Skip to main content
NCBI home page
Journal of Pediatric Psychology logoLink to Journal of Pediatric Psychology
. 2014 Oct 17;40(1):96–108. doi: 10.1093/jpepsy/jsu087

Parenting and Independent Problem-Solving in Preschool Children With Food Allergy

Lynnda M Dahlquist 1,✉, Thomas G Power 2, Amy L Hahn 1, Jessica L Hoehn 1, Caitlin C Thompson 1, Linda J Herbert 1, Emily F Law 1, Mary Elizabeth Bollinger 3
PMCID: PMC4288307  PMID: 25326001

Abstract

Objective To examine autonomy-promoting parenting and independent problem-solving in children with food allergy. Methods 66 children with food allergy, aged 3–6 years, and 67 age-matched healthy peers and their mothers were videotaped while completing easy and difficult puzzles. Coders recorded time to puzzle completion, children’s direct and indirect requests for help, and maternal help-giving behaviors. Results Compared with healthy peers, younger (3- to 4-year-old) children with food allergy made more indirect requests for help during the easy puzzle, and their mothers were more likely to provide unnecessary help (i.e., explain where to place a puzzle piece). Differences were not found for older children. Conclusions The results suggest that highly involved parenting practices that are medically necessary to manage food allergy may spill over into settings where high levels of involvement are not needed, and that young children with food allergy may be at increased risk for difficulties in autonomy development.

Keywords: developmental perspectives, parenting, psychosocial functioning

The development of autonomy is well established as an important developmental task of early childhood (Erikson, 1963; Sroufe, Egeland, Carlson, & Collins, 2005). Crucial changes in autonomy, self-reliance, and social skill development take place during the preschool years through the child’s increasing independence and interaction with the environment (Howes & Lee, 2006; Power, 2000). Children at this age are highly dependent on their parents to structure the world around them to facilitate their growth and development (Maccoby & Martin, 1983). Therefore, disruptions in parent–child interactions during the preschool years have the potential to disrupt developmental trajectories with far-reaching consequences into adolescence and beyond (Sroufe et al., 2005). For example, high levels of dependence in young children are associated with internalizing symptoms (LaFreniere, Provost, & Dubeau, 1992), insecure attachment (Sroufe, Fox, & Pancake, 1983; Waters & Deane, 1985), and low competence with peers (LaFreniere et al., 1992). Longitudinal studies show that overly dependent preschool children are more likely to show developmental delays and/or passive/dependent behavior during middle childhood (Kagan & Moss, 1960; Wender, Pederson, & Waldrop, 1967).

Parents play a crucial role in facilitating autonomy development by providing children opportunities for independent activities and by interacting with children in ways that help them learn new skills and develop confidence in their ability to independently solve problems and regulate their emotions (Bugental & Grusec, 2006; Power, 2004; Wood, Bruner, & Ross, 1976). Autonomy-promoting parenting behaviors take into account the child’s perspective and provide encouragement, hints, and general problem-solving strategies as needed, but ultimately allow children to solve their own problems (Grolnick, Gurland, DeCourcy, & Jacob, 2002; Grolnick, Price, Beiswanger & Sauck, 2007). In contrast, when parents are overly directive and/or take over responsibility for solving a problem, either by telling the child what to do or actually solving the problem themselves, it can undermine children’s sense of self-efficacy and competence (Colman & Thompson, 2002; Grolnick et al., 2002, 2007; Shell & Eisenberg, 1992, 1996) and interfere with autonomy development (Deci, Driver, Hotchkiss, Robbins, & Wilson, 1993; Grolnick & Ryan, 1989). These parenting behaviors are sometimes referred to as “controlling parenting” (Grolnick et al., 2002, 2007), “parental overinvolvement” (Hudson & Rapee, 2001, 2002), and in some cases as an element of “overprotection,” in that they prevent or protect children from experiencing failure (Holmbeck et al., 2002; Kiel & Buss, 2009). For the purposes of the current study, we refer to parenting behaviors that interfere with independent problem-solving as “overinvolvement.” Parents who are anxious (Hudson & Rapee, 2001; Ollendick & Benoit, 2012; Whaley, Pinto, & Sigman, 1999) and parents who perceive their child to be physically vulnerable or who are worried about their child’s medical status (Hullmann, Wolfe-Christiansen, Meyer, McNall-Knapp, & Mullins, 2010; Thomasgard & Metz, 1993, 1995) have been shown to be at increased risk for demonstrating parenting behaviors that do not promote autonomy.

Food allergy is a potentially life-threatening disease that is most commonly first identified in the first 2 years of life. Despite an 18% increase in food allergy prevalence from 1997 to 2007 (Branum & Lukacs, 2009), the psychosocial impact of food allergy among the 4% of children in the United States who are currently estimated to have food allergy is significantly understudied. Although relatively less is known about the psychosocial impact of food allergy on children compared with other chronic illnesses, recent surveys of parents suggest that food allergy affects important aspects of children’s daily functioning and aspects of parenting that have implications for autonomy development (Cummings, Knibb, King, & Lucas, 2010). For example, managing childhood food allergy requires parents to carefully restrict children’s exposure to food allergens. This can be a formidable task, requiring parents to monitor every ingredient in every food the child eats. Parents uniformly report that this is difficult to accomplish and often requires drastically restricting the child and the family’s activities outside the home to avoid accidental exposures (Bollinger et al., 2006). In the process, however, children’s exposure to a variety of learning environments, especially independent activities and interactions with peers, may be limited. Such restrictions, although medically warranted, could inadvertently interfere with the child’s opportunities to develop autonomy and social skills.

Food allergy also increases the likelihood of parental anxiety about their children’s well-being. Moderate levels of concern regarding the child’s safety are expected to be necessary for parents to initiate appropriate restrictions of children’s activities and prevent allergen exposure. However, because of the potential catastrophic consequence of exposure to food allergens and the unpredictability and uncontrollability of the child’s exposure to allergens outside the home, having a child with a serious food allergy may elicit elevated anxiety in some parents, potentially resulting in greater perceived threat in the child’s environment and more overinvolved parenting (Hudson & Rapee, 2001, 2002; Kiel & Buss, 2009; Ollendick & Benoit, 2012).

