Sex Differences in Parent Attachment
among Adolescents of Parents with
Chronic Medical Condition
Name: Danielle Dadon Student number: s21031412 Master Thesis Clinical Psychology Supervisor: Dr. D.S. Sieh
Institute of Psychology University of Leiden Date: 08-08-2018
Abstract
Parent attachment is believed to be a protective factor in adolescent adjustment to parental chronic medical condition (CMC). CMC is characterized by impaired health due to ongoing adverse physical symptoms. The perceived quality of attachment may differ between males and females. This study aimed to investigate sex differences in the perceived quality of parent attachment between adolescents and parents in families affected by CMC. Positive associations between adolescents’ and ill parents’ reports of attachment were examined in same-sex and opposite-sex dyads as well. In total, 83 Dutch families with 132 adolescents (53% girls; mean age = 15.1 years), 83 parents with CMC and 83 healthy parents participated in the study. The perceived quality of parent attachment was measured using the Inventory of Parent and Peer Attachment (IPPA) for adolescents, and Parent-Child Interaction Questionnaire (OKIV-R) revised from Lang (2001) for both parents. Results indicated that adolescents reported a higher quality of attachment to mothers compared to fathers, while parents reported an equal quality of attachment to boys and girls. In addition, positive associations between adolescents’ and parents’ perceived quality of attachment were found in dyads consisting of girls, while discrepancies in reports were found in dyads consisting of boys. In conclusion, health professionals should take into account adolescents’ sex while working with adolescents who are dealing with parental illness, and if needed, aim to increase the quality of attachment in order to facilitate a better adjustment.
Introduction
Approximately, 10% of children grow up with a parent affected by a chronic medical condition (CMC) (Barkmann, Romer, Watson, & Schulte-Markwort, 2007). CMC is characterized by ongoing adverse physical symptoms, some of which are severe pain, lack of appetite, and fatigue (Visser, 2007). Literature suggests that parents affected by CMC face daily difficulties which affect their ability to take care of their offspring’s needs (Korneluk, & Lee, 1998). The lack of parental availability, in turn, is believed to influence the quality of the parent-child relationship (Bannink, Broeren, Looij-Jansen, & Raat, 2013). This study will focus on sex differences in the perceived quality of parent attachment between adolescents and parents affected by CMC.
Parent attachment, as John Bowlby (1982) defined it, is a continuous and profound bond between infants and their caregivers. The theory of attachment focuses on infants’ innate inclination to seek closeness with their parents, and its impact on their adjustment throughout life (Fraley, Heffernan, Vicary, & Brumbaugh, 2011). More specifically, parent attachment provides a secure basis from which the child can acquire self-confidence and independence to cope successfully with challenges in life (Ainsworth, 1991). While parent attachment is considered to be an integral part throughout one’s lifespan, relatively few studies have focused on the continuity or change in parent attachment during adolescence (Buist, Deković, Meeus, & van Aken, 2002; Posada & Lu, 2011).
Adolescence is an intense developmental period, marked by cognitive, social, and biological changes (Rawatlal, Kliewer, & Pillay, 2015). One of these changes is a reconstruction of the attachment, in which adolescents engage in exploratory behaviors independently from their parents, yet still rely on them when needed (Allen, Hauser, Bell, & O'Connor, 1994). Furthermore, Steinberg and Morris (2001) found that adolescence is characterized by a high emotional distance of adolescents from their parents, increased conflicts and low levels of closeness. Although the development of parent attachment during adolescence may seem clear, it is believed to be influenced by the sex of both parents and children (Paikoff, & Brooks-Gunn, 1991).
