Development of an Observational Parental Scaffolding Measure for Youth with Spina Bifida

Abstract

Objective

To examine the reliability and validity of a new observational measure of parental scaffolding, as well as the impact of parental scaffolding on academic and social outcomes among youth with spina bifida (SB).

Methods

As part of a larger study, 137 families of youth with SB participated in family interaction tasks and self-report questionnaires at the baseline assessment. Teachers also reported on youth’s academic independence and competence, as well as social skills. Guided by previous research and theoretical formulations, a rational approach to measure development was employed whereby maternal and paternal scaffolding composites were created using the Family Interaction Macro-coding System (Holmbeck, Zebracki, Johnson, Belvedere, & Hommeyer (2007). Parent-child interaction macro-coding manual. Unpublished coding system. Chicago: Loyola University Chicago).

Results

The scaffolding measure demonstrated acceptable interrater and scale reliabilities. Additionally, both the maternal and paternal scaffolding composites were significantly associated with scores from self-report questionnaires of parenting behaviors in the expected directions. Maternal scaffolding was positively associated with IQ, academic competence, academic independence, and social self-control in youth with SB, whereas paternal scaffolding was positively associated with social cooperation and social self-control. Differences in scaffolding emerged between mothers and fathers, as well as across demographic variables.

Conclusion

Initial findings support the use of the scaffolding measure. Future research should continue to examine the utility of this scaffolding measure in families of youth with SB.

Introduction

Spina bifida (SB), a congenital birth defect affecting the central nervous system, occurs in approximately 3 of every 10,000 live births in the United States (Boulet et al., 2008). While advancements in medical care have improved newborn survival rates (McLaughlin et al., 1985), SB continues to have a widespread impact on the well-being of youth. In particular, youth with SB contend with notable physical disabilities, neurocognitive deficits, and problems with psychosocial adjustment (Copp et al., 2015; Holmbeck et al., 2003). Such difficulties can negatively affect adult educational and employment outcomes, as well as overall quality of life (Bier et al., 2005; Holmbeck & Devine, 2010). This pervasive impact of SB on youth and their families underscores the importance of isolating modifiable factors that help children with SB overcome these challenges.

Family factors have gained increasing attention in the pediatric psychology literature as being one potential protective factor (e.g., Holmbeck & Devine, 2010; Kazak, Alderfer, & Reader, 2017). Indeed, research in the context of SB has linked the family environment and specific parenting behaviors (e.g., warmth/acceptance, enforcement of age-appropriate rules) to academic outcomes, psychosocial adjustment, and autonomy development in youth (Holmbeck & Devine, 2010; Holmbeck, Shapera, & Hommeyer, 2002; Loomis, Javornisky, Monahan, Burke, & Lindsay, 2008; O’Hara & Holmbeck, 2013). Despite this evidence, as well as theories highlighting the influential nature of parenting on child skill and behavioral development (Baumrind, 1989; Vygotsky, 1978), research examining parenting in SB remains limited.

Parental scaffolding, a process through which adults support children’s learning and ultimately enhance task performance, may be one important parenting process that fosters skill development in this population (Wood, Bruner, & Ross, 1976). The concept of scaffolding originated from the tutoring literature, but has since been applied across diverse settings and populations. Today, scaffolding can broadly be defined as a behavior, whereby adults, “facilitate or otherwise shape children’s learning by transforming tasks that are beyond the child’s current abilities into activities that the child can understand and master” (Hammond & Carpendale, 2015, p. 369). During the scaffolding process, parents support children’s mastery of regulatory strategies by engaging and maintaining the child’s interest, helping them to manage their frustration, and structuring the task to match the child’s ability/developmental level (Bibok, Carpendale, & Müller, 2009; Wood et al., 1976). Notably, research in the field of developmental psychology has linked greater parental scaffolding to better executive functioning and attention, problem-solving, behavioral functioning, and academic outcomes among typically developing children (Bibok et al., 2009; Hammond, Müller, Carpendale, Bibok, & Liebermann-Finestone, 2012; Mattanah, Pratt, Cowan, & Cowan, 2005; Neitzel & Stright, 2003).

Though most existing work in this area focuses on typically developing children, researchers have begun extending the scaffolding literature to include children with disabilities (e.g., intellectual, language; Baker, Fenning, Crnic, Baker, & Blacher, 2007; Guralnick, Neville, Hammond, & Connor, 2008), as well as a traumatic brain injury (Gerrard-Morris et al., 2010; Treble-Barna et al., 2016). Preliminary work indicates that scaffolding provided by adults may promote the development of social skills, cognition, and emotion regulation in children with disabilities or cognitive impairment (Baker et al., 2007; Gerrard-Morris et al., 2010; Norona & Baker, 2014). Thus, parental scaffolding may be especially important for neurologically vulnerable populations, such as individuals with SB, as it may help children compensate for cognitive challenges.