Even in the absence of elevated anxiety, because so many aspects of the food allergic child’s daily life must be monitored and controlled, it would be easy for these interaction patterns to become overgeneralized and come to predominate the ways in which parents interact with their children. If highly involved parenting generalizes to tasks that are unrelated to food allergy and do not require high levels of parental involvement, possible interference with the independent exploration necessary for autonomy development could result. Although the present study is, to our knowledge, the first to investigate parenting practices in childhood food allergy, evidence of parental overinvolvement in aspects of the child’s life that are unrelated to health has been reported in other chronic health conditions that require a great deal of parental involvement, such as juvenile rheumatoid arthritis (Power, Dahlquist, Thompson & Warren, 2003) and spina bifida (Holmbeck et al., 2002).

The present study examined parent–child interactions during tasks that were unrelated to food—solving easy and difficult puzzles—to determine whether parents of children with food allergy demonstrated more evidence of overinvolved parenting behaviors than parents of age-matched healthy preschoolers; and to identify whether children with food allergy showed any evidence of emerging limitations in autonomy development compared with age-matched healthy peers. The methodology was adapted from studies in the developmental and clinical literatures that have used observations of parent–child interactions during structured play, problem-solving, and teaching tasks to identify (a) parental behaviors that promote or potentially hinder autonomy development and (b) dependent and autonomous child behaviors (Colman & Thompson, 2002; Denham, Renwick, & Holt, 1991; Hudson & Rapee, 2002; Kelly, Brownell, & Campbell, 2000).

In keeping with self-determination theory (Grolnick & Ryan, 1989; Grolnick et al., 2007), we considered parental help-giving behaviors that scaffold and foster independent problem-solving (e.g., suggesting general and puzzle-specific task-completion strategies) as “autonomy-promoting.” Parental behaviors that interfere with independent problem-solving (e.g., telling the child where to place a puzzle piece, or personally manipulating puzzle pieces), especially on tasks that the child should be able to complete without help, were considered indicative of parental “overinvolvement.” Time to puzzle completion, latency to help-seeking, and the child’s direct and indirect requests for help also were coded. Asking for help when it was not needed (e.g., when the puzzle task was easy or before spending much time independently trying to solve the puzzle), as well as high levels of help-seeking in general, were considered indicators of lower levels of child autonomy.

Because dramatic changes in autonomy develop between the ages of 3 and 6 years, especially when children start kindergarten (Higgins & Parsons, 1983), we hypothesized that younger children (i.e., 3- to 4-year-olds) would demonstrate less autonomy (i.e., ask for help sooner and more often) than older children and that parents would provide more help (of all kinds) to younger children compared with older children. We hypothesized that parents of children with food allergy would demonstrate more help-giving behaviors in general, and more evidence of overinvolvement in particular, than parents of healthy children. We also hypothesized that children with food allergy would demonstrate less autonomous problem-solving than their healthy peers. Finally, we explored whether the relation between health status and parental help-giving behaviors and child help-seeking behaviors differed for younger versus older children.

Method

Participants

Participants in the food allergy group were recruited from urban and suburban allergy clinics via flyers and personal contact with physicians and nurses. Participants in the comparison group were recruited from general pediatric clinics in the same greater metropolitan area via flyers posted in the clinic and referrals from other participants. Children with primary, severe immune disorders, autism, severe sensory deficits (e.g., blind, deaf), mental retardation or significant developmental delay, serious chronic illness (e.g., cancer, diabetes, or severe asthma requiring intubation or pediatric intensive care unit hospitalization in the past year), or less severe food allergy (e.g., gastrointestinal symptoms only) were excluded from the study. Mothers and children who did not speak English also were excluded. A total of 163 mother–child pairs were assessed for eligibility; of these, 10 did not meet study criteria, 4 declined to participate, and 16 (representing both food allergy and control participants) cancelled their home visit and for various reasons were not able to be rescheduled.

The final sample of participants included 133 children between the ages of 36 and 83 months (M = 58.21 months, SD = 14.23) and their mothers (M = 36.39 years, SD = 4.40). Of the total sample, 69 children were male, 103 were White, 15 were Black, 6 were Asian, 3 were Latino, and 8 were of an unspecified ethnicity. The mean Hollingshead socioeconomic status (SES) index for the entire sample was 55.10 (SD = 8.64), indicating that the mean social position of participants fell within Hollingshead’s (1975) “major business or professional” category. All of the mothers had at least a high school education (M = 16.88 years of education, SD = 1.85).

The food allergy group consisted of 66 children with potentially life-threatening IgE-mediated food allergy (i.e., those with a risk of anaphylaxis) and their mothers. The comparison group consisted of 67 age-matched children without chronic illnesses and their mothers. Children with food allergy and their mothers did not differ from their healthy peers and their mothers with respect to age, ethnicity, SES, grade in school, home-school status, whether they received any special education services, single word receptive vocabulary as measured by the Peabody Picture Vocabulary Test (PPVT) or visual–motor integration ability as measured by the Visual–Motor Integration (VMI). However, there were more boys in the food allergy group than the control group, χ2(1) = 7.25, p < .01. (See Table I for comparisons of descriptive data for the entire sample and for the younger and older age-groups within the food allergy and control groups).

Table I.