Sex differences have been found in the relationship of adolescents with both parents (Gorrese, & Ruggieri, 2012). The importance of sex in parent attachment is emphasized in the psychoanalytic theory, which assumes that adolescents identify with their same-sex parent in an attempt to develop their own sense of autonomy and separation (Chodorow, 1978). Findings across
studies regarding sex differences in adolescents’ perceived quality of attachment were inconsistent; while some studies did not find differences in adolescents’ quality of attachment to mothers and fathers (Lapsley, Rice, & FitzGerald, 1990; Mattanah, Lopez, & Govern, 2011; McCormick & Kennedy, 1994), others found significant differences in boys’ and girls’ perceived quality of attachment to both parents (Paterson, Field, & Pryor, 1994; Pipp, Shaver, Jennings, Lamborn, & Fischer, 1985). Nevertheless, the majority of research shows that adolescent boys and girls display a higher quality of attachment to their same-sex parent than to their opposite sex-parent (Buist et al., 2002; Starrels, 1994).
In particular, when sex differences were found, the gap in the perceived quality to both parents was greater for girls than for boys (Buist et al., 2002; Paterson et al, 1994). Deković and Meeus (1995) suggested that girls are more dependent on parent attachment compared to boys due to their high focus on social interactions, which are often utilized as a source of support and warmth. Hence, girls’ relationships are usually more profound compared to those of boys, as they exhibit more empathy, nurturing, and vulnerability (Gorrese et al., 2012). On the contrary, boys exhibit more independent behavioral patterns, as their relationships are characterized by emotional restrictions and autonomy (Feder, Levant, & Dean, 2007). A cohort design study of Buist et al. (2002) among 288 families, found that changes in the perceived quality of parent attachment were influenced by the sex of both parents and adolescents. Results indicated that adolescents’ perceived quality of attachment to their same-sex parent decreased gradually, whereas the quality of attachment to the opposite-sex parent decreased in a nonlinear pattern, which may imply a stronger parent-child conflict (Buist et al., 2002).
In regard to the parents’ sex, it seems to affect the perceived quality of parent attachment (Starrels, 1994). Studies found that mothers’ relationships with their children are closer and more engaged than those of fathers (Baxter, 2002; Smetana, Campione, & Metzger, 2006; Youniss, & Smollar, 1987). While mothers are responsible for parenting their children regardless of their sex, fathers are more involved with their sons than with their daughters (Aldous, Mulligan, & Bjarnason, 1998), yet their involvement significantly increases during adolescence (Lei & Wu, 2007). Furthermore, Steinberg et al. (2001) found that the mother-daughter dyad is generally the strongest one of all parent-child dyads. As the quality of attachment seems to differ between mothers and fathers, the literature emphasizes the importance of taking into account the sex of each member of the dyad (Russell & Saebel, 1997). Therefore, this study will focus on parent
attachment in same-sex dyads (i.e. mother-girl, father-boy) and opposite-sex dyads (i.e. father-girl, mother-boy) in order to examine how the perceived quality of parent attachment differs for males and females.
Despite the relevance of the quality of parent attachment as perceived by adolescents, fewer studies have examined parents’ perception of attachment and comparing it with the perceptions of their children (Rice et al., 1996). When comparing parents’ and adolescents’ reports of attachment, parents usually display a more positive view than their children (Aquilino, 1999; Ohannessian, Lerner, & von Eye, 2000). The existence of such incongruence between parents’ and adolescents’ perceptions can increase adjustment difficulties among adolescents, as well as affect their growing individuality (Ohannessian et al., 2000). Furthermore, according to Pelton, Steele, Chance, and Forehand (2001), discrepancies between parents and adolescents may increase in the presence of a family stressor, such as a chronically ill family member. Therefore, this study will include parents’ reports of attachment, in addition to those of adolescents, in order to provide a broader perspective of family dynamics in light of parental illness.
According to the Family System Theory by Bowen (1966), an event in the life of a member of a family, such as parental illness, can affect the lives of other family members. Respectively, a meta-analysis conducted by Beck (1999) showed that most studies found a positive relationship between the psychological functioning of the parent and of the child. Furthermore, adolescents of parents with CMC are prone to experience chronic stress, which may result in adjustment difficulties, such as internalizing problem behavior (Sieh, Meijer, Oort, Visser-Meily, & van der Leij, 2010a). These problems, in turn, have been linked with a low quality of parent attachment (Buist et al., 2016).