Since its creation, the concept of scaffolding has been operationalized in many ways. When Wood et al. (1976) first coined the term in the context of tutoring, they theorized that scaffolding consists of six specific processes, including (a) recruitment (e.g., engaging child’s interest in the task), (b) direction maintenance (e.g., ensuring that child’s actions are geared toward task objectives), (c) frustration control (e.g., regulating child’s negative emotions), (d) reduction in degrees of freedom (e.g., simplifying task), (e) marking critical features (e.g., highlighting aspects of the task critical for completion), and (f) demonstration (e.g., modeling how to complete the task). As a result, a number of studies have employed methodologies that encompass some or all of these basic tenets when applying the concept of scaffolding specifically to parent–child interactions. Yet, there is variability in the types of scaffolding assessed (e.g., verbal vs. nonverbal scaffolding), the tasks developed to elicit scaffolding behaviors from parents, and the coding systems employed to quantify these behaviors (e.g., Bernier, Carlson, & Whipple, 2010; Landry et al., 2002).

With regard to the differences in methodologies used to assess scaffolding, past research has examined observed parent–child interactions across completing a variety of tasks, including solving puzzles (Bibok et al., 2009), cleaning up after a tea party (Hammond & Carpendale, 2015), completing typical daily activities and toy play (Gerrard-Morris et al., 2010; Landry et al., 2002), problem-solving paper-and-pencil tasks (e.g., maze; Baker et al., 2007), and conversing about event-type memories (e.g., an important and sad memory; McLean & Mansfield, 2012). When it comes to coding these observational data, studies focusing only on verbal scaffolding have often coded the content of adults’ verbalizations, such that hints, prompting, elaborations, and conceptual linkages that facilitated problem-solving were coded as scaffolding (Bibok et al., 2009; Landry et al., 2002). In contrast, studies focusing on both verbal and nonverbal scaffolding have used principles from Wood et al. (1976) to create coding guides (e.g., parents rated on 5-point scale based on how often they meet scaffolding criteria; Hammond & Carpendale, 2015; Hammond et al., 2012) or used codes from existing rating systems as a proxy for scaffolding (e.g., autonomy-support; Bernier et al., 2010).

While the majority of the aforementioned studies examined parental scaffolding in the context of younger, typically developing children, scaffolding research with older children and adolescents (Abbeduto, Weissman, & Short-Meyerson, 1999; Mattanah et al., 2005; McLean & Mansfield, 2012) and those with disabilities/health conditions does exist (Baker et al., 2007; Gerrard-Morris et al., 2010; Guralnick et al., 2008). Research with these populations has generally utilized methods similar to those just described. However, given differences in cognitive functioning across these groups, some studies have tailored tasks to match the developmental level of these participants (Baker et al., 2007; Mattanah et al., 2005; McLean & Mansfield, 2012).

Given the variability in the scaffolding literature and the fact that this construct has yet to be explored in the context of SB, the current study sought to validate a measure of parental scaffolding by utilizing a new methodological approach. First, similar to past research, scaffolding was conceptualized as a verbal and nonverbal process in accordance with the framework provided by Wood et al. (1976). Second, observational tasks that were (a) developmentally appropriate and (b) specific to the experiences of those with SB were utilized to elicit parent–child interactions that likely naturally exist within the home. Third, to assess each component of the scaffolding process, this study used a validated observational coding system that has been employed with a variety of chronic health conditions to quantify aspects of parent–child interactions (i.e., Family Interaction Macro-coding System [FIMS]; Holmbeck, Zebracki, Johnson, Belvedere, & Hommeyer, 2007). Although this coding system has not yet been used to assess parental scaffolding, six codes from the FIMS that aligned with the scaffolding framework proposed by Wood et al. (1976) and were thought to capture key elements of the scaffolding process were used to create a scaffolding composite.

Collectively, this new approach was chosen due to the lack of consensus in the literature regarding the best method of assessment and because SB is distinct from and more complex than the other child populations in which scaffolding has previously been assessed (i.e., the condition is akin to having a physical/intellectual disability and chronic medical condition combined; Stiles-Shields et al., 2019). As such, family interaction tasks requiring motor movement (e.g., cleaning up materials, problem-solving paper-and-pencil tasks) and/or higher-order cognitive skills (e.g., discussing an event-type memory) were not appropriate due to the limitations common in this population (Copp et al., 2015; Holmbeck et al., 2003). Instead, interaction tasks were tailored to the specific needs and challenges faced by individuals with SB, such as accessibility barriers to socialization. Additionally, as previously discussed, the FIMS coding system was designed for and has been validated with this unique population (Kaugars et al., 2011).

Convergent validity for the scaffolding composite was examined by measuring correlations with questionnaires assessing similar parenting constructs, including acceptance (i.e., warmth, nurturance, emotional support), behavioral control (i.e., demanding appropriate behavior, enforcement of behavioral compliance), and psychological control (i.e., intrusive, attempting to control behavior using manipulation; Steinberg & Silk, 2002). It was expected that scaffolding would be positively associated with parent ratings of acceptance and behavioral control, but negatively associated with parent ratings of psychological control. Although these correlations were expected to be of moderate magnitude, scaffolding was hypothesized to be its own distinct parenting construct and correlations were therefore expected to be significant but modest. Concurrent validity for the scaffolding composite was evaluated by assessing correlations with questionnaires measuring youth’s academic functioning and social skills (Holmbeck & Devine, 2009). Based on previous scaffolding research (e.g., Baker et al., 2007; Mattanah et al., 2005), it was expected that scaffolding would be positively associated with youth’s academic and social outcomes. In particular, greater scaffolding was hypothesized to be associated with greater academic competence, performance, and independence, as well as greater social cooperation, assertion, and self-control in youth with SB.