Demographics and Screening Scores

Variable Full sample (n = 133)
 t df
Food allergy (n = 66)
 Control (n = 67)
M SD Min Max M SD Min Max
Child age (months) 57.36 14.60 36.00 82.92 59.05 13.91 36.34 83.98 −0.69 131
Mother age (years) 36.92 4.42 27.00 50.00 35.88 4.36 27.00 47.00 1.34 125
Mother education 16.97 1.95 12.00 20.00 16.79 1.76 12.00 20.00 0.53 124
Hollingshead SES 54.08 9.65 24.00 66.00 56.11 7.43 29.50 66.00 −1.31 114.56
PPVT 113.20 13.62 72.00 140.00 112.50 12.21 75.00 159.00 0.31 129
VMI 103.55 17.68 57.00 155.00 104.88 17.68 61.00 149.00 0.59 129
Younger children ( < 60 months) (n = 73)
Food allergy (n = 36) Control (n = 37)
Child age (months) 45.89 7.29 36.00 59.66 48.39 7.19 36.34 59.10 −1.47 71
Mother age (years) 35.79 3.80 27.00 46.00 34.53 3.69 27.00 45.00 1.39 66
Mother education 17.14 1.94 12.00 20.00 17.18 1.57 13.00 20.00 −0.09 66
Hollingshead SES 53.26 9.43 30.00 66.00 55.76 7.52 29.50 66.00 −1.21 62.91
PPVT 111.94 15.63 72.00 139.00 110.86 10.99 75.00 127.00 0.34 69
VMI 103.41 21.35 57.00 155.00 104.38 19.19 61.00 149.00 −0.20 69
Older children ( ≥ 60 months) (n = 60)
Food allergy (n = 36) Control (n = 37)
Child age (months) 71.12 7.38 60.16 82.92 72.21 7.20 61.44 83.98 −0.58 58
Mother age (years) 38.24 4.79 28.00 50.00 37.40 4.61 29.00 47.00 0.69 57
Mother education 16.75 1.97 12.00 20.00 16.37 1.88 12.00 19.00 0.76 56
Hollingshead SES 55.07 9.99 24.00 66.00 56.54 7.44 34.00 66.00 −0.62 54
PPVT 114.67 10.91 90.00 140.00 114.47 13.45 93.00 159.00 0.06 58
VMI 103.70 12.65 82.00 142.00 105.50 15.93 70.00 139.00 −0.49 58
Full sample
 χ2 Younger (<60 months)
 χ2 Older (≥60 months)
 χ2
Food allergy
 Control
 Food allergy
 Control
 Food allergy
 Control
n % n % n % n % n % n %
Male 42 63.6 27 40.3 7.25* 22 61.1 17 45.9 1.69 20 66.7 10 33.3 6.67*
Female 24 36.4 40 59.7 14 38.9 20 54.1 10 33.3 20 66.7
Child ethnicity 3.70
    White 52 78.8 51 76.1 29 80.6 28 75.7 7.01 23 76.7 23 76.7 .44
    Black 5 7.6 8 11.9 1 2.8 3 8.1 4 13.3 5 16.7
    Asian 2 3.0 4 6.0 0 0.0 3 8.1 2 6.7 1 3.3
    Latino 1 1.5 2 3.0 1 2.8 2 5.4 0 0 0 0.0
    Other 6 9.1 2 3.0 5 13.9 1 2.7 1 3.3 1 3.3
Grade placement 3.15 1.91 1.44
    Not in school 9 13.6 5 7.5 9 25.0 5 13.5 0 0.0 0 0.0
    Preschool 32 48.5 39 58.2 24 66.7 31 83.8 8 26.7 8 26.7
    Kindergarten 17 25.8 14 20.9 1 2.8 1 2.7 16 53.3 13 43.3
    First grade 5 7.6 9 13.4 0 0 0 0 5 16.7 9 30.0
Special education 4 6.5 2 3.2 1.69 3 8.3 2 5.4 1 3.3 0 0.0 1.13
Open in a new tab

Measures

Family Demographics

Parents completed a brief questionnaire assessing various demographic variables. Information collected included the ages and food allergy status of all family members, the parents’ occupations and highest year of school completed for calculation of Hollingshead’s (1975) index of SES, and the child’s grade/placement in school (if applicable) and home-school and special education status.

Vocabulary and Visual–Motor Integration Screening

To screen for basic receptive vocabulary skills that could influence children’s interactions with their parents or their understanding of experimental tasks, the widely used PPVT III (Dunn & Dunn, 1997) was administered to each child. The PPVT consists of a spiral-bound series of cards divided into four quadrants, with each quadrant containing a picture. The examiner reads a corresponding vocabulary word and asks the child to point to the quadrant with the picture that best represents each word. Initial items are concrete (e.g., ball, house), while advanced items represent more sophisticated vocabulary and concepts (e.g., verbs, adverbs). Possible age-normed standard scores range from 40 to 160. The PPVT demonstrates excellent internal consistency (median α = .94) and 1-month test–retest reliability estimates in the .90s, and is highly correlated (.82–.92) with Verbal IQ scores (Dunn & Dunn, 1997).

Visual–motor skills that could potentially affect puzzle execution were screened with the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI) (Beery & Beery, 2004). The VMI is composed of a sequence of 30 geometric forms that the child must either imitate or copy using a pencil and paper, starting with basic shapes (i.e., vertical line, circle) and progressing to more intricate geometric designs (i.e., concentric and three-dimensional objects). Possible age-normed standard scores range from 45 to 155. The VMI has been shown to have good internal consistency (mean α = .82) and 1-week test–retest reliability (.89), and to correlate with other measures of visual perception and visual–motor abilities as well as Performance IQ scores (Beery & Beery, 2004).

Procedure

The study was approved by the institutions’ respective institutional review boards. Potential participants were screened for eligibility in person or by phone by a trained research assistant and given the option to either participate at home or at the institution; 98% opted for a home visit.

Graduate students and advanced undergraduate students served as experimenters. The experimenters explained to mothers that the purpose of the study was to examine how parents felt about their children’s health, how their children’s health relates to parenting and feelings of worry and stress, how young children develop independence and the ability to handle challenges, and how parents and children with different health conditions interact with each other. They also informed mothers that the study sought to examine how parents and children learn to live with illness and its treatment to better understand the things that influence how parents and children with food allergy interact and to help find ways to improve their lives. Mothers were informed that experimenters would watch the videotapes to identify different styles of parent–child interaction, differences in children’s reactions to success and challenge, and the different ways children approach solving problems. The experimenters then obtained informed consent from the mothers and provided them with a set of questionnaires to complete. While the mothers completed the questionnaires, the children completed the experimental puzzle tasks. After both puzzles were completed, the experimenter administered the PPVT followed by the VMI.

Experimental Task

An experimental task based on that developed by Colman and Thompson (2002) was used to capture parenting behaviors as well as children’s ability to function independently in the face of challenge. Children were presented with two different puzzle tasks: an easy puzzle and a difficult puzzle. The easy puzzle was an age-appropriate puzzle of Donald Duck (Hasbro©, Pawtucket, R.I., 2003) with eight large, easy-to-manipulate pieces. The difficult puzzle was a 41-piece “See Inside” (Ravensburger Spieleverlag©, Ravensburg, Germany, 1992) puzzle of an airport scene that was designed for children ≥8 years. The difficult puzzle depicted one picture on the puzzle board (e.g., the interior of an airplane) and a different picture on the puzzle pieces (e.g., the exterior of the airplane). Pilot testing indicated that 3- to 6-year-old children were not able to complete the difficult puzzle within a 6-min time limit. The children completed the easy puzzle first and then the difficult puzzle.1 The children were shown a picture of the completed puzzle and were told to refer to the picture or ask their mothers for help if they had difficulty completing the puzzle. Mothers were instructed to allow their children to work independently and continue completing their questionnaires, but were told that they could provide help if solicited by their child.

