Observed Macro- and Micro-Level Parenting Behaviors During Preadolescent Family Interactions as Predictors of Adjustment in Emerging Adults With and Without Spina Bifida

Emerging adulthood (ages 18–25 years) is a distinct developmental period characterized by widespread change, such as exploration of career interests, changes in world views, intensification of romantic partnering, and increased autonomy (Arnett, 2000). For youth with spina bifida (SB), a congenital birth defect, the achievement of milestones during emerging adulthood may be particularly difficult because of the challenges inherent in intense medical care management (e.g., intermittent catheterization, bowel programs, medications, and nutritional programs), impaired cognitive ability, and lower social skills (Zukerman, Devine, & Holmbeck, 2011). Emerging adults with SB demonstrate difficulties with social (e.g., peer/romantic relationships), educational (e.g., college attendance), emotional (e.g., internalizing/externalizing symptoms), and health-related adjustment (e.g., substance use; Bellin et al., 2010, 2011; Murray et al., 2014; Roux, Sawin, Bellin, Buran, & Brei, 2007; Zukerman et al., 2011). Further, parenting behaviors that support or inhibit the development of autonomy may be especially important for youth with SB, whose families are often highly involved in their medical care. Yet, few studies have examined parenting behaviors as prospective predictors of autonomy-related emerging adulthood adjustment across social, educational, emotional, and health-related domains. The development of autonomy is a dynamic and interactive familial process in which the child achieves independence while maintaining connectedness with parents (Friedman, Holmbeck, DeLucia, Jandasek, & Zebracki, 2009). Parenting behaviors that promote or undermine a child’s autonomy development begin before adolescence and may have important implications for the development of more mature forms of autonomy and subsequent adjustment at later developmental stages. Children with chronic health conditions are often granted more decision-making control (e.g., over medical regimens) starting in middle childhood (Holmbeck et al., 1998), yet research has revealed that children with SB tend to lag behind their typically developing (TD) peers by ∼2 years with respect to several indices of autonomy development (e.g., behavioral, decision-making, and emotional autonomy; Davis, Shurtleff, Walker, Seidel, & Duguay, 2006; Devine, Wasserman, Gerschensen, Holmbeck, & Essner, 2011; Friedman et al., 2009). Difficulties with autonomy development in children with SB may persist into emerging adulthood and influence the likelihood that young adults attend college, experience romantic relationships, and develop stable social networks (Zukerman et al., 2011). The influence of autonomy-promoting or -inhibiting parenting on youth adjustment has emerged as a crucial area of research, particularly in studies of pediatric populations (e.g., epilepsy, SB; Fastenau et al., 2004; Holmbeck, Coakley, Hommeyer, Shapera, & Westhoven, 2002; Holmbeck, Johnson et al., 2002; McKernon et al., 2001). The majority of this research has identified three distinct and salient parenting constructs that impact youth adjustment: Psychological control, behavioral control, and acceptance. Psychological control is characterized by parenting behaviors that are critical and manipulative of a child’s thoughts and feelings (Barber & Harmon, 2002; Holmbeck, Johnson et al., 2002; Holmbeck, Shapera, & Hommeyer, 2002). Psychologically controlling behaviors include parental stifling of the child’s communication, encouragement of emotional/psychological dependence, and parental suppression of individuality (Steinberg, 1990). In contrast, behavioral control (i.e., parental demandingness) refers to expectations and rules that parents set forth for age-appropriate child behavior, such as parental willingness to confront their child if he/she disobeys, age-appropriate supervision, and expectations for mature behavior (Baumrind, 1991). Finally, parental acceptance is typically defined as the degree to which a parent is affectionate, emotionally supportive, approving, and involved (Holmbeck, Shapera et al., 2002). Generally, youth tend to be adversely affected by psychological control, whereas behavioral control and parental acceptance promote positive adjustment outcomes. For example, studies have indicated that higher levels of behavioral control and acceptance are linked to better academic performance, social competence, and fewer behavior problems (Holmbeck, Hommeyer, & Shapera, 2002). In contrast, excessive psychological control may disrupt autonomy development and promote dependency (Barber & Harmon, 2002; Baumrind, 1991). Psychological control has been associated with higher rates of internalizing symptoms, externalizing symptoms, and adolescent substance use in pediatric (Luyckx, Goossens, Missotten, & Moons, 2011) and nonpediatric populations (Aquilino & Supple, 2001). This body of research suggests that optimal development occurs when youth are granted developmentally appropriate levels of autonomy in the context of continued parental involvement and support. Similarly, investigators have measured more specific autonomy-related parenting behaviors. In particular, researchers have studied parenting that aids in the promotion of autonomy while maintaining a positive and accepting relationship between parent and child (termed “autonomy-relatedness”), which has been associated with a number of positive psychosocial outcomes. For example, research suggests that greater autonomy-relatedness in parenting is linked to better dating competence, ability to better cope with peer pressure, and higher levels of self-esteem (Allen, Hauser, Bell, & O’Connor, 1994; Best, Hauser, & Allen, 1997). Further, perceived parental promotion of autonomy for children with SB has been associated with positive adjustment during adolescence and emerging adulthood, such as educational achievement (Loomis, Javornisky, Monahan, Burke, & Lindsay, 1997) and increased well-being (e.g., lower levels of internalizing and externalizing symptoms; Allen et al., 1994, 2006; Barber, 1996; Noom, Dekovic, & Meeus, 1999; Pavlidis & McCauley, 2001). Although the link between autonomy-promoting or -inhibiting parenting behaviors and child adjustment is well-established, advances in this area of research have been limited by a heavy reliance on single method (usually questionnaires), single informant (usually mothers), single group (i.e., lack of a matched comparison sample), and cross-sectional research approaches (Holmbeck, Coakley et al., 2002; Holmbeck et al., 2003). Unfortunately, exclusive reliance on questionnaire data, even when collected from multiple informants, introduces the problem of shared method variance (Holmbeck, Coakley et al., 2002; La Greca & Lemanek, 1996). In contrast, macro- and micro-level observational methods provide researchers with rich information and permit a less-biased approach to examining youth–parent interactions, which may be distinct from the family member’s own perceptions (Kaugars et al., 2011). In macro-level analyses, a researcher codes for the overall frequency, intensity, and quality of observed parental behaviors (e.g., warmth, responsiveness, intrusiveness, and permissiveness) throughout family interactions. In contrast, micro-level coding involves assessment of specific parent–child conversation pragmatics at the level of utterances (i.e., each statement by each family member receives a code; Lasky & Klopp, 1982). To date, the majority of observational approaches in pediatric psychology research have relied on broad and macro-level indicators of parent–child communication and behavior (Dunn et al., 2011; Lim, Wood, Miller, & Simmens, 2011). However, studies that integrate macro- and micro-levels of analyses would be helpful in providing cross-validation of research findings and in identifying variables to be used in future targeted interventions (Holmbeck et al., 2003; Rodriguez et al., 2013). Thus, the present study sought to examine macro- and micro-level observed parenting behaviors during preadolescence as predictors of emerging adulthood adjustment in individuals with SB, thereby addressing limitations of the existing literature. Specifically, we assessed the long-term impact of observed macro-level (e.g., psychological and behavioral control and acceptance) and micro-level (e.g., autonomy-relatedness, undermining autonomy, and undermining relatedness; Allen, Hauser, Bell, Boykin, & Tate, 1996; Johnson & Holmbeck, 1995) preadolescent family interactions on educational (i.e., college attendance), social (i.e., romantic/sexual experience, friends), emotional (i.e., internalizing and externalizing symptoms), and health-related (i.e., cigarette and alcohol use) adjustment outcomes in emerging adults with and without SB 10 years later. It was hypothesized that parenting behaviors that undermine autonomy development (high levels of psychological control and undermining autonomy and relatedness) would predict less adaptive outcomes across the educational, social, emotional, and health-related domains in emerging adults with SB and TD youth. Similarly, it was expected that parental behaviors that encourage autonomy (high levels of autonomy-relatedness, behavioral control, and acceptance) would lead to better adjustment in all domains in emerging adulthood. Given that youth with SB may display greater dependence on their parents for medical and social needs, and that youth with SB spend more time with their parents (and less time with friends) than their TD peers (Blum, Resnick, Nelson, & St. Germaine, 1991), relations among the parenting variables and outcomes were expected to be especially strong for youth with SB.