In Rolland’s (1999) Family System-Illness Model, which provides ways to adaptively cope with parental illness, parent attachment is considered to be a protective factor in adolescent adjustment to a chronically ill family member. Inspired by Rolland’s theory, a study among families affected by CMC showed that high quality of parent attachment was associated with lower levels of adolescents’ stress, emphasizing the importance of parent attachment in adolescent adjustment (Sieh, Dikkers, Visser-Meily, & Meijer, 2012). Furthermore, the authors identified parent attachment and adolescents’ sex as possible protective and risk factors, respectively, with girls being more sensitive to experience stress than boys (Sieh et al., 2012)
More specifically, parents with CMC are more likely to display lower parenting sensitivity, responsiveness, and affection towards their children than healthy parents (Broth, Goodman, Hall, & Raynor, 2004; Cornish et al, 2006). Consequently, the lack of emotional closeness within parent attachment promotes insecure behavior patterns in children (Wan, & Green, 2009). In a prospective study on the stability of parent attachment from infancy to adolescence, young adults of depressed mothers reported a deterioration in the quality of parent attachment compared to stable and secured individuals (Weinfield, Sroufe, & Egeland, 2000). Correspondently, the study of Evans, Keenan, and Shipton (2007) found that children of mothers with chronic pain reported higher levels of attachment insecurity compared to children of healthy mothers.
The overall findings above suggest that there may be sex differences in the perceived quality of parent attachment among family members affected by CMC. As parent attachment is considered to be a protective factor in adolescent adjustment to parental CMC (Bannink et al., 2013; Sieh et al, 2010a), further investigation of possible sex differences may be valuable while working with adolescents who are dealing with parental illness. This study aims to investigate sex differences in the perceived quality of parent attachment among families affected by CMC, see Figure 1. The first research question is whether there are differences in the perceived quality of parent attachment between adolescent boys and girls, as well as mothers and fathers. The second research question is whether parents’ and adolescents’ reports of attachment positively correlate with each other in same-sex and opposite-sex dyads.
We hypothesize that (H1) adolescent girls will report a higher quality of attachment to mothers compared to fathers, whereas adolescent boys will report a higher quality of attachment to fathers compared to mothers. (H2) Ill Fathers will report a higher quality of attachment to adolescent boys compared to girls, whereas ill mothers will report equal quality of attachment to adolescent girls and boys. (H3) Parents’ and adolescents’ reports of attachment will positively and significantly correlate with each other. The correlations will be higher in same-sex dyads (mother-girl, father-boy) compared to opposite-sex dyads (mother-boy, father-girl).
Figure 1.
Sex differences in the quality of parent attachment among adolescents of parents affected by chronic medical condition Parent Sex Adolescent Sex Same-Sex Dyad (Ill Mother-Girl Ill Father-Boy) Parental Chronic Medical Condition
The Perceived Quality of Parent Attachment Opposite Sex-Dyad
(Ill Father-Girl Ill Mother-Boy)
Method
Participants
In total, 132 adolescents, 83 parents with CMC, and 83 healthy parents participated in this study. Of all adolescents, parents with CMC, and healthy parents, 53%, 63.9%, and 31.3% were females, respectively, see Table 1. Exclusion criteria for adolescents were insufficient fluency of Dutch, living outside of the Netherlands, severe chronic diseases, and cognitive disabilities. Inclusion criterion for adolescents was living with at least one parent affected by CMC, for a period longer than 6 months. Parental CMC was defined as a disease involving at least one organ system, with an impaired health for more than 6 months (Sieh et al., 2012). In addition, since cancer is not a chronic illness by definition, it was excluded from analyses (Sieh, Visser-Meily, & Meijer, 2013). Families with a single parent were excluded from analyses due to missing scores of the healthy spouse. Families with same-sex parents were included since homosexuality is a part of society, as it has a prevalence of 5% in the population (Bogaert, 2004). In total, 29 adolescents of 19 single parents were excluded, and 4 adolescents of 4 families with same-sex parents (male-male) were included.