Children were given a maximum of 6 min to complete each puzzle. Both puzzle tasks were videotaped and time to puzzle completion (in seconds) was recorded. One hundred ten children (85%) completed the easy puzzle within the time limit; none of the children finished the difficult puzzle within the time limit. Following completion of the puzzles, the experimenter administered the PPVT and the VMI to allow for a comparison of basic receptive vocabulary and visual–motor skills between children with food allergy and their peers. Parents received a $50.00 gift card for participation; children received a small inexpensive ($2.00) toy.

Colman and Thompson (2002) helped validate this task by showing that children with insecure attachments (children who typically demonstrate more dependent behavior—Sroufe et al., 1983; Waters & Deane, 1985) asked for help during these puzzle tasks more quickly, made more inability statements (e.g., “I can’t do this”), and engaged in more unnecessary help-seeking than children with secure attachments. In other studies using similar coding systems, researchers have demonstrated that maternal autonomy-promoting strategies during such tasks are associated positively with teacher ratings of children’s assertiveness (Denham et al., 1991) and associated negatively with children’s avoidance of subsequent challenging tasks (Kelley, Brownell, & Campbell, 2000).

Behavioral Coding of Parent–Child Interactions

Parent–child interactions were transcribed, checked for accuracy, and then coded by graduate and undergraduate research assistants who were provided a coding manual with definitions and examples of each behavior code. Although most coders generally were aware that the study was designed to test whether children’s health status affected parent–child interactions and children’s responses to easy and difficult problem-solving tasks, the health status of the children they coded was not evident in the videos. In addition, coders were instructed to code every parent and child utterance, such as parent commands (“Sit still”), praise (“Good job”), and indicating a response is correct or incorrect (“That’s right, it does fit there”) and child on-task utterances (“I don’t see the blue piece”), oppositional statements (“I don’t want to try that piece”) or positive statements about the task (“This is easy”) to minimize coder awareness of the specific behaviors of interest to the researchers. Weekly coding training meetings included group discussions of coding guidelines and detailed group review of a set of training videotapes that coders had independently coded until all coders were in agreement regarding the appropriate behavioral codes. Research assistants were required to reach a minimum of 80% agreement over all of the behavioral codes (agreements/agreements + disagreements) on a minimum of five different criterion videotapes before they were allowed to code independently.

Approximately 26% of the experimental sessions were independently coded by two or three coders and discussed in weekly coding supervision meetings to resolve disagreements and achieve a scoring consensus. A second coder independently coded an additional 16% of the experimental sessions. Mean percent interobserver agreement was 93 (range = 81–100); interclass correlations were excellent (Hallgren, 2012), ranging from .97 to .99 for total maternal behaviors and total child behaviors.

Maternal Help-Giving

Based on other studies assessing autonomy-promoting parenting (Colman & Thompson, 2002; Denham et al., 1991; Grolnick et al., 2007; Kelley et al., 2000), the following autonomy-promoting maternal help-giving behaviors were coded: general help (i.e., general puzzle-solving strategies, such as “Try finding all of the outside pieces first” or “Look at the pieces and see if any of them look like the picture”), and specific help (i.e., puzzle-specific suggestions, such as “Try to find pieces that look like the wing” or “Maybe you can find the piece with the car and start there”).

We also coded two maternal help-giving behaviors that, in the context of a task that the child is supposed to execute independently, reflect maternal overinvolvement (Colman & Thompson, 2002; Grolnick et al., 2007): providing the answer (i.e., showing the correct placement of a piece) and physical direction (touching/picking up or moving the puzzle board or pieces).2 Number of elapsed seconds before the mother’s first help offering also was recorded.

Child Help-Seeking

The following child behaviors were coded: direct help-seeking requests (e.g., “Mommy I need help”) and indirect help-seeking (i.e., negative statements about the task or their ability to complete the task, such as “Mommy, this is too hard” or “I can’t do this”). Shorter latencies to seeking help in general (number of elapsed seconds before the child’s first help request) and greater amounts of help-seeking—especially on the easy puzzle for which most children should not have needed assistance—were considered indicators of less autonomous problem-solving (Colman & Thompson, 2002).

To control for individual differences in speed of puzzle completion, occurrences of maternal and child behaviors were summed and then divided by puzzle duration. For ease of interpretation, scores were converted to rate per minute.

Analysis Plan

Before analyses, the distributions of all variables were evaluated. Log10 transformations were used to correct significant skew and kurtosis evident in the child and maternal behavior variables (Tabachnick & Fidell, 2007). Alpha was set to .05; t tests were used to compare the demographic characteristics and VMI and PPVT scores of the food allergy and control groups. Although there were more boys in the food allergy group than the control group, boys and girls differed significantly only in the rate of child help requests during the difficult puzzle, t(128) = 2.63, p = .01, with boys making more requests than girls. Therefore, sex was controlled in subsequent analyses involving this dependent variable.

Person correlations were used to test hypothesized relations between age and child help-seeking, parental help-giving, and puzzle performance. To determine whether parents of children with food allergy demonstrated more overinvolvement and children with food allergy demonstrated less autonomy on the puzzle tasks, and whether these patterns differed by child age, 2 × 2 analyses of variance (ANOVAs) with health status (food allergy vs. control) and age-group (3- to 4-year-olds vs. 5- to 6-year-olds) as between subjects variables were conducted on the parent’s help-giving behaviors, the child’s direct and indirect requests for help, as well as latencies to first help request and first help-giving response. Significant interaction effects were explored via post hoc t tests and by chi-square analyses of group differences in the proportion of parents who did or did not provide the child the answer (i.e., the correct placement of a puzzle piece) and the proportion of children who did or did not make indirect requests for help. Analysis of covariance (controlling for the child’s rate of indirect help-seeking) was used to further explore group differences in parental rates of providing the answer. Examination of the literature on autonomy development and parenting revealed effect sizes in the medium to medium–large range (Colman & Thompson, 2002; Denham, et al., 1991). Power analyses indicated adequate power (i.e., > 0.80) to detect a medium effect size (f = .25), and less power to detect slightly smaller effect sizes (e.g., power of 0.59 to detect an effect size of f = .19) for the proposed 2 × 2 ANOVAs.

Results

Means, ranges, and standard deviations for all dependent variables for the food allergy and healthy samples and the age-based subgroups are presented in Table II.

Table II.

