. Most of the parents in the sample are

well educated and successful people who undoubtedly have a sense of what good

parenting should look like. They may have responded to the questionnaires by reporting

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on what they know is the right way as opposed to what goes on in their household on a

consistent basis. Therefore, the self-report format of these questionnaires may not have

been ideal.

Using the TARLS definition of at risk as the outcome variable, authoritarian

parenting appears to be a significant predictor of the preschoolers who show signs of

being at risk for depression. Authoritarian parenting refers to a parenting style that is

detached and controlling as well as somewhat less warm than other parents. There is no

negotiation between parents and children as parents are viewed as the absolute authority.

Obedience is considered a virtue and punishments are usually punitive and forceful and

are used when there is a conflict between the beliefs or actions of their child and their

standard of acceptable conduct (Baumrind, 1989). Such parenting is a predictor for

preschool children who show signs of being at risk for depression.

This finding is consistent with that of Belden and Luby (2006) who investigated

the relationship between preschool depression severity and parental emotional support

and found that preschoolers who demonstrated higher depression severity scores

experienced parenting strategies that were less emotionally supportive. While the authors

do not refer to the term authoritarian parenting, they describe emotional support as a

mother’s expression of positive regard, encouragement on novel tasks, a sense of when

the child is in need of encouragement, and respecting the child’s need for autonomy.

This description clearly describes the antithesis of authoritarian parenting that lacks a

parent’s expression of positive regard, encouragement, and providing a sense of

autonomy for the child. Rather, it is controlling and does not provide emotional warmth

or encouragement.

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Additionally, using TARLS as the outcome variable, the lack of flexible family

functioning is a predictor for preschool children who are at risk for developing

depression. Family flexibility refers to the degree of change that occurs in terms of its

leadership, role relationships, and relationship rules. The focus of flexibility is the

quality and expression of leadership and organization, role relationship, and relationship

rules and negotiations (Olson, Gorall & Tiesel, 2007). A system that functions at the low

extremes of flexibility (i.e., being too rigid) is associated with preschoolers who are at

risk for depression. This finding is consistent with that of Kashani et al. (1999) who

compared anxious and depressed children and adolescents with respect to their

perceptions of their family environments. One of the findings of this study was that poor

family functioning and specifically low adaptability was observed in families of

depressed children.

The authoritarian parenting style and rigid family functioning are consistent in

many ways. Controlling parents who demand obedience and do not allow for negotiation

create a home environment which is rigid and inflexible. Such a parenting style fosters a

home environment that does not adapt to new situations and circumstances in a flexible

and functional way. Therefore, it is intuitive that those two variables are both significant

predictors for preschoolers who are at risk for developing depression. Preschool children

whose emotional needs are not met due to a lack of warmth, emotional support, and

feelings of control and independence show signs of being at risk for depression later on in

life. Children who spend most of their lives in rigid home environments that are not

flexible to the needs of their children, external circumstances, or changes in their own

family, are at risk. In order for children to thrive they need to be in a warm and

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emotionally supportive environment that has rules and boundaries but also allows for a

healthy amount of autonomy and flexibility.

The other parenting style hypothesized to be a predictor in the study was

permissive parenting which refers to a parenting style that is noncontrolling,

nondemanding, and relatively warm. Permissive parents are accepting of their children’s

impulses, demands and desires and are non-punitive. They make few maturity demands.

Permissive parents allow their children to regulate their own activities. Parents are

present as resources for their children to use as they wish but are not there to alter their

children’s current or future behavior. They do not demand that the attitudes or behaviors

of their children meet externally defined standards (Baumrind, 1989).