Methods

Participants

Participants were recruited as part of a larger, ongoing longitudinal study examining family adjustment among youth with SB (e.g., O’Hara & Holmbeck, 2013). Data for the current analyses were from the baseline assessment and focused exclusively on parenting, as well as academic- and social-related outcomes in youth with SB. Families of youth with SB were recruited from four hospitals and a statewide association in the Midwest. Trained graduate and undergraduate research assistants approached families during hospital clinic visits and sent recruitment letters. At enrollment, eligible children: (a) were diagnosed with SB (types included myelomeningocele, lipomeningocele, and myelocystocele); (b) were ages 8–15; (c) were proficient in English or Spanish; (d) had the involvement of at least one primary caregiver; and (e) were living within 300 miles of the laboratory (to allow for data collection at participants’ homes).

One hundred and sixty-three of the 246 families approached for recruitment initially agreed to participate in the study. Of those 163 families, 21 families could not be contacted or later declined, and two families did not meet the inclusion criteria. Therefore, the final sample of participants included 140 families of children with SB (53.6% female; 53.5% Caucasian; M age = 11.40). Those who declined participation did not differ from participants with regard to type of SB (i.e., myelomeningocele vs. other), χ² (1) = 0.0002, shunt status, χ² (1) = 0.003, or occurrence of shunt infections, χ² (1) = 1.08 (all p’s > .05).

Given our interest in parent–child interactions, only families who completed the family interaction task at the baseline assessment were included in the current analyses, yielding a final subsample of 137 families (98% of the larger sample). Youth included in this subsample did not differ from the larger sample with regard to age, gender, type of SB, lesion level, shunt status, or socioeconomic status (SES). Children with SB ranged from 8 to 15 years of age (M = 11.41 years, SD = 2.45), and 53.3% were female. Approximately half of the children were Caucasian (52.6%). With regard to family structure, most parents were married to the child’s biological mother/father (67.9%). Some biological parents had separated (2.2%) or were divorced and never remarried (5.8%), whereas others were remarried (2.9%) or living with a significant other after the divorce (0.7%). The remaining families had a variety of family structures (e.g., widowed, separated/divorced from step-parents, never married; 20.5%). For most children, both their mother and father participated in the family interaction task (75.2%). However, a number of children participated with only their mother (22.6%) or father (2.2%). Additional demographic information is presented in Table I.

Table I.

Child Demographic and Condition-Related Characteristics

	n (%) or M (SD)
Gender: female	73 (53.3)
Age	11.41 (2.45)
Race
Caucasian	72 (52.6)
African-American/Black	18 (13.1)
Hispanic/Latino	39 (28.5)
Other	8 (5.9)
Family SES	39.46 (16.00)
IQ	85.70 (19.68)
SB type
Myelomeningocele	116 (84.7)
Lipomeningocele	13 (9.5)
Myelocystocele	2 (1.5)
Unknown/not reported	6 (4.4)
Lesion level
Lumbar	68 (49.6)
Sacral	41 (29.9)
Thoracic	21 (15.3)
Unknown/not reported	7 (5.1)
Shunt present	104 (75.9)

Note. Demographic information is based on a sample of 137 youth with SB who participated in family interaction tasks at T1 with at least one parent. IQ = intelligence quotient; SB = spina bifida; SES = socioeconomic status.

Procedure

The current study was approved by the university and hospital institutional review boards. Trained research assistants (i.e., undergraduate and graduate students) collected data in families’ homes during two separate 3-hr home visits at the baseline assessment. Prior to data collection, parents provided informed consent and children provided assent. Parents also completed releases of information allowing the research team to obtain data from medical charts, health professionals, and teachers. During the home visit, parents and youth independently completed questionnaires and participated in videotaped structured family interaction tasks. Families received gifts (e.g., t-shirts, pens) and monetary compensation ($150) for their participation.

