(Withdrawn) Examining the Role of Family Supports, Resources, and Stressors in Parental Coping Among Children with Emotional, Developmental or Behavioral Disorders

Background: Caregivers of children who have emotional, behavioral, or developmental problems experience considerable strain and stress related to caring for their child’s special needs. The enormous burden of caregiving can decrease a parent’s ability to provide care, impacting the health of the child, the parents, and overall family functioning. Caregiving strain can be exacerbated by lack of financial resources, insufficient social support, and increased functional impairments in children. To manage these challenges, these parents report the need for family support services, including assistance with coordinating health care, respite care, peer support, or family or individual counseling. Informed by the Double ABCX model of family stress, this study examined the role of formal and informal supports and family resources and stressors in parent coping for families of children with emotional, behavioral, or developmental problems.

Methods: The study sample was drawn from the National Survey of Children’s Health and included children with special health care needs (0-18 years) who were identified as having an ongoing emotional, behavioral, or developmental problem through the Children with Special Health Care Needs screening tool (n=12,139). Data from 2016 through 2019 was pooled. Parent coping was derived from a single ordinal item on the survey. It was recoded into a binary variable, indicating how a parent feels they are coping with the day-to-day demands of raising children (very or somewhat well or not very well/not well at all). Formal supports included parents’ perception of having adequate healthcare and care coordination, receipt of cash assistance and food stamps, and formal emotional supports (peer support, counseling, or support groups). Informal supports included informal sources of emotional support (spouse, family member, friend, or church) and neighborhood support. Family resources included continuous health insurance, household income and language, and parent education levels. Family stressors included the child’s functional impairments and level of exposure to adverse childhood experiences (ACEs). Multivariable logistic models regressed independent variables on parent coping, controlling for child demographic characteristics.

Results: Formal family supports critical for greater parent coping among children with emotional, behavioral, or developmental problems included receiving adequate access to health care (OR=2.34***) and help with care coordination OR=1.675**). Informal supports associated with increased parent coping included having one or more sources of emotional support (OR=2.81***) and living in a supportive neighborhood (OR=1.78***). One family stressor was associated with reduced parent coping: a child's exposure to 2 or more adverse childhood experiences (OR=0.43***). Family resources associated with increases in parents’ coping included higher level of education (OR=1.35*) and higher levels of family income (OR=1.64**).

Conclusions: For parents of children with emotional, behavioral, or developmental problems, receipt of adequate health services and help with care coordination, as well as access to informal emotional and neighborhood supports, are associated with increased parent coping. Families with lower household incomes and parental education levels, in which children are exposed to higher level of ACEs, are at greater risk for poor parent coping. Facilitating formal and informal supports for these families may be especially important for parental functioning.

*p<.05; **p<0.01; ***p<0.001