While research shows that such parenting is not ideal and will have implications

for the way such children learn to function and navigate their social worlds (Baumrind,

1967; 1968), it may not be associated with depressed functioning in children. Findings of

the current study demonstrate that depression in young children is associated with home

environments that do not offer emotional support to children. Permissive parenting can

be thought of as the antithesis of this. Emotional support is too plentiful in such homes,

and children get whatever it is that they want or ask for. Their children’s emotions

dictate what will happen in the household at any given moment. While such practice is

not good parenting and lacks structure, rules, and appropriate boundaries, it was not

associated with depression in children. Rather, depression in children was impacted by

homes that lack emotional warmth and caring.

The dysfunctional discipline practices of laxness, overreactivity and hostility were

not found to be significant predictors of preschoolers who show signs of being at risk for

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depression. The literature review cited studies that examined the relationship between

discipline techniques and signs of depression in school age children. Research was

lacking regarding the relationship between parental discipline techniques and internal

disorders in preschool children. According to this study, there was no significant

relationship between parental dysfunctional discipline practices and signs of depression

in preschool children. It is possible that this is due to the fact that parents do not typically

begin disciplining their children until age 2 or 3 or even later in some cases. Therefore,

the practices they use in this area may not have such a profound impact during the

preschool years. While it may influence a child’s external behaviors, it may take longer

for internalizing disorders to emerge as a result of such practices. However, as the

children get older and the years of discipline increase, a relationship emerges between

dysfunctional discipline practices and signs of depression in school-age children and

adolescents.

While it was hypothesized that two aspects of family functioning would be

associated with depression, only adaptability was found to be a significant predictor and

family cohesion was not. There was evidence that a lack of family cohesion is associated

with older children diagnosed with depression but such evidence was not found with

preschoolers. It is possible that preschool children are not as sensitive to the lack of

cohesion in families as are older children and are, therefore, not as impacted by it. It is

also possible the families are more cohesive in the early years when the children are

younger. However, with time and different stages and challenges, families may have a

tendency to become less cohesive so that school-age children and adolescents are more

exposed to such family environments.

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While only two of the hypothesized predictors were found to be significantly

related to symptoms of depression in preschool children, an additional analysis was

conducted to determine if the combination of all the hypothesized variables had any

impact on depression in preschoolers.

A Receiver Operating Characteristic Curve (ROC Curve) was plotted to

determine how well the familial factors predict the outcome of at-risk preschoolers

according to the teacher report and the less stringent definition of at risk. The curve in

Figure 1 depicts the full model, with authoritarian parenting, permissive parenting,

laxness, over reactivity, hostility, cohesive family functioning, and flexible family

functioning serving as predictors. Graphical model expression is important for evaluating

model accuracy. For instance, if one were to use a spectrum of student background

information captured by seven model predictors to assess whether a student is at risk of

depression, it would be important to know the extent, to which this information is

predictive of student mental health. This graphical summary goes beyond the traditional

way of model testing, which primarily relies on the parameter p-values. In the current

model, despite the fact that not all variables were found to be statistically significant at

the alpha of p<.1, the ROC curve indicates that familial factors can work together to

predict preschoolers who are at risk for depression. Based on this model, the true

positive rate is counter-balanced by the low false positive rate, which is desirable for

good predictions.

Erikson’s Stages of Psychosocial Development

Erikson’s theory can help explain why authoritarian parenting and rigid family

functioning can impact symptoms of depression. In Erikson’s theory of psychosocial

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development, there are eight stages of development in which healthy developing human

beings should pass from infancy to late adulthood. In each stage, the individual is

confronted with and hopefully masters new conflicts. Each stage builds on the successful

completion of earlier stages (Erikson & Erikson, 1981). When stages are not completed

successfully, it can lead to future problems. When parental practices impact the child in a

way so that the outcome of the conflict is the crisis as opposed to healthy adjustment,

symptoms of psychopathology can emerge. When there is a lack of flexibility in the

home and authoritarian parenting, especially during the earlier stages of development,

maladaptive outcomes such as mistrust and shame and doubt can emerge. Trusting

relationships and autonomy are not fostered in such home environments. Therefore, the

child has lost the foundation with which to successfully navigate the remainder of the

stages and depression can emerge.