Observational Assessment of Parent–Child Interactions

Following a warm-up game (i.e., family builds a tower based on a set of rules), parents and youth with SB completed three interaction tasks that were counterbalanced. Tasks included (a) two age-appropriate vignettes, (b) transferring of condition-related responsibilities task, and (c) a conflict task. During the two vignettes, families were presented with two age-appropriate, socially relevant situations that youth may encounter and they were asked to discuss potential resolutions. One of these situations was specific to individuals with SB (e.g., whether or not a child with SB will be able to go on a weekend trip organized by their school), whereas the other was broader (e.g., child is feeling left out by a friend). During the transferring of responsibilities task, families identified and discussed one or two SB-related responsibilities that could eventually be transferred from the parent(s) to the child (e.g., independent catheterization). Given the variability in the presentation of SB (Copp et al., 2015; Holmbeck et al., 2003), families were free to self-identify responsibilities that they deemed appropriate for transfer. Prior to conducting the conflict task, families completed the Parent–Adolescent Conflict Scale (PAC; Prinz, Foster, Kent, & O’Leary, 1979) where they indicated the presence, frequency, and intensity of potentially conflictive issues. In addition to the standard 15 items included in the scale (e.g., “Whether s/he does chores around the house”), 10 items were added for the current study to assess conflict specific to SB (e.g., “How s/he does his/her skin checks” or “How s/he talks about spina bifida with others”; Psihogios & Holmbeck, 2013). For the conflict task, families were presented with the five issues that they rated on the PAC as the most common and intense across family members; they were then asked to discuss and problem-solve potential resolutions to at least three of the issues. Families were given 10 min to complete each of the four interaction tasks. All tasks were coded and included in the scaffolding composite to obtain a comprehensive assessment of scaffolding across different contexts.

Coding of Observational Data

Family interactions were coded using the FIMS, which is a macro-coding method that has been used with families of youth with a variety of chronic health conditions (Holmbeck et al., 2007; Kaugars et al., 2011). After viewing an entire family interaction task, trained undergraduate and graduate students rated the family on codes assessing interaction style, conflict, affect, control, problem-solving, and family systems using 5-point Likert type ratings. All interactions were coded by two trained undergraduate and/or graduate students to increase interrater reliability. Coders completed comprehensive training and were required to achieve 90% reliability prior to coding the videotapes. Overall, the FIMS consists of 113 separate codes, 36 code types, and an additional seven family systems code types (e.g., “Family is overly close, stuck, over-concerned with each other”). Each of the code types includes ratings for each individual family member (i.e., mother, father, child), only the parents (i.e., mother, father), or for the family as a whole (Kaugars et al., 2011). Behavioral descriptions for each code are outlined in the manual (Holmbeck et al., 2007).

In the current study, six codes from the FIMS were used to capture and create a composite measure of parental scaffolding (see Table II for specific codes). Higher scores on the composite indicate that more scaffolding behaviors by parents were observed, whereas lower scores indicate the absence of scaffolding (i.e., less of these scaffolding-type behaviors were observed). The selection of these six codes was guided by both a review of the existing literature and theoretical formulations. As previously discussed, the literature review indicated that parental scaffolding is a process through which caregivers enhance children’s learning and skill-mastery by adapting tasks to meet the child’s ability level (Bibok et al., 2009; Wood et al., 1976). After this review of the literature, a rational approach to measure development was employed whereby maternal and paternal scaffolding were assessed using codes that mapped onto four theoretical domains: recruitment, direction maintenance, frustration control, and reduction in degrees of freedom (Wood et al., 1976). While the scaffolding framework proposed by Wood et al. (1976) includes six theoretical domains (i.e., recruitment, direction maintenance, frustration control, reduction in degrees of freedom, marking critical features, and demonstration), these four domains were selected as being the most appropriate, given the nature of the family interaction tasks. More specifically, the tasks used in the current study focused on discussions between parents and children (i.e., problem-solving areas of conflict within the family and potentially difficult SB-related situations), rather than being more hands-on in nature (e.g., solving a puzzle or mathematical equations). In other words, parents were generally scaffolding youth’s problem-solving of various situations that are relevant to this complex medical population. Thus, the scaffolding domains of marking critical features and demonstration were not relevant, given the types of tasks employed in this study. Other nonverbal elements of the scaffolding process (e.g., gesturing, facial expressions) were assessed and included in the coding process.

Table II.

FIMS Items Included in the Scaffolding Composite

Scaffolding theoretical domain	FIMS items
Recruitment	Requests input from childa
	Promotes dialogue and collaboration
Reduction in degrees of freedom	Structuring of task
Direction maintenance	Requests input from childa
Frustration control	Attempted resolution of issues
	Supportiveness
	Humor and laughter

Note. FIMS = Family Interaction Macro-coding System.

^aFIMS item fulfills two theoretical domains, but was only included once in the scaffolding composite.

Questionnaire Measures

Demographics

Mothers and fathers reported on demographic information, such as youth age, gender, and race/ethnicity. The Hollingshead Index of SES was used to assess family SES, with higher scores indicating higher SES (Hollingshead, 1975). Additionally, SB-related medical information, including SB type (i.e., myelomeningocele, meningocele, or lipomeningocele), lesion level (i.e., sacral, lumbar, or thoracic), and shunt status, was collected via parent report on the Medical History Questionnaire (Holmbeck et al., 2003) and medical chart reviews.

Parenting Behaviors

Maternal and paternal parenting behaviors were assessed via parent report on the Child’s Report of Parent Behavior Inventory (CRPBI-P; Schludermann & Schludermann, 1970). On this 52-item measure, parents rate items (e.g., “I am very patient with my child”) on a 3-point scale ranging from 1 (not like me as a parent) to 3 (a lot like me as a parent). The CRPBI-P yields three parenting dimensions, including acceptance/rejection, autonomy/psychological control, and firm/lax control. In the current study, these three dimensions were labeled as acceptance, behavioral control, and psychological control, respectively. Internal consistency was adequate for each of these dimensions (α = 0.63–0.81).

