Influence of attention deficit disorder on mother's [sic] perception of family stress : or, "Lady, why can't you control your child?" PDF
Preview Influence of attention deficit disorder on mother's [sic] perception of family stress : or, "Lady, why can't you control your child?"
THE INFLUENCE OF ATTENTION DEFICIT DISORDER ON MOTHER'S PERCEPTION OF FAMILY STRESS: OR, "LADY, WHY CAN'T YOU CONTROL YOUR CHILD ?" By ANNE FRANCES CRONIN A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 1995 Copyright 1995 by Anne Frances Cronin TABLE OF CONTENTS LIST OF TABLES V INTRODUCTION 1 Purpose of this Study 1 Attention Deficit Disorder 4 Characteristics of the Disorder 4 History and Social Issues 6 Interventions and other Controversies 8 The Family and ADD 9 Cystic Fibrosis 11 History and Social Issues 11 Characteristics of the Disorder 12 Interventions 13 The Family and CF 15 LITERATURE REVIEW 17 The Social Construction of the Family 17 The Mother Role 2 Challenges to the Mother Role 22 The Resiliency Model of Family Stress 25 Pile-up of Stressors 26 Family Vulnerability 29 The Sick Role 31 "Disease" Boundary 31 "Treatment" Boundary 34 Normalization 36 Model of Human Occupation 38 Occupational Role Analysis 38 Environmental Press 4 Theory Grounding this Research 41 THE COLLECTION AND ORDERING OF DATA 45 Grounded Theory and Analytic Induction 45 Rationale and Specific Aims 46 Sampling 47 Instrumentation 53 Open Coding 55 Labeling Factual Data 55 Themes and Issues 56 Drawing Conclusions 57 Validity and Reliability Issues 60 Reliability of Interviews 60 Triangulating Data 62 Emergent Themes 63 ... Medications and social perception in ADD 63 ni Challenges to Mother's sense of well-being in ADD 67 ADD and the Health Care System 68 Perception of Antagonism by the Health Care Establishment 70 Adolescence and Chronic Disability 73 Siblings and Chronic Disability 75 Special Issues and Ethical Concerns 78 MAKING AND VALIDATING STATEMENTS OF RELATIONSHIPS ... 83 RMFSA Constructs 84 Family Demands 85 Family Resources 90 Family Appraisal 103 Normalization Theory 115 Covering Up 119 Maintaining a Routine 121 Model of Human Occupation 126 Environmental Analysis 128 Volitional Analysis 130 Summary 135 CONCLUSIONS 137 Discussion 137 CF Findings 138 ADD Findings 139 Implications for Theory 142 Implications for Health Care Providers 144 Limitations of this Study 149 Directions for Further Research 152 .... "Lady, why can't you control your child?" 154 APPENDIX A. THEORY CONSTRUCTS EMBEDDED IN THE INTERVIEW 158 APPENDIX B. CODES IMBEDDED INTO INTERVIEW TRANSCRIPTS 161 APPENDIX C. ADD APPRAISAL GRAPH- SOCIAL NETWORK & INCOME162 APPENDIX D. ADD APPRAISAL GRAPH- DEMANDS & NUMBER OF CHILDREN 163 APPENDIX E. CF APPRAISAL GRAPH- SOCIAL NETWORK & INCOME 164 APPENDIX F. CF APPRAISAL GRAPH- DEMANDS & NUMBER OF CHILDREN 165 LIST OF REFERENCES 166 BIOGRAPHICAL SKETCH 176 IV LIST OF TABLES Table page 1 Integration of MOHO and RMFSA Constructs 43 2 Demographic Summary 49 3 ADD Sample Summary 51 4 CF Sample Summary 52 5 Summary of Demands 88 6 Summary of Social Network 93 7 Biological and Adoptive ADD Family Incomes Compared 100 8 Biological and Adoptive ADD Demands and Resources Compared 103 9 Appraisal Summary 105 LIST OF FIGURES Figure page 1 Adjustment Phase of the RMFSA 27 2 The Adaptation Phase of the RMFSA 32 3 Environmental Influences from MOHO 42 4 Characteristics of ADD and CF Sample Compared 50 5 Comparison of ADD and CF Demands by Type 87 6 Distribution of Demands and Social Network 89 .... 7 Social Resources Compared in ADD and CF Samples 92 8 Distribution of Demands: Biological and Adopted ADD compared to CF 99 9 Social Networks: Biological and Adopted ADD compared to CF 102 10 Appraisal: ADD and CF Samples Compared 107 11 Appraisal: Biological and Adopted ADD compared to CF 108 12 Influences on ADD Appraisal 110 13 Influences on CF Appraisal Ill VI Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy THE INFLUENCE OF ATTENTION DEFICIT DISORDER ON MOTHER'S PERCEPTION OF FAMILY STRESS: OR "LADY, WHY CAN'T YOU CONTROL YOUR CHILD ?" By Anne Frances Cronin August, 1995 Chairperson: Constance Shehan, Ph. D. Major Department: Sociology Maternal perceptions of stress vary in the presence of chronic childhood conditions. Behavioral disabilities however are expected to influence the perception of stress differently than medical or physical disorders. This qualitative study consists of interviews with 22 mothers of children with attention deficit disorder (ADD), a behavioral disorder, and 23 mothers of children with cystic fibrosis (CF), a physical disorder. Open-ended questions explore family demands, resources, time use, routines, concerns, and support. Mothers in both groups report persistent vigilance in the care of their children. This perceived need for vigilance creates an undercurrent of tension in even routine daily activity. Both groups of mothers report problems of decreasing compliance and personal responsibility as the child enters adolescence. Mothers in both groups report a vn change in personal priorities and expectations resulting from interaction with their child. Both groups are highly child-focused in daily routines and leisure. The experiences of CF mothers in this study are consistent with research findings on other chronic conditions. CF mothers report that their extended family provides extensive physical and emotional support. While CF mothers report a persistent emotional sorrow associated with the disease, they are generally able to "normalize" their daily routines. CF mothers describe their children and families as "normal", and are generally positive in their outlook. The ADD child's behavioral deviations result in social censure of both the child and the mother. With this condition families are not afforded the legitimacy of "illness" or social affirmation for positive parental performance. Thus, mothers of children with ADD have less family support, high perception of child related demands, and tend toward a more negative view of themselves. The demands of ADD are not easily routinized, and few ADD mothers are able to normalize care for their child. Mothers of adopted children with ADD fared a little better than the biological mothers. While the general patterns were similar, the adoptive mothers reported more support from their extended family and a more positive vin sense of personal control. Implications for health care professionals and future research are offered. IX INTRODUCTION Purpose of this Study The prevalence of chronic childhood conditions is increasing as patterns of childhood morbidity and mortality change (Woodroffe & Glickman, 1993). Advanced medical technologies have increased survival rates and the increased chronicity seen in children in the United States. Ten to 20% of individuals under 18 years of age in the U.S. have chronic health conditions (Jackson & Vessey, 1992). While there is much research pertaining to family stress and associated with childhood disability, few studies have included a comparison group. Although high levels of stress have been reported, there is no comparison standard for critical analysis of the findings. Other studies have included a comparison group of families, but have also lumped several disability types together. In either case it is difficult to determine if the stresses parents report are anomalous, similar across disabilities, or disability specific.
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