Measurements
Demographic variables and illness characteristics. Questionnaires for parents and
adolescents consisted of questions regarding gender, age, employment status, and educational level. Parents were further asked about their illness type and duration.
Parent attachment. Adolescents’ perceived quality of parent attachment was measured
by the Inventory of Parent and Peer Attachment (IPPA) by Armsden and Greenberg (1987), consisted of three scales (communication, confidence, and alienation) about both mother and father. The overall IPPA score of parent attachment was calculated by first reverse-scoring the negatively worded items and then summing the response values (12 items for each parent; 4-point Likert scale from 1 = almost never or never, to 4 = almost always or always). Higher scores signify a higher quality of attachment (Armsden et al., 1987). In this study, reliabilities were Cronbach’s alpha (α) = .87 for attachment to mothers and α = .84 for attachment to fathers.
Parents’ perceived quality of attachment was measured by the Parent-Child Interaction Questionnaire (OKIV-R) revised from Lang (2001). In this study, we chose to use average scores of both parents rather than solely those of the ill parents since parental illness affects the entire
family (Visser-Meily et al, 2009), as it creates interdependency between family members in various interactions (Sieh, Visser-Meily, Oort, & Meijer, 2012). Thus, we found it more representable to include spouses of parents with CMC while examining the perceived quality of parent attachment in families affected by parental illness. The overall score of OKIV-R was calculated by first summing the 21 items for each parent, using a 5-point Likert scale from 1 =
completely inapplicable, to 4 = exactly applicable, and then calculating the average score of both
ill and healthy parents. Higher scores indicated a higher quality of attachment to adolescents (Lange, 2001). This scale showed a good reliability of Cronbach’s alpha (α) = .87.
Procedure
Participants were recruited through advertisements on websites, hospitals, rehabilitation and community centers, schools, and health care professionals between September 2008 and April 2010. Once the families signed an informed consent form, an appointment with research assistants was scheduled at the families’ home. Both adolescents and parents filled questionnaires. As a reward for their participation, adolescents received either a gift voucher, a cinema ticket, or a phone cover. The study was approved by the ethical committee of the Research Institute of Child Development and Education of the University of Amsterdam on July 2, 2008.
Statistical Analysis
All analyses of this study were conducted using IBM SPSS Statistics (version 22). The hypotheses were tested through analyzing existing datasets of both parents and adolescents. Descriptive statistics, independent and paired t-tests, and Pearson correlations were used to present groups characteristics and differences. In addition, no normality tests were performed to examine samples’ distribution, as the statistical tests we used were resistant to non-normality (Gastwirth, Gel, & Miao, 2009). Prior to analyses, we conducted tests of missing values in order to examine their significance level and distribution. In addition, we performed demographic statistics to identify any pre-existing differences between groups in order to control for any confounding. Descriptive statistics were used to describe demographic variables of participants. All statistical tests were two-tailed with an alpha level of α = .05. We used small, medium, and large effect size with a value of d = .1, d = .3, and d = .5, respectively (Cohen, 1992).
Our first hypothesis was examined by performing two paired t-test in order to compare the quality of attachment to mothers and fathers as perceived by adolescent boys and girls. First, we created two variables; attachment to mother and attachment father for boys and girls separately. We then compared the scores of attachment to each parent in order to examine whether they evaluated the quality of attachment to the same-sex parent as higher than to the opposite-sex parent. Our second hypothesis was tested by conducting two paired t-tests in order to compare the quality of attachment to boys and girls as perceived by mothers and fathers. First, we divided parents scores into two groups; attachment of mothers and attachment of fathers. Within each group, we compared means of attachment to boys and girls, using adolescents’ sex as an indication of the subject of attachment.