Academic Competence

Teachers and parents reported on youth’s academic competence using the Parent/Teacher Rating Scale of Child’s Actual Behavior (PRSCAB/TRSCAB), based on the Harter Self-Perception Profile for Children (Harter, 1985). This measure consists of 15 items and yields five subscales: scholastic competence, social acceptance, athletic competence, physical appearance, and behavioral conduct. For each item on the PRSCAB/TRSCAB, the respondent is asked to first identify which of two statements best describes the youth (e.g., “My child is really good at his/her school work” or “My child cannot do the work assigned”), and then to rate whether the statement is “really true” or “sort of true” for the child. Both the teacher and parent versions have shown adequate psychometric properties (Cole, Gondoli, & Peeke, 1998). The scholastic competence subscale was used in the current study and internal consistency was adequate for the sample (α = 0.75–0.91).

Academic Performance

Teachers reported on youth’s academic performance using the Teacher Report Form (TRF; Achenbach & Rescorla, 2001), a widely used and validated measure for children ages 6–18 years old. The TRF yields T-scores and percentiles for eight problem subscales, three second-order problem subscales, nine DSM-oriented subscales, and two adaptive functioning subscales. The academic performance subscale consists of six items; for each item, the teacher is asked to list a school subject and then rate the student’s performance for that subject on a scale from 1 (far below grade level) to 5 (far above grade level). The academic performance subscale was used in the current study and internal consistency was adequate (α = 0.97).

Academic Independence

Teachers rated youth’s academic independence using the Child Behavior Questionnaire which was developed for the current study, based on work by Egeland, Pianta, and O’Brien (1993). This 67-item measure assesses academic motivation, social competence and peer acceptance, compliance, and disruptive behavior, as well as the child’s completion of SB-related tasks. Teachers also rate their relationship with the child’s parents and their perception of the parent’s overprotectiveness. The academic independence subscale (i.e., behavioral compliance, required assistance from the teacher, and the child’s attention level) was used in the current study and demonstrated adequate internal consistency in this sample (α = 0.80).

Social Skills

Teachers and parents reported on youth’s social skills using the Social Skills Rating System (SSRS; Gresham & Elliot, 1990). This measure assesses skills essential for social competence, yielding subscales related to social skills and problematic behaviors. Teachers and parents rated how frequently the child engages in various behaviors, from 0 (Never) to 2 (Very Often). The current study used three social skill subscales: cooperation, assertion, and self-control. The SSRS has demonstrated satisfactory internal consistency (Gresham & Elliot, 1990) and internal consistency was adequate in this sample across all three subscales (α = 0.78–0.90).

Data Analytic Plan

Interrater reliability coefficients were computed for the maternal and paternal scaffolding composites using intraclass correlations (ICCs). ICC values ≤0.40 indicated poor to fair agreement, 0.41–0.60 moderate agreement, 0.61–0.80 good agreement, and 0.81–1.00 excellent agreement between the two coders (Landis & Koch, 1977). To determine internal consistency of the maternal and paternal scaffolding composites, Cronbach’s α’s were calculated using item mean scores across the two coders and four tasks for each item. Adequate internal consistency was defined as reliability coefficients of 0.70 or higher.

Pearson bivariate correlations were used to examine associations between parental scaffolding and the parent questionnaire variables to establish convergent validity. In particular, convergent validity was examined by computing Pearson correlations between the maternal and paternal scaffolding composites and scales selected from questionnaires assessing similar parenting constructs (i.e., acceptance, behavioral control, psychological control). Strong, statistically significant correlations (i.e., p < .05) between observational scaffolding scores and similar questionnaire data were considered evidence of convergent validity. Concurrent validity was also evaluated by calculating correlations between the scaffolding composites and youth’s academic functioning and social skills (Holmbeck & Devine, 2009). Guided by findings in the broader literature, significant associations between these variables provided further evidence of validity (e.g., Baker et al., 2007; Mattanah et al., 2005). Consistent with guidelines outlined by Cohen (1992), the magnitude of correlation coefficients were interpreted as follows: r = 0.10 denoted a small effect, r = 0.30 denoted a medium effect, and r ≥0.50 denoted a large effect.

Results

Scaffolding Reliability

Interrater Reliability

Prior to computing reliabilities, the six items included in the scaffolding composite were collapsed across all four observational tasks (i.e., warm-up, vignettes, transferring of condition-related responsibilities task, and conflict task) for each coder. Interrater reliabilities were then computed for the scaffolding composite using ICCs, in which the maternal and paternal scaffolding composites were examined separately. Both the maternal and paternal scaffolding composite demonstrated adequate interrater reliability. Reliability coefficients were 0.71 and 0.76 for mothers and fathers, respectively.

Internal Consistency

Each of the six items included in the scaffolding composite was collapsed across coders and the four observational tasks to create mean scores. Next, Cronbach’s α reliability coefficients were computed to determine the internal consistency of the maternal and paternal scaffolding composites. Cronbach’s α’s were adequate for both composites. Alpha coefficients were 0.83 and 0.86 for mothers and fathers, respectively.