Descriptive Statistics for Raw Dependent Variables

Variable Puzzle Younger (3–4 years old, n = 73)
 Older (5–6 years old, n = 60)
Food allergy (n = 36)
 Control (n = 37)
 Food allergy (n = 30)
 Control (n = 30)
M SD M SD M SD M SD
Mother variables
 General helpa Easy 0.34 0.42 0.47 0.69 0.16 0.44 0.04 0.16
Difficult 0.67 0.52 0.76 0.61 0.45 0.68 0.45 0.75
 Specific helpa Easy 1.56 2.30 1.27 1.43 0.03 0.15 0.20 0.85
Difficult 3.31 2.44 2.80 2.06 0.79 1.04 1.25 1.89
 Providing the answera Easy 0.40** 0.54 0.12 0.24 0.01 0.07 0.05 0.16
Difficult 0.83 0.81 0.63 0.67 0.17 0.30 0.32 0.70
 Physical directiona Easy 2.44 3.50 1.36 1.97 0.06 0.25 0.30 0.95
Difficult 4.82 4.37 3.55 2.43 1.17 1.68 1.48 2.40
 Latency to first helpb Easy 164.78 156.69 161.65 151.10 302.00 120.30 327.10 88.24
Difficult 112.89 134.53 90.00 98.43 191.40 142.73 202.93 156.76
Child variables
 Time to solve puzzleb Easy 233.44 98.33 196.11 102.53 105.63 69.02 98.90 62.14
Difficult NA NA NA NA
 Direct help requestsa Easy 0.84 0.94 0.82 0.89 0.14 0.35 0.13 0.44
Difficult 1.14 0.96 0.94 0.73 0.38 0.45 0.49 0.84
 Indirect help requestsa Easy 0.22** 0.40 0.03 0.09 0.06 0.29 0.09 0.26
Difficult 0.26 0.39 0.19 0.33 0.19 0.41 0.17 0.32
 Latency to first help requestb Easy 186.94 161.40 142.30 149.06 304.93 125.74 323.20 101.11
Difficult 102.08 131.43 88.14 120.34 212.27 142.88 211.00 152.87
Open in a new tab

aRate per minute.

bSeconds.

**Food allergy significantly different from controls, p ≤ .01.

Developmental Patterns in Task Performance, Child Help-Seeking and Parental Help-Giving

As can be seen in Table III, regardless of health status, younger children solved the easy puzzle less quickly than older children. None of the children solved the difficult puzzle. Younger children directly requested help earlier and more often than older children on both puzzles. On both puzzles, mothers provided more general and puzzle-specific puzzle-solving suggestions to younger children and were also more likely to be physically directive and provide the answer (i.e., the correct placement of a puzzle piece) with younger children. Mothers also provided help to younger children earlier in the puzzle task.

Table III.

Pearson Correlations Between Child Age and Parent and Child Behaviors

Variable Correlations with age
Food allergy
 Control
Easy puzzle Difficult puzzle Easy puzzle Difficult puzzle
Child behaviors
    Time to solve puzzle −.73** NA −.66** NA
    Direct help requests −.55** −.58** −.44** −.30*
    Indirect help requests −.30* −.07 −.16 −.04
    Latency to first help request .68** .54** .75** .49**
Mother behaviors
    General help −.28* −.27* −.46** −.31*
    Specific help −.42** −.61** −.45** −.42**
    Providing the answer −.47** −.45** −.29* −.22
    Physical direction −.47** −.46** −.44** −.44**
    Latency to first help .66** .46** .70** .47**
Open in a new tab

*p < .05; **p < .01.

Parental Help-Giving Behaviors as a Function of Child Health Status and Age

A series of 2 × 2 ANOVAs, with health status (food allergy vs. control) and age-group (3-to 4-year-olds vs. 5- to 6-year-olds) as between-subjects variables, was conducted on the rates of the mothers’ help-giving responses. As illustrated in Figure 1, a significant age by health status interaction was obtained for providing the answer, F(1, 125) = 7.92, p = .006, f = .25 (medium effect size). Mothers of younger children with food allergy were more likely than mothers of younger healthy children to intervene during the easy puzzle by showing the child where to place a puzzle piece, t(45.74) = 2.74, p = .009. This pattern remained evident even after controlling for differences in the child’s rate of indirect requests for help, F(1, 67) = 5.50, p = .02. f = .29 (medium effect size). Approximately 53% of the mothers of children with food allergy showed the child the correct placement of at least one of the easy puzzle pieces, compared with 30% of the mothers of healthy younger children, χ2(1) = 4.00, p = .045. Health status was not related to providing older children the answer, p > .25. Neither the main effect of health status nor the age by health status interaction was significant for the rate of mothers’ general help-giving, specific help-giving, physical direction, or latency to first help-giving on the easy puzzle, or for any of the mothers’ behaviors for the difficult puzzle, all p values > .05.

Figure 1.

Figure 1.

Open in a new tab

Age by health status interaction for mothers providing the answer on the easy puzzle.

Child Help-Seeking Behaviors as a Function of Health Status and Age

A series of 2 × 2 ANOVAs with health status (food allergy vs. control) and age-group (3- to 4-year-olds vs. 5- to 6-year-olds) as between-subjects variables was conducted on the rates of the child’s direct and indirect requests for help. As illustrated in Figure 2, a significant age by health status interaction was obtained for indirect help-seeking on the easy puzzle, F(1, 125) = 4.61, p = .034, f = .19 (small–medium effect size). Younger children with food allergy were significantly more likely to make indirect requests for help than their younger healthy peers, t(35.94) = 2.69, p = .01. Approximately 39% of the younger children with food allergy made indirect requests for help on the easy puzzle, compared with 14% of the healthy younger children, χ2(1) = 6.10, p = .013. In contrast, few of the older children made any direct (n = 8) or indirect (n = 6) requests for help on the easy puzzle. Health status did not affect older children’s indirect help-seeking on the easy puzzle, t(57) = − 0.33, p = .74. Neither the main effect of health status nor the age by health status interaction was significant for children’s direct help-seeking on the easy puzzle, the latency to first help request for either puzzle, or for direct or indirect help-seeking on the difficult puzzle, all p values > .05.

Figure 2.

Figure 2.

Open in a new tab

Age by health status interaction for children’s indirect help requests on the easy puzzle.

Discussion

These observations of mothers helping their children in two puzzle-solving tasks identify complementary patterns of child and maternal behavior that emerged as a function of child age and child health status. As expected, 3- to 4-year-olds (compared with 5- to 6-year-olds), regardless of their health status, directly asked their mothers for help with both puzzles sooner and more frequently and took a longer time to solve the easy puzzle (none of the children solved the difficult puzzle in the time provided). Mothers, in turn, provided younger children with more help (both specific and general), helped their children sooner, were more likely to provide the child the answer, and were more likely to physically direct the child’s behavior. These patterns are understandable given that the puzzles were harder for younger children and that the children likely needed more help completing them.

