Disciplinary choices of mothers of deaf children and mothers of normally hearing children
Introduction
Because children with disabilities can occasion some unique parenting challenges, some have hypothesized a link between childhood disabilities and physical maltreatment (cf., Ammerman, 1991; Ammerman, Van Hasselt, & Hersen, 1988; Sobsey, 1994). Although advocates for this hypothesis have been able to marshal considerable theoretical support for their position, limited empirical evidence has caused others to question the notion of a simple link between child maltreatment and childhood disabilities (e.g., Coon, Beck, & Coon, 1980; Starr, Dietrich, Fischoff, Ceresnie, & Zweier, 1984). Within the last decade, however, a growing body of research has provided empirical evidence of the association between childhood disabilities and maltreatment. For example, using the methodology of the Second National Incidence Study (Office of Human Development Services, 1988), Westat (1993) provided evidence that children with disabilities were approximately 1.7 times more likely to be maltreated than children without disabilities. In a hospital-based epidemiological study of maltreatment, Sullivan and Knutson (1998) established a disability rate among maltreated children that was approximately twice the disability rate among nonmaltreated children. Extending those findings to a school-based population study that was not compromised by possible sampling biases, Sullivan and Knutson (2000) reported that the relative risk for physical abuse varied as a function of the disability classification of the children. For example, although risk for physical abuse among persons with a physical disability was approximately 1.2 times that of nondisabled children, risk for physical abuse among children with other disabilities ranged from 2 to 7.3 times that of nondisabled children.
The methodology of the Westat (1993) and Sullivan and Knutson (2000) studies did not permit an unequivocal determination as to whether the disabilities contributed to maltreatment or whether maltreatment contributed to the disabilities. Within the Sullivan and Knutson (1998) study, however, a subgroup of subjects could be identified where there was unequivocal medical evidence that the disability was present prior to maltreatment. Based on analyses of that subgroup, there was support for the hypothesis that some disabilities (e.g., hearing impairment, speech and language disorders, health-related disabilities, developmental disabilities) were more likely to be risk factors than consequences of maltreatment. For those disabilities that seemed to be risk factors, the question remained as to why children with a disability are at greater risk of maltreatment than are children without a disability.
One hypothesis that has been advanced to account for the putative disability-maltreatment link is that rearing a disabled child may occasion more parental stress than rearing a nondisabled child (Ammerman et al., 1988; Benson Gross, Messer, Kellum, & Passmore, 1991; Verdugo, Bermjo, & Fuertes, 1995). There are, however, at least two lines of evidence that cast doubt on the hypothesis that stress can be used to account for a disability-abuse link. First, there is some evidence that rearing children with disabilities does not necessarily occasion unique stress (Ammerman & Patz, 1996). It is also the case that the level of reported stress associated with rearing a child with a disability does not necessarily covary with the severity of the disability (e.g., Benedict, Wulff, & White, 1992; Embry, 1980, Starr et al., 1984, Verdugo et al., 1995). Perhaps more importantly, based on a comprehensive review of the physical abuse literature published across two decades, Knutson and Schartz (1997) concluded that support for the link between parental stress and abuse was not particularly strong. An alternative hypothesis to account for the disability-physical abuse connection can be derived from a discipline-mediated model of physical abuse (cf., Greenwald, Bank, Reid, & Knutson, 1997).
Discipline-mediated models of physical abuse have suggested that physical child abuse in the form of injurious physical discipline might not be qualitatively different from normative physical discipline. Rather, some abusive discipline can be conceptualized as normative discipline that has escalated to an injurious level. In this theoretical model the escalation in discipline can be due to either the ineffective disciplinary strategies of the parents (cf., Greenwald et al., 1997) or some unique interactions between the child and the caretaker that compromise parental efforts to influence the child's behavior (cf., Knutson & Bower, 1994). In both models, physically abusive parenting is seen as a reflection of the characteristics of the parent (e.g., selecting ineffective disciplinary strategies), the characteristics of the child (e.g., communicative limitations), and the confluence of those child and parental factors in a dynamic disciplinary context. Thus, in a discipline-mediated model, the occurrence of abuse is placed in a microsocial context where a parent's attempt to influence the child's behavior in a specific context is ineffective and, as a result, the parent adopts more intensive strategies and more punitive strategies. Such a model could account for the association between some childhood disabilities, such as communication disorders, and maltreatment.
