Childhood Developmental, Emotional and Behavioral Health and Parent Well-Being and Career Decisions: A Generalized Structural Equation Model

Background/Purpose. Approximately 20% of children in the U.S. aged 3 -17 years have been diagnosed with an emotional, behavioral, or developmental disorder, including 1% that suffer from one or more autism spectrum disorders (ASD). For every 70% of school children that have one diagnosed disorder, 41% have at least two or more co-occurrences of these disorders. Mesosystem linkages and processes affect a child’s development, microsystem elements (individual, home environment, parents) interact with the exo-system (school, parents’ workplace, social network, neighborhood) to affect outcomes. Using two datasets, we examined the underlying dimensions of the co-occurrence of EBH disorders in children and tested the hypothesis that the comorbidity of EBH problems would have direct effects on parental career and social processes and indirect effects on family flourishing.

Methods: We used data from the nationally representative panel study on the impact of childhood behavioral problems on childcare and employment decision-making and the Child and Adolescent Health Measurement Initiative (CAHMI). First sample comprised a cohort of 533 parents of children aged 0 -13 years while CAHMI comprised n=5,652 parent-child dyads (diagnosed with autism, ADHD, and EBH problems)—preliminary analysis involved exploratory and confirmatory factor analysis to examine the latent factors associated with these comorbidities. We fitted a generalized structural equation modeling (GSEM) to test hypotheses that Autism, ADHD, and EBH, respectively, had a direct positive (detrimental) effect on parents' decisions to change careers, cut work, and experience aggravation respectively and that parents’ decisions in these areas had an indirect positive effect on family resilience and flourishing.

Results: There was a high level of correlation between the EBH problems, parental aggravation, and the decision to cut work. Example statistics include direct effects of autism on parents’ decision to cut work (-0.63), change careers (-0.43), and experience aggravation (-1.20) were similar to ADHD path to parents’ decision to cut work (-.28), change careers (-0.12), and experience aggravation (-1.0) and for EBH problems on decision to cut work (-1.00), change careers (-0.12), and experience aggravation (-1.52), all statistically significant. However, the indirect effects on family resilience were minimal except for parental aggravation (0.13). Goodness-of-fit statistics for the final model's coefficients, variance estimates, and standard errors yielded statistically significant Chi-squared statistics, including the Satorra-Bentler scaled test of model saturation (1.75 with a significance level greater than 0.5), suggesting that we cannot reject the null hypotheses.

Implications: This study highlights the predominant pattern of EBH and developmental disorders among children in families and the direct and indirect effects on parents’ career decisions and paths to family resilience. Findings suggest that child emotional, behavioral and developmental well-being is a significant factor for parent work performance and career development. They demonstrate the need for integrated workplace policies and programs recognizing the parent/worker as not dissociated from their family. The study further highlights the need to strengthen and develop (rather than cut off) programs and services for families with children with developmental needs. Further research on the etiology of patterns of comorbidity of developmental disorders among children is needed.