Consistent with our expectations that children with food allergy might demonstrate limitations in their autonomy development, when working on the easy puzzle, young children with food allergy made more indirect requests for help than young children in the healthy comparison group. These included statements such as “This is hard” or “I can’t do this.” Because these differences were not observed during the difficult puzzle, this pattern of behavior may reflect a greater tendency to solicit help when it is not actually needed—but only in an indirect way (there were no such differences in direct requests for help). No health status differences were found for older children with the easy puzzle—probably because the easy puzzle presented little challenge for 5- to 6-year-olds. The differences in indirect help-seeking found here do not appear to be a function of motor or verbal skills, as the groups did not differ with respect to visual–motor or receptive vocabulary skills.

This pattern of differences in help-seeking probably does not simply reflect a developmental delay in autonomy development, because the requests for help mostly strongly related with child age in this study (direct requests) did not differ across the food allergy and healthy groups. The group differences were only significant for indirect requests for help (often framed as inability statements) and therefore may reflect an early pattern of helplessness in problem-solving (Burhans & Dweck, 1995). Such a behavior pattern, if persisting into middle childhood, could lead to children avoiding challenging situations in the future and lead to problems in developing effective ways of coping with failure (Deiner & Dweck, 1978). Such overly dependent behavior patterns might also interfere with the development of competence in relations with peers (LaFreniere et al., 1992). Future research should examine whether this indirect form of help-seeking in children with food allergy generalizes to contexts outside of the mother–child relationship (e.g., relationships with teachers or peers) and also whether such early patterns of help-seeking predict later problems in coping with academic, health, and social challenges.

Although the actual source of the group differences in maternal behavior cannot be determined from this study, the pattern of maternal behavior observed here is consistent with our expectations that mothers of children with food allergy might generalize some of the adaptive patterns of high involvement they developed in one domain (to protect their child from exposure to potentially dangerous foods) to an unrelated domain (to protect their child from frustration on a visual–motor task). Specifically, mothers of 3- to 4-year-old children with food allergy were more likely to provide their children the answer during the easy puzzle task. This tendency to provide what could be considered unnecessary help-giving during the easy puzzle may reflect a tendency for mothers of young children with food allergy to be overly involved or unnecessarily helpful in situations in which their assistance may not be needed. Similar tendencies to demonstrate highly involved parenting behaviors beyond the context in which they are adaptive have been observed in parents of children with other chronic illnesses (Anderson & Coyne, 1991; Holmbeck et al., 2002; Power et al., 2003). Such parenting practices, if pervasive, may subtly undermine the child’s independent problem-solving and autonomy development, and may have contributed to the patterns of indirect help-seeking observed here. This might be particularly true for behaviors such as providing the child the answer—it essentially prevents the child from solving the problem him- or herself.

Unexpectedly, mothers did not differ on any of the other help-giving strategies—that is, general help, specific help, physical direction, and latency to first help—nor did they differ during the difficult puzzle. This suggests that the tendency of mothers to provide greater help to young children with food allergy does not involve all types of help-giving (e.g., giving the child hints or making general suggestions) in all situations, but is restricted to forms of help that represent overinvolvement (i.e., giving the answer) in a situation where the child really does not need help (i.e., the easy puzzle).

Surprisingly, the other form of overinvolvement coded here (i.e., physical direction) did not differ between the groups. One explanation for this negative finding is that this code covered a wide range of behaviors (e.g., slightly moving a piece that got stuck vs. moving the puzzle piece into the correct position), so it is possible that not all occurrences of physical direction represented overinvolvement. Possibly a more differentiated system for coding physical direction may have revealed other differences between the groups.

In a cross-sectional study such as this one, where only the frequencies of maternal and child behavior were observed, it is difficult to determine whether the patterns of maternal behavior observed here contributed to child dependency or whether child dependency elicited maternal help. However, the fact that health status group differences in maternal behavior were evident even when the child’s rate of indirect help-seeking was controlled suggests that the food allergy mothers’ higher rate of unnecessary help-giving was not completely driven by the child’s help-seeking. Future longitudinal studies following the pattern of help-seeking and help-giving over time could help address this issue.

The failure to find comparable patterns in child help-seeking and maternal help-giving with older children may reflect the fact that the easy puzzle did not pose much challenge for the older children and therefore did not elicit enough variability in help-seeking. It is also possible that the patterns observed in this study reflect temporary differences in parent–child interaction that eventually diminish over time as parents gain confidence in managing exposures or as children demonstrate competence in avoiding allergen exposure. For the hard puzzle, in contrast, both older and younger children likely required significant assistance regardless of health status, so no differences emerged. Future studies should use a wider range of puzzle tasks that differ in their level of difficulty for older children and follow children longitudinally to better identify individual differences in autonomous problem-solving in 5- to 6-year-olds. This would make it possible to determine whether the helplessness in problem-solving found at the early ages continues into middle childhood or whether it simply represents a short-term developmental phase.

The contributions of this study should be considered within the context of its limitations. Maternal help-giving and child help-seeking were observed only during two short puzzle tasks; it is not known whether the observed patterns of help-seeking and overinvolvement generalize to day-to-day mother–child interactions involving challenge or health management. Moreover, the differences in child and maternal behavior were rather limited—only demonstrated for the most overinvolved category of maternal behavior (providing the answer) and for negative statements by the child about the task or the self (indirect requests for help). The current methodology also does not shed any light on the process of the maternal–child interaction, such as how child help-seeking behaviors change in response to parenting behaviors. Future studies should consider sequential analyses of parent–child interactions. Additionally, the cross-sectional design made it impossible to directly explore developmental questions. Moreover, the sample was fairly homogeneous, with most of the participants being European American, most of the mothers college educated, and most of the children appearing to be above average cognitively. It is not clear what pattern of results would have emerged in a lower income sample. Because mothers with lower education or income tend to be less autonomy-promoting with their young children (Kuczynski, Kochanska, Radke-Yarrow, & Girnius-Brown, 1987; Neitzel & Stright, 2004; Rickel, Williams, & Loigman, 1988) and more likely to be overinvolved (Thomasgard & Metz, 1997), it is not clear whether the differences found here would be diminished or enhanced in a sample of lower income families. Clearly, future studies should examine these processes in families representing a wider range of education and social class.