Risk Factors

While Belden, Luby, and Spitznagel (2006) found that a family history of mood

disorders and stressful life events were significant risk factors for depression in early

childhood, the current study did not yield such findings. This may be due to the fact that

the current study utilized a screening measure that identified students as at risk for

depression. Belden, Luby, and Spitznagel (2006), on the other hand, conducted extensive

interviews utilizing DSM-IV criteria for Major Depressive Disorder (MDD) to determine

whether each child met diagnostic criteria for MDD. A family history of mood disorders

and stressful life events were found to be risk factors for preschool children who met

diagnostic criteria for MDD, but may not be significant risk factors for students who are

merely at risk for developing depression later on in life.

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Limitations and Future Research

There are several important limitations of the study. The first one is the size of

the sample. While the sample size met the minimum requirements indicated by the

power analysis, it was still not large enough to include a large number of cases in which

children did demonstrate signs of being at risk for depression. In future studies, a larger

sample should be included that would ensure enough events for all the various analyses to

have as much power as possible.

Additionally, it would be ideal for a future research study to use a case control

design where data from a number of cases are collected that meet criteria for at risk as

well as a number of cases that do not meet criteria for at risk. The two sets of cases

should be matched in as many other ways possible. Analyzing the differences in the two

sets of data will provide clear implications regarding the impacts of familial factors on

the development of depression in young children.

Another limitation of the study is the homogeneity of the sample. Most of the

sample is comprised of children from middle to upper class families in Queens,

Manhattan, and Nassau County. Almost one third of the sample (31.5%) is made up of

homes with incomes at or above $100,000. Because it is known that there is a greater

likelihood of psychopathology in children from low income homes (Keenan, Shaw,

Walsh, Delliquadri, & Giovanelli, 1997) it would be preferable to include a more

heterogeneous sample with regard to socioeconomic status.

Additionally, 78.3% of the parents completing the surveys held an advanced

degree. Therefore, the majority of the sample was very educated and whether or not they

practice effective parenting techniques and create a balanced family environment, they

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undoubtedly have knowledge about what these things should look like. Some of their

responses may have been a reflection of what they know is the more effective way of

parenting as opposed to what their actual parenting practices and family environments

are. Future research should include families whose parents have a more heterogeneous

range of educational backgrounds.

Future research may also want to decrease the subjectivity involved in responses.

Perhaps there is a more objective way of collecting data about familial factors instead of

utilizing a self-report. An observation technique or video recording of home

environments may pose more logistical difficulties but may provide data that is more

objective and accurate.

Since the current study has shown that authoritarian parenting and rigid family

functioning is associated with signs of depression in preschool children, future research

should begin to explore potential interventions for these factors. Parent training

programs that teach methods of authoritative parenting which have been used to

effectively decrease negative externalizing behaviors may also be effective in decreasing

symptoms of internalizing disorders. Programs that help parents create home

environments that are balanced and adaptable may also be effective. Such programs can

be used as prevention techniques for all parents as everyone would undoubtedly benefit.

However, they can also be used once a child is identified as being at risk for depression to

prevent symptoms from increasing in number and intensity and helping the child function

more effectively before they meet criteria for a depressive disorder.

Educational Implications

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Familial Factors

Findings of the current study have important implications for preschools. First, it

is of paramount importance for preschool administrators, teachers, assistants and all other

school personnel including therapists, nurses, and bus drivers to be aware that

preschoolers do exhibit signs of depression and these symptoms can be identified at an

early age. Schools can determine whether or not children are at risk and if they are, they

can seek help for such children right away to improve the prognosis. Schools can also

work with parents and help them identify symptoms of depression in their children as

well as facilitate treatment. Preschools can also offer programming for parents to teach

appropriate parenting styles and family functioning.

