237 - Challenging the Deficit Narrative: Early Parenting Strengths in Families of Children with Cerebral Palsy

Publication Number: 3229.237

Mary Lauren Neel, Emory University School of Medicine, Atlanta, GA, United States; Larken R. Marra, Emory University School of Medicine, Decatur, GA, United States; Junwen Huang, Children's Healthcare of Atlanta, Atlanta, CA, United States; A. Joselyn Barahona, Emory University School of Medicine, Atlanta, GA, United States; Paige S. Ryals, Emory University School of Medicine, Atlanta, GA, United States; Daniela Castro, Emory University School of Medicine, Atlanta, GA, United States; Allison McIntyre, Emory University, Atlanta, GA, United States; Melissa M. Murphy, University of Colorado School of Medicine, Aurora, CO, United States; Nathalie L. Maitre, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, United States

Background: Recent publications suggest suboptimal dyadic interactions between children with CP and their parents as compared to children without CP. Studies also suggest less supportive parenting characteristics, including higher intrusiveness and lower sensitivity, in parents of children with CP.

Objective: We aimed to characterize parenting style and parent/child emotional connection in the largest US cohort of infants with CP. We also examined differences in parenting style scores based upon the degree of parent/child emotional connection and neurological severity.

Design/Methods: Our study included children between 4-13 months with CP, all assessed with the Hammersmith Infant Neurological exam to classify severity of neurological involvement. Parents completed the Parenting Styles and Dimensions Questionnaire to quantify degree of authoritative, authoritarian, and permissive parenting styles. Dyads also completed a free play session coded for the Welch Emotional Connection Screen (WECS), whereby parents and children receive an overall score for emotional connection as well as ordinal scores for 4 subscales (Table 1).
We used descriptive statistics across the cohort, one-way Anovas and Spearman's rho correlations to determine differences in parenting style scores by WECS scores, and Pearson's Chi-squared analyses to examine differences in emotional connection by severity of neurological involvement.

Results: We included n=201 dyads in our cohort. Mean child corrected age at assessment was 9 months (+/- 4); 50% were born preterm and 13% of had HINE scores < 40 (significant neurological involvement). Parenting style scores for the cohort are depicted in Figure 1. 89% of our dyads were emotionally connected on standardized behavioral coding. There was no difference in average HINE score between dyads who were emotionally connected versus those who were not (Figure 2). Higher authoritative parenting was associated with higher child facial expressiveness on WECS (rs=0.157, p=0.043), and higher authoritarian and permissive parenting were both associated with lower parent facial expressiveness (rs=-0.154, p=0.048; rs=-0.154, p=0.048, respectively).

Conclusion(s): In this large cohort of parents of infants with CP, authoritative parenting (balanced in responsiveness and structure) was prevalent, but authoritarian and permissive parenting were uncommon. Most dyads were emotionally connected, in contrast to previous studies suggesting dyadic interaction difficulties. More work is needed to expand on the nuances of parenting and dyadic interactions in parents and their children with CP or other developmental conditions.

Table 1. Demographics and cohort scores


Figure 1. Distribution of score frequency by parenting styles for parents of child with cerebral palsy
Figure 1. Histograms depicting distribution of score frequency for authoritative (A), authoritarian (B), and permissive (C) parenting styles measured with the Parenting Styles and Dimensions Questionnaire (PSDQ) in our cohort (the largest US cohort of infants with CP) .


Figure 2. Severity of child motor impairment not associated with parent/child emotional connection
Boxplot showing median and interquartile range of child HINE scores of dyads who are (median 58, IQR 48-63.5) or who are not (median 58, IQR 54-59) emotionally connected on the Welch Emotional Connection Screen (WECS) behavioral coding. There is no difference between child HINE scores between dyads who are emotionally connected (mean 54.9, SD 11.7) as compared to dyads who are not emotionally connected (mean 55.7, SD 8.4). Chi-squared analysis showed no significant differences.