Despite these limitations, however, the task used here was effective in yielding some differences in maternal and child behavior related to food allergy status, identifying important differences in help-giving and help-seeking behavior in this population that is potentially at risk for delays in autonomy development. Strengths of this study include the use of observational methods, the detailed coding of help-seeking and help-giving patterns, and the use of demographically similar families of children with potentially life-threatening food allergies and healthy controls. Longitudinal research is needed to examine help-giving and help-seeking behaviors prospectively from toddlerhood, and examine the maternal and paternal attitudinal and emotional factors that contribute to these behaviors. Finally, the developmental consequences of these differences in parental involvement and child dependency should be investigated in later academic achievement, peer, family, and illness self-management contexts.

Acknowledgment

The authors thank Claire Ackerman, Lindsay Clendaniel, Soumitri Sil, Susan Horn, Wendy Pinder, Alexandra Psihogios, Lauren Hall, Elizabeth Silberholz, Allyson Crehan, and Catherine Dodson for their help with data collection and data coding.

Footnotes

1 Because we intended to do a modified replication of Colman and Thompson’s methodology and because task persistence can be affected by preceding failure experiences (Burhans & Dweck, 1995), we did not counterbalance the order of presentation of the easy and difficult puzzles.

2 Although we were primarily interested in maternal behaviors that clearly indicated overinvolvement, we also considered the possibility that an overuse of specific and direct helpgiving—especially on an easy task or if given too soon, that is, before the child had adequate time to attempt to solve the puzzle independently—could also reflect overinvolvement. Consequently, we also examined amount and timing of general and specific maternal helpgiving.

Funding

This study was funded by Grant No R03HD057313 from the National Institute of Child Health and Development, National Institutes of Health; and by Washington State University.

Conflicts of interest: None declared.