It is incumbent on school psychologists working in preschool settings to be aware

that symptoms of depression can exist at such a young age and to know what symptoms

look like so that they can work effectively with students, teachers and parents in this

regard. School psychologists are in a position to develop awareness programs for parents

and teachers as well as to foster a home-school relationship in which symptoms can be

detected early and treated effectively.

Finally, preschool teachers have the wonderful opportunity of modeling

appropriate styles, techniques and environments for parents and caregivers. Preschool

parents are often heavily involved in their child’s education, are often in the school

building and are usually the ones transporting their children to and from school. Parents

and caregivers can learn a tremendous amount by observing a teacher’s daily interactions

with students, the way he or she handles transgressions as well as the nurturing but

structured environment that is created within the four walls of the classroom.

Conclusion

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The purpose of this study was to look at the relationship between symptoms of

depression in preschool children and family factors such as parenting styles, discipline

practices and family functioning. Results of the study indicate that preschoolers do

demonstrate signs of depression, that parents and teachers do not always agree regarding

whether or not certain symptoms exist and that there is a relationship between the

parenting style of flexibility as well as rigid family functioning. The less flexible the

parenting style and the more rigid the family functioning, the greater chance there is of

preschoolers showing signs of depression. Additionally, it was found that familial factors

can work together to predict preschoolers who are at risk for depression. These findings

are important in that they demonstrate that early identification of at-risk preschoolers is a

possibility and when identifying these youngsters, input from both parents and teachers is

important. The findings also demonstrate that prevention and intervention programs can

and should be developed which focus on aspects of parenting and family environment.

Dear Parent/Guardian,

My name is Malka Ismach and I am student in the School Psychology specialization of the Ph.D. Program in Educational Psychology and Principal Investigator of a research study of the relationship between the way family members interact with each other and the existence of signs of depression in preschool children.

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Familial Factors

This is a consent form for participation in the study described above, which has two components. First, I will ask you to complete a brief checklist regarding the typical behaviors of your child. This survey will take 1 or 2 minutes to complete. Several weeks later, I will ask that you complete three surveys regarding your parenting styles and practices and the family functioning in your home. Completing the surveys will take about 15-20 minutes of your time. Your responses will remain confidential and your name will not appear anywhere on the actual survey. A numerical code will be assigned to each child and only this code will appear on the response sheet. The only person with access to the numerical codes will be me. Again, your responses to all questions will remain confidential as I will not ask you to put your name on any of the response sheets.

Second, your child’s teacher will complete the same brief checklist regarding the behaviors that he/she typically exhibits in school. Responses to these questions will remain confidential as well. Your child’s teacher will not be asked to put your child’s name on the actual response sheet. He/She will be given a cover sheet with the child’s name on it which he/she will be instructed to tear off prior to returning the checklist. The actual checklist will only contain the child’s assigned numerical code.

The risks from participating in this study are no more than encountered in everyday life. The benefits of your participation are that as a result of the research, there will be more information available regarding the relationships between familial factors and signs of depression in young children. These benefits may help in the implementation of effective prevention programs for depression in young children.

I am offering a $5.00 Amazon gift card to all participants, which will be distributed once the surveys are collected. If you are willing to complete the surveys via an e-mail based version, a $6.00 gift card will be offered.

Taking part in this study is voluntary. You may choose not to take part. Your child’s standing at the school will in no way be affected by the decision to participate or not to participate. If you begin, you may stop at any time. By signing your name below, you are agreeing to participate in the study and a survey packet will be distributed to you in the near future.