Scaffolding Descriptives

Mean scores for maternal and paternal scaffolding were 3.31 (SD = 0.36) and 2.99 (SD = 0.47) on a 5-point Likert scale, respectively. Paired samples t-tests revealed significantly higher levels of scaffolding in mothers than in fathers, t(102) = 6.89, p < .001. When examining links between the demographic variables and parental scaffolding using bivariate Pearson correlations, no significant associations were found between parental scaffolding and child age or gender. While greater maternal scaffolding was associated with a higher IQ in youth with SB, r = 0.21, p < .05, associations between paternal scaffolding and youth IQ were nonsignificant. One-way ANOVAs examining differences in maternal and paternal scaffolding based on SB type (i.e., myelomeningocele, meningocele, or lipomeningocele) were also nonsignificant. However, one-way ANOVAs indicated that scaffolding levels differed significantly between Caucasian, African-American, and Hispanic/Latino mothers, F(2, 123) = 13.52, p < .001, and fathers, F(2, 97) = 3.18, p < .05. Post hoc comparisons revealed that Caucasian (M = 3.43, SD = 0.30) and Hispanic/Latino mothers (M = 3.27, SD = 0.35) engaged in significantly higher levels of scaffolding than African-American mothers (M = 2.98, SD = 0.41). Similarly, Caucasian fathers (M = 3.05, SD = 0.49) engaged in significantly higher levels of scaffolding than African-American fathers (M = 2.62, SD = 0.59). SES was also positively correlated with both maternal (r = 0.37, p < .001) and paternal scaffolding (r = 0.27, p < .01).

Scaffolding Validity

Parenting Measures

Bivariate correlation coefficients and p-values are presented in Table III. As expected, the maternal scaffolding composite was positively associated with maternal report of acceptance and negatively associated with maternal report of psychological control. Similarly, paternal scaffolding was negatively associated with paternal report of psychological control and a positive trend emerged for paternal report of acceptance (p = .065). All other correlations between parental scaffolding and parent-report questionnaires were not significant (see Table III).

Table III.

Correlations Between Observed Parental Scaffolding and Parent Report of Other Parenting Behaviors

CRPBI-P scales	Maternal scaffolding	Paternal scaffolding
1. Acceptance	.32***	.19
2. Behavioral control	−.12	−.15
3. Psychological control	−.26**	−.21*

Note. Ns range from 87 to 122. Correlations for mother report on CRPBI are presented for maternal scaffolding and correlations for father report on CRPBI are presented for paternal scaffolding. CRPBI = Child’s Report of Parent Behavior Inventory.

^* p < .05.

^** p < .01.

^*** p < .001.

Youth Academic and Social Outcomes

Bivariate correlation coefficients and p-values are presented in Table IV. To minimize the chance of Type 1 error, data reduction techniques were employed (Holmbeck, Li, Schurman, Friedman, & Coakley, 2002). Specifically, for constructs with mother, father, and teacher report on questionnaires (i.e., academic competence, social skills), data from all three informants were aggregated if α ≥0.70 (i.e., reports were treated as items on a scale). If data from all three informants did not meet this criterion, then data from two informants were aggregated if r ≥0.40. Reports of academic competence met the initial alpha criterion and therefore mother, father, and teacher report were averaged to create a composite score (α = 0.76). Academic performance and independence were examined using only teacher report. While mother, father, and teacher reports of social skills did not meet the initial alpha criterion, mother and father report were correlated above 0.40 and were therefore averaged (rs = 0.51–0.55, ps < .001). Teacher report of social skills was examined separately in all analyses.

Table IV.

Correlations Between Parental Scaffolding and Youth’s Academic and Social Outcomes

Scales/composites	Maternal scaffolding	Paternal scaffolding
Parental scaffolding
1. Maternal scaffolding
2. Paternal scaffolding	.22*
Youth academic functioning
3. Academic competence (M, F, T)	.19*	.12
4. Academic performance (T)	.18	.18
5. Academic independence (T)	.19*	−.05
Youth social functioning
6. Social cooperation (M, F)	.02	.25*
7. Social assertion (M, F)	.06	.15
8. Social self-control (M, F)	.23*	.23*
9. Social cooperation (T)	.13	−.11
10. Social assertion (T)	.05	.15
11. Social self-control (T)	.08	.10

Note. Ns range from 87 to 131. Reporters for each scale denoted in parentheses. M = mother report, F = father report, T = teacher report.

^* p < .05.

Consistent with our hypotheses, bivariate correlations revealed significant associations between maternal scaffolding and youth’s academic competence and independence, such that greater maternal scaffolding was associated with better academic competence and independence. A positive trend emerged between maternal scaffolding and academic performance (p = .061). Though a positive trend emerged between paternal scaffolding and academic performance (p = .099), all other correlations between paternal scaffolding and youth’s academic outcomes were nonsignificant (see Table IV).

