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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
32
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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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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Familial Factors
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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Familial Factors
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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Familial Factors
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 [email protected], or my advisor, Dr. Marian Fish, at (212) 817-8290 or [email protected]. 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, [email protected].
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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