I agree to participate in this study. ____________________________ ____________Participant’s signature Date

__ I prefer paper based version __ I prefer e-mail based version Please provide e-mail address here: ___________________________________

I may publish results of the study, but names of people, or any identifying characteristics, will not be used in any of the publications. If you would like a copy of a summary of the study, please indicate that in the space provided below. Additionally, please provide me with your address below so that I can send you the gift card once the surveys are collected:

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Name: _______________________

Address: ___________________________________________

___________________________________________

E-mail: _________________________________

____ Yes, please send me a copy of the summary of the study

If you have any questions about this research, you can contact me at (917) 373-4883 or mismach@gc.cuny.edu, or my advisor, Dr. Marian Fish, at (212) 817-8290 or mfish@gc.cuny.edu. If you have questions about your rights as a participant in this study, you can contact Kay Powell, IRB Administrator, The Graduate Center/City University of New York, (212) 817-7525, kpowell@gc.cuny.edu.

Thank you for your participation in the study.

Sincerely,

___________________Malka Ismach, M.S. EdPrincipal Investigator

Washington Early Emotional Development Program

University In St. Louis 18 South Kingshighway, Suite 101SCHOOL OF MEDICINE St. Louis, MO 63108

314 – 286 – 2730

Preschool Feelings Checklist

Child’s Code ________ Gender F M Date Checklist Completed ________________

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Name of Person Completing Checklist _________________________________

Relationship to Child _________________________________________

This Student:

Is almost always interested in playing with other kids. Y N

Frequently appears sad or says he/she feels sad. Y N

Has a lot of trouble following simple directions or rules. Y N

Seems not to be as excited about play or activities as much as other kids. Y N

Whines or cries a lot. Y N

Can’t pay attention to games or tasks for very long. Y N

Keeps to him/herself. Y N

Pretend plays about scary or sad things. Y N

Blames him/herself for things. Y N

Seems to lack confidence. Y N

Doesn’t react to things that other children his/her age find exciting or Y N upsetting.

Often seems to be very tired and has low energy. Y N

Seems to feel overly guilty. Y N

Failed to gain weight or has lost weight (without being on a diet.) Y N

Used to behave his/her age but now seems to act younger Y N(for example, used to be potty trained but now soiling clothes).

Seems more irritable or grouchy than other children his/her age. Y N

Luby J., Heffilfinger, A, Mratkotsky C, Hildebrand, T (1999), Preschool Feelings Checklist. St. Louis, MO: Washington University.

FACES IVDavid H. Olson, Ph.D., Dean M. Gorall, Ph.D., Judy W. Tiesel, Ph.D.

Life Innovations P.O. Box 190 Minneapolis, MN 55440

Child’s Code:

Parent Information:

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Age: ______ Sex: M: ___ F: ___ Date: _________________________Education:(a)___ Some High School (b) ___ Completed High School(c) ___ Some college (d)___ Completed College (e)___ Advanced DegreeIncome: (If relevant)(a) ___ Less than $10,000 (b)___ $10-20,000 (c) ___ $20-30,000(d)___ $30-40,000 (e)___ $40-50,000 (f) ___ $50-60,000(g)___ $60-80,000 (h)___ $80-100,000 (i) ___ $100,000 or moreEthnic Background: (check all that apply)(a)___ Asian American (d) ___ Hispanic/Latino (g) ___ White/Caucasian(b)___ Black/African American (e) ___ Mixed Race(c)___ Hawaiian or Pacific Islander (f) ___ Native AmericanCurrent relationship status:(a)___ Single, never married (e) ___ Married, not first marriage(b)___ Single, divorced (f ) ___ Life-partnership(c)___ Single, widowed (g) ___ Living together(d)___ Married, first marriage (h) ___ SeparatedCurrent living arrangement:(a)___ Alone (d)___ With Others(b)___ With Parents (e)___ With Children(c)___ With Partner (f )___ With Partner and ChildrenUse Current Family: If no current Family, use Family of OriginFamily Structure: (a) ____ Two parents (biological) (d) ___ Two Parent (same sex)

(b) ____ Two parents (step family) (e) ___ One Parent(c) ____ Two parents (adoptive)

