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

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.