Consistent with the discipline-mediated model of physical abuse, it has been suggested that communication difficulties could play a central role in the physical abuse of children with disabilities (e.g., Embry, 1980; Knutson, Schartz, & Zaidi, 1991; Sullivan & Knutson, 1998; Verdugo et al., 1995). Because the vast majority of prelingually and perilingually deaf children have normally hearing parents, most prelingually and perilingually deaf children have parents who are not fully prepared to communicate effectively with their child. Because of the likely communicative difficulties between a deaf child and his or her parents, it has been suggested that deaf children are at particular risk for physical abuse (Sullivan, Brookhouser, Scanlan, Knutson, & Schulte, 1991). Consistent with that hypothesis are data indicating that parents of deaf children are more likely to report the use of physical discipline (e.g., Schlesinger & Meadow, 1972) and that deaf children are at increased risk of physical abuse relative to their normally hearing peers (e.g., Sullivan and Knutson, 1998, Sullivan and Knutson, 2000).
Although the presence of the disability per se has been hypothesized to influence discipline and abuse by parents of deaf children, it is also possible that the association between disability and abuse reflects something about the habilitative or rehabilitative efforts that parents adopt to meet the needs of their child. Often parents of disabled children are confronted with difficult choices when attempting to meet the special needs of their child. How they respond to those choices could reflect something about parenting and the manner with which the parents attempt to influence their child's development. In recent years, pediatric cochlear implantation for deaf children has moved from being an experimental procedure to a clinically accepted intervention (National Institute of Health, 1995). Yet, because of the highly variable outcome of cochlear implants, there continues to be considerable controversy regarding implantation of children (cf., Balkany, 1996; Lane & Bahan, 1998; Wever, 2002). Thus, parents of deaf children are often confronted by that controversy as well as the challenge of meeting the needs of their child. Thus, it is possible that parents who seek an implant might approach child discipline differently than parents who elect not to seek an implant for their deaf child.
Recent work using Analog Parenting Tasks (APT) (e.g., Fagot, 1992; Knutson & Bower, 1994; Knutson et al., 1991; Rodriquez & Sutherland, 1999; Zaidi, Knutson, & Mehm, 1989) suggests that it should be possible to assess the disciplinary preferences of parents of disabled and nondisabled children to determine whether the presence of a disabled child in the household influences disciplinary preferences of the parent. Thus, the present study used an analog test of disciplinary preferences to determine whether rearing a deaf child would influence the disciplinary preferences of parents. Additionally, the study was designed to determine whether disciplinary preferences differed between parents seeking an implant for their deaf child and parents who elected not to seek an implant for a deaf child.
Section snippets
Subjects
Three samples of mothers participated in the study. The first sample consisted of 57 mothers of prelingually deaf children who had been consecutively evaluated for cochlear implantation at The University of Iowa Department of Otolaryngology—Head and Neck Surgery. To be eligible for an implant in this protocol, the child had to be at least 24 months of age at the time of referral and had to be either congenitally deafened or had to have incurred a profound bilateral hearing loss prior to 18
Results
Prior to the conduct of the planned analyses of the APT using one-way ANOVAs, the three groups of mothers were contrasted with respect to the demographic characteristics of their households. These preliminary analyses used one-way ANOVA for continuous variables (e.g., number of children in the household) and Chi Square tests of association for categorical variables (e.g., single parenthood; social class Hollingshead, 1975). No group differences approached statistical significance (all p's >
Discussion
The findings of the present study provide evidence that mothers who were rearing a child with a profound hearing loss are more likely to endorse the use of physical discipline in response to depicted child transgressions and more likely to escalate that discipline in response to destructive or dangerous acts than were mothers of normally hearing children. Thus, the findings are consistent with the hypothesized link between rearing a communicatively-impaired child and risk of physical abuse
Acknowledgement
The assistance of Steve Berthoff, Rhonda C. Boyd, Shawna Ehlers, Kathleen Murray, Mary Bower Russa, Mary Beth Selner-O’Hagen and Rebecca Wald is gratefully acknowledged.
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The development of this paper was supported, in part, by research grant MH61731 funded by NIMH and ACYF, John F. Knutson, Principal Investigator, and, in part, by a research grant awarded to Department of Otolaryngology—Head and Neck Surgery, University of Iowa, (Number 2 P50 DC 00242) from the National Institute of Deafness and Other Communication Disorders, National Institutes of Health; grant RR00059 from the General Clinical Research Centers Program, Division of Research Resources, NCRR, NIH; the Lions Clubs International Foundation; and the Iowa Lions Foundation.
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Present address: Department of Neurology, Creighton University Medical School, Omaha, NE, USA.