Family Member: (a)___ Father (b)___ Mother Number of Children in Family: (a) ____ None (b) ____ One (c) ___ Two (d) ____ Three(e) ____ Four (f) ____ Five (g) ___ Six or moreIs there a family history of mood disorders (depression or anxiety) on either the maternal or paternal side of the family? Y NHas there been a stressful life event during the past year (e.g. loss of job, death of family member or close friend, birth of sibling, divorce etc.)? Y N Comments:__________________________

Child Information (Please provide information regarding the child attending preschool, through which you were recruited for this study):Sex of child: Male __ Female __ Age of Child: _____Relationship to Child: Mom ___ Dad ___ Legal Guardian___ Number of Child in Birth Order of Family: Oldest ___ Youngest ___ Middle ___ If Child is a Middle Child: Number of children above child ____ Number of children below child ___

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Directions to Family Members: Family members should complete the instrument independently, not consulting ordiscussing their responses until they have been completed. Fill in the corresponding number in the space.

1 2 3 4 5StronglyDisagree

GenerallyDisagree

Undecided GenerallyAgree

StronglyAgree

1. Family members are involved in each others’ lives ___2. Our family tries new ways of dealing with problems ___3. We get along better with people outside our family than inside ___4. We spend too much time together ___5. There are strict consequences for breaking the rules in our family ___6. We never seem to get organized in our family ___7. Family members feel very close to each other ___8. Parents equally share leadership in our family ___9. Family members seem to avoid contact with each other when at home ___10. Family members feel pressured to spend most free time together ___11. There are clear consequences when a family member does something wrong ___12. It is hard to know who the leader is in our family ___13. Family members are supportive of each other during difficult times ___14. Discipline is fair in our family ___15. Family members know very little about the friends of other family members ___16. Family members are too dependent on each other ___17. Our family has a rule for almost every possible situation ___18. Things do not get done in our family ___19. Family members consult other family members on important decisions ___20. My family is able to adjust to change when necessary ___21. Family members are on their own when there is a problem to be solved ___22. Family members have little need for friends outside the family ___23. Our family is highly organized ___24. It is unclear who is responsible for things (chores, activities) in our family ___25. Family members like to spend some of their free time with each other ___26. We shift household responsibilities from person to person ___27. Our family seldom does things together ___28. We feel too connected to each other ___29. Our family becomes frustrated when there is a change in our plans or routines ___30. There is no leadership in our family ___31. Although family members have individual interests, they still participate in family activities ___32. We have clear rules and roles in our family ___33. Family members seldom depend on each other ___34. We resent family members doing things outside the family ___35. It is important to follow the rules in our family ___

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36. Our family has a hard time keeping track of who does various household tasks ___37. Our family has a good balance of separateness and closeness ___38. When problems arise, we compromise ___39. Family members mainly operate independently ___40. Family members feel guilty if they want to spend time away from the family ___41. Once a decision is made, it is very difficult to modify that decision ___42. Our family feels hectic and disorganized ___

1 2 3 4 5StronglyDisagree

GenerallyDisagree

Undecided GenerallyAgree

StronglyAgree

43. Family members are satisfied with how they communicate with each other ___44. Family members are very good listeners ___45. Family members express affection to each other ___46. Family members are able to ask each other for what they want ___47. Family members can calmly discuss problems with each other ___48. Family members discuss their ideas and beliefs with each other ___49. When family members ask questions of each other, they get honest answers ___50. Family members try to understand each other’s feelings ___51. When angry, family members seldom say negative things about each other ___52. Family members express their true feelings to each other ___

1 2 3 4 5Very

DissatisfiedSomewhatDissatisfied

Generally Satisfied

Very Satisfied

ExtremelySatisfied

How satisfied are you with:53. The degree of closeness between family members ___54. Your family’s ability to cope with stress ___55. Your family’s ability to be flexible ___56. Your family’s ability to share positive experiences ___57. The quality of communication between family members ___58. Your family’s ability to resolve conflicts ___59. The amount of time you spend together as a family ___60. The way problems are discussed ___61. The fairness of criticism in your family ___62. Family members concern for each other ___