References

  1. Anderson B, Coyne J. “Miscarried helping” in the families of children and adolescents with chronic diseases. In: Johnson J H, Johnson S B, editors. Advances in child health psychology. Gainesville: University of Florida; 1991. pp. 167–177. [Google Scholar]
  2. Beery K E, Beery N A. Beery-Buktenica Developmental Test of Visual-Motor Integration, 6th edition (BEERY™ VMI) 5th ed. Minneapolis, MN: NCS Pearson, Inc; 2004. [Google Scholar]
  3. Bollinger M E, Dahlquist L M, Mudd K, Sonntag C, Dillinger L, McKenna K. The impact of food allergy on the daily activities of children and their families. Annals of Allergy, Asthma, and Clinical Immunology. 2006;96:415–421. doi: 10.1016/S1081-1206(10)60908-8. [DOI] [PubMed] [Google Scholar]
  4. Branum A, Lukacs S. Food allergy among children in the United States. Pediatrics. 2009;124:1549–1555. doi: 10.1542/peds.2009-1210. [DOI] [PubMed] [Google Scholar]
  5. Bugental D B, Grusec J E. 2006. Socialization processes. In N. Eisenberg (Ed.), W. Damon & R. M. Lerner (General Eds.), Handbook of child psychology, Vol. 3, Social, emotional, and personality development (pp. 366–428). New York: Wiley. doi: 10.1002/9780470147658.chpsy0307. [Google Scholar]
  6. Burhans K K, Dweck C S. Helplessness in early childhood: The role of contingent worth. Child Development. 1995;66:1719–1738. [PubMed] [Google Scholar]
  7. Colman R A, Thompson R A. Attachment security and the problem-solving behaviors of mothers and children. Merrill-Palmer Quarterly. 2002;48:337–359. [Google Scholar]
  8. Cummings A J, Knibb R C, King R M, Lucas J S. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: A review. Allergy. 2010;65:933–945. doi: 10.1111/j.1398-9995.2010.02342.x. [DOI] [PubMed] [Google Scholar]
  9. Deci E L, Driver R E, Hotchkiss L, Robbins R J, Wilson I M. The relations of mothers’ controlling vocalizations to children’s intrinsic motivation. Journal of Experimental Child Psychology. 1993;55:151–162. doi: 10.1006/jecp.1993.1008. [DOI] [PubMed] [Google Scholar]
  10. Deiner C, Dweck C. An analysis of learned helplessness: Continuous changes in performance, strategy, and achievement cognitions following failure. Journal of Personality and Social Psychology. 1978;36:451–462. [Google Scholar]
  11. Denham S, Renwick S, Holt R. Working and playing together: Prediction of preschool social-emotional competence from mother-child interaction. Child Development. 1991;62:242–249. [Google Scholar]
  12. Dunn L M, Dunn L M. PPVT-III Peabody Picture Vocabulary Test. 3rd ed. Circle Pines, MN: American Guidance Service; 1997. [Google Scholar]
  13. Erikson E H. Childhood and society. New York: Norton; 1963. [Google Scholar]
  14. Grolnick W S, Gurland S T, DeCourcy W, Jacob K. Antecedents and consequences of mothers' autonomy support: An experimental investigation. Developmental Psychology. 2002;38:143–155. [PubMed] [Google Scholar]
  15. Grolnick W, Price C, Beiswinger K, Sauck C. Evaluative pressure in mothers: Effects of situation, maternal, and child characteristics on autonomy supportive versus controlling behavior. Developmental Psychology. 2007;43:991–1002. doi: 10.1037/0012-1649.43.4.991. [DOI] [PubMed] [Google Scholar]
  16. Grolnick W S, Ryan R M. Parent styles associated with children’s self-regulation and competence in school. Journal of Educational Psychology. 1989;81:143–154. [Google Scholar]
  17. Hallgren K. Computing inter-rater reliability for observational data: An overview and tutorial. Tutorials in Quantitative Methods for Psychology. 2012;8:23–34. doi: 10.20982/tqmp.08.1.p023. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Higgins E T, Parsons J E. Social cognition and the social life of the child: Stages as subcultures. In: Higgins E T, Ruble D N, Hartup W W, editors. Social cognition and social development: A sociocultural perspective. Cambridge: Cambridge University Press; 1983. pp. 15–62. [Google Scholar]
  19. Hollingshead A B. Four factor index of social status. New Haven, CT: Yale University; 1975. [Google Scholar]
  20. Holmbeck G N, Johnson S Z, Wills K E, McKernon W, Rose B, Erklin S, Kemper T. Observed and perceived parental overprotection in relation to psychosocial adjustment in preadolescents with a physical disability: The mediational role of behavioral autonomy. Journal of Consulting and Clinical Psychology. 2002;70:96–110. doi: 10.1037//0022-006x.70.1.96. [DOI] [PubMed] [Google Scholar]
  21. Howes C, Lee L. Peer relations in young children. In: Balter L, Tamis-LeMonda C S, editors. Child psychology: A handbook of contemporary issues. New York: Psychology Press; 2006. pp. 135–151. [Google Scholar]
  22. Hudson J L, Rapee R M. Parent-child interactions and anxiety disorders: An observational study. Behaviour Research and Therapy. 2001;39:1411–1427. doi: 10.1016/s0005-7967(00)00107-8. [DOI] [PubMed] [Google Scholar]
  23. Hudson J L, Rapee R M. Parent-child interactions in clinically anxious children and their siblings. Journal of Clinical Child and Adolescent Psychology. 2002;31:548–555. doi: 10.1207/S15374424JCCP3104_13. [DOI] [PubMed] [Google Scholar]
  24. Hullmann S E, Wolfe-Christensen C, Meyer W H, McNall-Knapp R Y, Mullins L L. The relationship between parental overprotection and health-related quality of life in pediatric cancer: The mediating role of perceived child vulnerability. Quality of Life Research. 2010;19:1373–1380. doi: 10.1007/s11136-010-9696-3. [DOI] [PubMed] [Google Scholar]
  25. Kagan J, Moss H A. The stability of passive and dependent behavior from childhood through adulthood. Child Development. 1960;31:577–591. doi: 10.1111/j.1467-8624.1960.tb05809.x. [DOI] [PubMed] [Google Scholar]
  26. Kelley S, Brownell C, Campbell S. Mastery motivation and self-evaluative affect in toddlers: Longitudinal relations with maternal behavior. Child Development. 2000;71:1061–1071. doi: 10.1111/1467-8624.00209. [DOI] [PubMed] [Google Scholar]
  27. Kiel E, Buss K. Maternal accuracy and behavior in anticipating children’s responses to novelty: Relations to fearful temperament and implications for anxiety development. Social Development. 2009;19:304–325. doi: 10.1111/j.1467-9507.2009.00538.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Kuczynski L, Kochanska G, Radke-Yarrow M, Girnius-Brown O. A developmental interpretation of young children’s noncompliance. Developmental Psychology. 1987;23:799–806. [Google Scholar]
  29. LaFreniere P J, Provost M A, Dubeau D. From an insecure base: Parent- child relations and internalizing behaviour in the pre-school. Early Development and Parenting. 1992;1:137–148. [Google Scholar]
  30. Maccoby E, Martin J. 1983. Socialization in the context of the family: Parent-child interaction. In E. M. Hetherington (Ed.), P. H. Mussen, (General Ed.), Handbook of child psychology, Vol 4. Socialization, personality, and social development (pp. 1–101). New York: Wiley. [Google Scholar]
  31. Neitzel C, Stright A D. Parenting behaviors during child problem solving: The roles of child temperament, mother education and personality, and the problem-solving context. International Journal of Behavioral Development. 2004;28:166–179. [Google Scholar]
  32. Ollendick T, Benoit K. A parent-child interactional model of social anxiety disorder. Clinical Child and Family Psychology Review. 2012;15:81–91. doi: 10.1007/s10567-011-0108-1. [DOI] [PubMed] [Google Scholar]
  33. Power T G. Play and exploration in children and animals. Mahwah, NJ: Lawrence Erlbaum; 2000. [Google Scholar]
  34. Power T G. Stress and coping in childhood: The parents’ role. Parenting: Science and Practice. 2004;4:271–317. [Google Scholar]
  35. Power T G, Dahlquist L M, Thompson S M, Warren R. Interactions between children with juvenile rheumatoid arthritis and their mothers. Journal of Pediatric Psychology. 2003;28:213–221. doi: 10.1093/jpepsy/jsg009. [DOI] [PubMed] [Google Scholar]
  36. Rickel A U, Williams D L, Loigman G A. Predictors of maternal child-rearing practices: Implications for intervention. Journal of Community Psychology. 1988;16:32–40. [Google Scholar]
  37. Shell R M, Eisenberg N. A developmental model of recipients’ reactions to aid. Psychological Bulletin. 1992;111:413. doi: 10.1037/0033-2909.111.3.413. [DOI] [PubMed] [Google Scholar]
  38. Shell R M, Eisenberg N. Children’s reactions to the receipt of direct and indirect help. Child Development. 1996;67:1391–1405. [PubMed] [Google Scholar]
  39. Sroufe L A, Egeland B, Carlson E A, Collins W A. The development of the person. New York: Guildford; 2005. [Google Scholar]
  40. Sroufe L A, Fox N E, Pancake V R. Attachment and dependency in developmental perspective. Child Development. 1983;54:1615–1627. [Google Scholar]
  41. Tabachnick B G, Fidell L S. Using multivariate statistics. 5th ed. Boston, MA: Pearson; 2007. [Google Scholar]
  42. Thomasgard M, Metz W P. Parental overprotection revisited. Child Psychiatry and Human Development. 1993;24:67–80. doi: 10.1007/BF02367260. [DOI] [PubMed] [Google Scholar]
  43. Thomasgard M, Metz W P. The vulnerable child syndrome revisited. Developmental and Behavioral Pediatrics. 1995;16:251–256. [PubMed] [Google Scholar]
  44. Thomasgard M, Metz W P. Parental overprotection and its relation to perceived child vulnerability. American Journal of Orthopsychiatry. 1997;67:330–335. doi: 10.1037/h0080237. [DOI] [PubMed] [Google Scholar]
  45. Waters E, Deane K E. Defining and assessing individual differences in attachment relationships: Q-methodology and the organization of behavior in infancy and early childhood. Monographs of the Society for Research in Child Development, 50. 1985 (Serial No. 209, Nos. 1–2), pp. 41–65. [Google Scholar]
  46. Wender P H, Pedersen F A, Waldrop MF. A longitudinal study of early social behavior and cognitive development. American Journal of Orthopsychiatry. 1967;37:691–696. doi: 10.1111/j.1939-0025.1967.tb00510.x. [DOI] [PubMed] [Google Scholar]
  47. Whaley S E, Pinto A, Sigman M. Characterizing interactions between anxious mothers and their children. Journal of Consulting and Clinical Psychology. 1999;67:826–836. doi: 10.1037//0022-006x.67.6.826. [DOI] [PubMed] [Google Scholar]
  48. Wood D, Bruner J S, Ross G. The role of tutoring in problem solving. Journal of Child Psychology and Psychiatry. 1976;17:89–100. doi: 10.1111/j.1469-7610.1976.tb00381.x. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Pediatric Psychology are provided here courtesy of Oxford University Press

RESOURCES