With regard to youth’s social skills, bivariate correlations revealed significant associations between scaffolding and self-control in youth. As expected, higher levels of both maternal and paternal scaffolding were associated with better social self-control (parent report). Moreover, greater paternal scaffolding was associated with more social cooperation in youth (parent report). Contrary to our hypothesis, neither maternal nor paternal scaffolding was associated with parent report of social assertion. All correlations between parental scaffolding and teacher report of social skills were nonsignificant.

Discussion

Mounting evidence indicates that parental scaffolding may bolster skill development (e.g., executive functioning, attention), as well as promote better academic and social outcomes among children (Baker et al., 2007; Bibok et al., 2009; Hammond et al., 2012; Mattanah et al., 2005). As such, this parenting behavior may be particularly important and impactful for children with a neurological impairment, such as SB, who frequently struggle across these domains of functioning (Copp et al., 2015; Holmbeck et al., 2003). Despite the potential benefits of scaffolding, this construct has yet to be examined in families of youth with SB. Thus, the current study sought to create and validate a new observational measure of parental scaffolding in this population. Given literature suggesting that mothers’ and fathers’ parenting behaviors may differentially affect youth outcomes, separate composites were created to assess maternal and paternal scaffolding (Lansford, Laird, Pettit, Bates, & Dodge, 2014). Overall, results provide preliminary psychometric support for this scaffolding measure.

Creation of the scaffolding composite was guided by the existing literature, including a widely accepted framework by Wood et al. (1976). Consistent with this framework, four distinct elements of the scaffolding process were assessed in the present study and included in the scaffolding composite: recruitment, direction maintenance, frustration control, and reduction in degrees of freedom (Wood et al., 1976). Not only was the scaffolding composite rooted in the literature and theoretically based, but it also demonstrated adequate reliability and internal consistency. Adequate interrater reliability coefficients (i.e., ICCs) indicate that these parenting behaviors were able to be reliably evaluated by coders using the macro-coding system. Additionally, both the maternal and paternal scaffolding composite demonstrated satisfactory internal consistency (i.e., Cronbach’s alpha coefficients), suggesting that items chosen during measure development are assessing the same general construct.

In addition to reliability, the maternal and paternal scaffolding composites demonstrated convergent validity. First, multiple significant associations were found between the scaffolding composites and parent report on the CRPBI-P, which is a valid, psychometrically sound questionnaire (Schludermann & Schludermann, 1970). As expected, maternal and paternal scaffolding were both negatively associated with the psychological control scale on the CRPBI-P. Moreover, a positive association emerged between maternal scaffolding and the acceptance scale on the CRPBI-P. In the context of the broader parenting literature, acceptance is conceptualized as a parenting behavior that is warm, nurturing, and emotionally supportive, whereas psychological control is considered parenting that is intrusive and attempts to control children via manipulation (Steinberg & Silk, 2002). Therefore, given the supportive nature of scaffolding, findings were in the expected direction and consistent with past work. Notably, the scaffolding composite and the CRPBI-P produced relatively modest, small-to-medium effects, providing support that scaffolding is its own distinct parenting construct.

As evidence of concurrent validity, associations were found between the scaffolding composite and youth’s academic and social outcomes in the expected directions. With regard to academics, significant associations emerged between maternal scaffolding and youth’s academic competence and independence, whereas no significant associations were found for paternal scaffolding. These findings for maternal scaffolding mirror previous research, suggesting that scaffolding may not only have important implications for typically developing children, but also for those with disabilities/health conditions such as SB (e.g., Baker et al., 2007; Mattanah et al., 2005). Considering the lack of significant associations between paternal scaffolding and youth’s academic outcomes, it is possible that mothers are uniquely situated to support academic independence and task success (e.g., improving ability to complete school work and figure out answers) in youth with SB (Lansford et al., 2014). Relatedly, maternal and paternal scaffolding were positively associated with youth’s social self-control, and paternal scaffolding was positively associated with youth’s social cooperation (i.e., both social skill composites were based on mother and father report). These correlations are consistent with a study by Baker et al. (2007) linking scaffolding to future social skills among children with developmental delays, further supporting the validity of this measure and highlighting the potential benefits of scaffolding behaviors for youth with SB. However, it is important to note that findings in the social domain were mixed, such that social skills based on teacher report were not significantly associated with the maternal or paternal scaffolding composite. This lack of significant findings for teacher report of social skills may be because other SB-related factors (e.g., condition severity, IQ, school support) are more salient predictors of youth’s social skills in the classroom. Additionally, teachers must manage a classroom of many students and, as such, may not be as attuned to each child’s specific skills, whereas parents may be more sensitive to or aware of their child’s social abilities across a variety of contexts (e.g., home, sports, playdates with friends).