Parenting ScaleD.S. Arnold, S.G. O’Leary, L.S. Wolff, and M.M. Acker

Please check appropriate boxes below:

Instructions: At one time or another, all children misbehave or do things that could be harmful, that are “wrong,” or that parents don’t like. Examples include:

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hitting someone whining not picking up toys running into the street forgetting homework throwing food refusing to go to bed arguing backhaving a tantrum lying wanting a cookie before dinner coming home late

Parents have many different ways or styles of dealing with these types of problems. Below are items that describe some styles of parenting. For each item, fill in the circle that best describes your style of parenting during the past two months with your preschool child indicated on the cover page.

SAMPLE ITEM:

At meal time…

I let my child decide 0---0------0---0---0---0 I decide how muchhow much to eat. my child eats.

1. When my child misbehaves…

I do something 0---0---0---0---0---0---0 I do somethingright away. about

it later.

2. Before I do something about a problem…

I give my child several 0---0---0---0---0---0---0 I use only onereminders or warnings. reminder or warning.

3. When I’m upset or under stress…

I am picky and on my 0---0---0---0---0---0---0 I am no more picky child’s back. than usual.

4. When I tell my child not to do something…

I say very little. 0---0---0---0---0---0---0 I say a lot.

5. When my child pesters me…

I can ignore 0---0---0---0---0---0---0 I can’t ignorethe pestering. pestering.

6. When my child misbehaves…

I usually get into a long 0---0---0---0---0---0---0 I don’t get into

argument with my child. an argument.

7. I threaten to do things that…

I am sure I can 0---0---0---0---0---0---0 I know I won’tcarry out. actually do.

8. I am the kind of parent that…

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sets limits on what 0---0---0---0---0---0---0 lets my child domy child is allowed to do. whatever he/she

wants.9. When my child misbehaves…

I give my child 0---0---0---0---0---0---0 I keep my talks shorta long lecture. and to the point.

10. When my child misbehaves…

I raise my voice 0---0---0---0---0---0---0 I speak to my child or yell. calmly.

11. If saying “No” doesn’t work right away…

I take some other 0---0---0---0---0---0---0 I keep talking and trykind of action. to get through

to my child.12. When I want my child to stop doing something…

I firmly tell my 0---0---0---0---0---0---0 I coax or begchild to stop. my child to stop.

13. When my child is out of my sight…

I often don’t know what my child is doing. 0---0---0---0---0---0---0 I always have

a good idea of what my child is doing.

14. After there’s been a problem with my child…

I often hold a grudge. 0---0---0---0---0---0---0 Things get back to normal quickly.

15. When we’re not at home…

I handle my child the 0---0---0---0---0---0---0 I let my child getway I do at home. away with a lot more.

16. When my child does something I don’t like…

I do something about it. 0---0---0---0---0---0---0 I often let itgo.every time it happens.

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17. When there is a problem with my child…

Things build up and I do 0---0---0---0---0---0---0 Things don’t get out

things I don’t mean to do. of hand.

18. When my child misbehaves, I spank, slap, grab, or hit my child…

never or rarely. 0---0---0---0---0---0---0 most of the time.

19. When my child doesn’t do what I ask…

I often let it go or end 0---0---0---0---0---0---0 I take some other

up doing it myself. action.

20. When I give a fair threat or warning…

I often don’t carry it out. 0---0---0---0---0---0---0 I always do what Isaid.

21. If saying “No” doesn’t work…

I take some other 0---0---0---0---0---0---0 I offer my child

kind of action. something niceso he/she will behave.

22. When my child misbehaves…

I handle it without 0---0---0---0---0---0---0 I get so frustrated or

getting upset. angry that my child can see I’m upset.

23. When my child misbehaves…

I make my child tell me why 0---0---0---0---0---0---0 I say “No” or take

he/she did it. some other action.

24. If my child misbehaves and then acts sorry…

I handle the problem 0---0---0---0---0---0---0 I let it go that time

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like I usually would.

25. When my child misbehaves…

I rarely use bad 0---0---0---0---0---0---0 I almost alwayslanguage or curse. use bad language.

26. When I say my child can’t do something…

I let my child 0---0---0---0---0---0---0 I stick to what I said.

do it anyway.

27. When I have to handle a problem…

I tell my child 0---0---0---0---0---0---0 I don’t say I’m sorry. I’m sorry about it.

28. When my child does something I don’t like, I insult my child, say mean things, or call my child names…

never or rarely. 0---0---0---0---0---0---0 most of the time.

29. If my child talks back or complains when I handle a problem…

I ignore the complaining 0---0---0---0---0---0---0 I give my child a talkand stick to what I said. about not complaining.

30. If my child gets upset when I say “No”…

I back down and 0---0---0---0---0---0---0 I stick to what I said.

give in to my child.

Parenting Styles and Dimensions Questionnaire

Robinson, C.C., Mandleco, B., Olsen, S.F., & Hart, C.H. (2001). The Parenting Styles

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and Dimensions Questionnaire (PSDQ). In B.F. Perlmutter, J. Touliatos &

G.W. Holden (Eds.), Handbook of family measurement techniques: Volume 3.

Instruments & Index (pp. 319 – 321). Thousand Oaks: Sage.

For each of the following items, rate how often you exhibit this behavior with your preschool child:1 – Never2 – Once in a while3 – About half of the time4 – Very often5 – Always

_____ 1. I am responsive to my child’s feelings and needs.

2. I use physical punishment as a way of disciplining my child.

3. I take my child’s desires into account before asking him/her to do

something.

4. When my child asks why he/she has to conform, I state: because I said so,

or I am your parent and I want you to.

5. I explain to my child how I feel about the child’s good and bad behavior.

6. I spank when my child is disobedient.

7. I encourage my child to talk about his/her troubles.

8. I find it difficult to discipline my child.

9. I encourage my child to freely express (himself)(herself) even when

disagreeing with me.

_____ 10. I punish by taking privileges away from my child with little if any

explanations.

11. I emphasize the reasons for rules.

12. I give comfort and understanding when my child is upset.

13. I yell or shout when my child misbehaves.

14. I give praise when my child is good.

15. I give into my child when the child causes a commotion about something.

16. I explode in anger towards my child.

17. I threaten my child with punishment more often than actually giving it.

_____ 18. I take into account my child’s preferences in making plans for the family.

19. I grab my child when being disobedient.

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20. I state punishments to my child and do not actually do them.

21. I show respect for my child’s opinions by encouraging my child to express

them.

22. I allow my child to give input into family rules.

23. I scold and criticize to make my child improve.

_____ 24. I spoil my child.

25. I give my child reasons why rules should be obeyed.

26. I use threats as punishment with little or no justification.

27. I have warm and intimate times together with my child.

_____ 28. I punish by putting my child off somewhere alone with little if any

explanations.

29. I help my child to understand the impact of behavior by encouraging my

child to talk about the consequences of his/her own actions.

_____ 30. I scold or criticize when my child’s behavior doesn’t meet my

expectations.

_____ 31. I explain the consequences of my child’s behavior.

_____ 32. I slap my child when the child misbehaves.

Table 15

Definitions of At-RiskDefinitions of At-Risk

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Construct Word Definition Measured As

PARC At-risk according to the

parent report and the

clinical definition of at risk

3 or more symptoms

reported by parent

TARC At-risk according to the

teacher report and the

clinical definition of at risk

3 or more symptoms

reported by teacher

PARLS At-risk according to the

parent report and the less

stringent definition of at

risk

1 or more symptoms

reported by parent

TARLS At-risk according to the

teacher report and the less

stringent definition of at

risk

1 or more symptoms

reported by teacher

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