Associations between parental scaffolding and youth outcomes are also particularly notable given the age range of youth in this sample (i.e., ages 8–15 years old). The broader literature primarily focuses on the effects of parental scaffolding in the context of early childhood (i.e., younger than age 8; e.g., Bibok et al., 2009; Hammond et al., 2012), rather than in later childhood and early adolescence. Indeed, research has found that the effects of parental scaffolding may diminish over time (Treble-Barna et al., 2016), which may have reduced the likelihood of finding significant associations with scaffolding in the present study. This may help to explain the lack of significant correlations between parental scaffolding and a number of child outcome variables. That being said, numerous significant correlations between parental scaffolding and youth academic and social outcomes did emerge. One possible explanation for these findings is that the developmental age of youth with SB may be significantly lower than their chronological age, thus increasing parental involvement and influence throughout the lifespan. Additional research delineating the interplay between parental scaffolding and child adjustment across development in the context of SB is needed.

Interestingly, there was variability in parental scaffolding levels based on parent demographic factors and SB-related characteristics. Consistent with the notion that there are distinct differences in parenting behaviors displayed by mothers and fathers (Lansford et al., 2014), mothers demonstrated significantly higher levels of scaffolding than fathers. Moreover, findings indicate that there may be differences in mothering and fathering across racial and ethnic groups, as well as based on SES. Parents of youth with SB who are from lower SES backgrounds may experience greater stress (Holmbeck & Devine, 2010) and have less time to engage in adaptive parenting styles because they are trying to meet the family’s basic needs. Additionally, there may be cultural differences in parenting across different racial and ethnic groups (Garcia Coll, Meyer, & Brillon, 1995), which should be considered and further examined in future research. Finally, maternal scaffolding was positively associated with youth IQ, indicating that parents may adapt their behaviors to meet their child’s ability level (Guralnick et al., 2008).

The current study had a number of strengths. First, there is a clear need to create an observational measure of parental scaffolding that can be used with families of youth with SB and other health/neurodevelopmental conditions, given the implications these behaviors could have for youth’s long-term adjustment. Notably, observational measures of parent–child interactions, in general, provide researchers with a unique opportunity to directly witness dynamic family interactions and obtain objective data, as well as identify potential areas for intervention. Second, the use of four parent–child interaction tasks provide rich, observational data that captures parental scaffolding across a number of different contexts (e.g., navigating and problem-solving conflict/difficult social situations). Third, the creation of the parental scaffolding composite was grounded in theoretical formulations from the broader literature and the items used are from a validated observational coding system (i.e., FIMS; Holmbeck et al., 2007; Kaugars et al., 2011). Fourth, youth’s academic and social functioning were assessed via reports from multiple informants (i.e., parents and teachers), which is important given differences in perspectives and the amount of contact each of these adults may have with youth (La Greca & Lemanek, 1996). Finally, validity and reliability were comprehensively assessed, including interrater reliability, internal consistency, and convergent and concurrent validity. Importantly, the evaluation of validity employed questionnaire methods which differed from the observational assessment strategy used to examine parental scaffolding.

Despite these strengths, results from this study should be interpreted in light of several limitations. Although this scaffolding composite was based on theoretical formulations in the literature, employing a rational approach to measure development can be inherently biased and subjective. Additionally, the sample used in the current study consisted mainly of individuals with SB who are higher functioning (i.e., 74.5% had IQs greater than 70). Indeed, there might be distinct differences in the dynamics of family interactions between higher and lower functioning individuals; differences in psychometric properties for the scaffolding composite between these groups could be evaluated with a larger overall sample. Moreover, generalizability of these findings to other populations may be limited considering the unique presentation of SB, such that individuals can experience a constellation of cognitive and physical deficits that vary in severity (Copp et al., 2015). Finally, it is possible that reciprocal relationships exist between parental scaffolding and youth functioning, such that youth’s functioning affects parental scaffolding behaviors and vice versa. These bidirectional relationships were not examined in the present study due to the cross-sectional nature of the data. Thus, additional, longitudinal research examining the reliability and validity of this scaffolding composite, as well as the long-term implications of scaffolding in this population, is needed.

In summary, the current study is the first to apply the scaffolding concept to families of youth with SB. Preliminary evidence of the validity and reliability of the scaffolding composite supports the future use of this measure with individuals with SB. Given the overlap between SB and many other chronic conditions (e.g., physical and intellectual disabilities, medical conditions), this measure may also be applicable to research with other pediatric populations. Results from this study provide researchers with a novel tool for measuring dynamic parenting processes in the context of multimethod research. Future work should further establish the validity of this measure and examine how these scaffolding composites intersect with SB-related characteristics (e.g., condition severity) and impact other outcomes (e.g., functional independence, self-care, and medical responsibility). Improving understanding of the impact of scaffolding on outcomes among youth with SB may, in turn, aid clinicians who seek to develop interventions. More specifically, the parenting behaviors implicated in the scaffolding process, including requesting input from children, promoting dialogue and collaboration, structuring of the task, attempted resolution of issues, supportiveness, and humor and laughter, are likely teachable. Indeed, past work suggests that parenting behaviors are often amenable to change via coaching interventions (e.g., Antonini et al., 2014; Schuhmann, Foote, Eyberg, Boggs, & Algina, 1998). Furthermore, future work should examine the clinical utility of this scaffolding measure, such as whether it is sensitive to changes in parenting over time (Alderfer et al., 2008). Improving knowledge about the impact of parental scaffolding has the potential to enhance long-term outcomes for youth with SB.