Hypothesis 3 was tested by conducting Pearson correlations between parents’ and adolescents’ reports of attachment in same-sex and opposite-sex dyads. First, we performed Fisher
z-transformation which converts the sampling distribution into a normal one (Cohen & Cohen,
1983). Second, we sorted adolescents and parents into four groups; mother-girl, mother-boy, father-girl, and father-boy. Within these groups, we conducted Person correlations to investigate the level of correspondence between their reports of attachment.
Results
Preliminary analyses
As missing values analyses showed less than 5% of missing data, we concluded that there is no need for statistical corrections (Buhi, Goodson, & Neilands, 2008). Independent t-tests and chi-square tests showed no significant differences between adolescent boys and girls in age, level of education, health, employment status, and religion. In addition, both CMC and healthy mothers and fathers did not significantly differ in age, employment, hours of work per week, level of education, religion, years of marriage, and the number of kids living at home.
Descriptive statistics
Descriptive statistics of adolescents and parents are shown in Table 1. All adolescents were Dutch. Adolescents’ age range was between 10 to 20 years (M = 15.2, SD = 2.44 for girls,
M = 14.9, SD = 2.2 for boys). Most of adolescents reported being healthy (87.1% of girls and
Approximately 71% and 16% of adolescents attended high school and primary school, respectively, with boys failing at least a year at school almost twice as often as girls (22.6% compared to 11.4%). Employment rates were quite high, with 41.4% for adolescent girls and 38.7% for adolescent boys, meaning that more than a third of all adolescents had a job.
The majority of parents were Dutch (98%). The average years of being in a relationship with a healthy spouse were 20.4 and 22.9 for mothers and fathers, respectively. The age range of parents with CMC was between 40 to 72 years (M = 53.6, SD = 4.58 for females, M = 59.2, SD
= 5.41 for males), and between 45 to 73 for healthy parents (M = 55.6, SD = 4.73 for females, M = 56.5, SD = 6.08 for males). Mean education level was slightly higher among parents with CMC
compared to healthy parents. Employment rates of the healthy parents were roughly 3.5 times higher than those of parents with CMC for both sexes, with 15.7% employed parents with CMC (11.3% females and 20% males) compared to 59% employed healthy parents (38.5% females and 68.4% males). Parental illness comprised of muscle disease, rheumatism, Parkinson disease, Stroke, paraplegia, contusion, multiple sclerosis, gastrointestinal diseases, and diabetes. Mean illness duration was 19.46 years for females (SD = 8.64, range between 9 to 44 years), and 22.56 years for males (SD = 14.69, range between 8 to 57 years), see Table 2.
Note. 1 Healthy refers to the absence of somatic diseases. 2 Adolescent education level ranges from elementary
school (1) to university (12); Primary education = lagere school. Lower vocational education = praktijkonderwijs (MLK, ZMLK), school voor (voortgezet), speciaal onderwijs (LOM, ZMOK. Intermediate vocational education = brugklas VMBO-HAVO-VWO, brugklas VMBO-HAVO, brugklas HAVO-VWO. High school = VMBO, HAVO, VMO, MBO. Pre-university = HBO. University = University. Other. 3 Parent education level ranges from elementary
school (1) to university (6)
Table 1. Demographic Characteristics of Adolescents and Parents
Female Male
Adolescents (n) 53% (70) 47% (62)
Mean age (SD) 15.2 (2.44) 14.9 (2.2)
Nationality (Dutch) 100% 100%
Healthy1 87.1% 84.3
Mean education level (SD)2 6.56 (3.45) 6.9 (3.18)
Primary education 14% 18%
Intermediate vocational education 10% 6%
High school 72% 71%
Pre-university 3% 0%
University 2% 0%
Other 0% 2%
Mean grade (SD) 6.94 (.93) 6.85 (.77)
Failed at least a year at school 11.4% 22.6%
Have a job 41.4% 38.7% Religious 30.6% 37.1% Ill parents (n) 63.9% (53) 36.1% (30) Nationality (Dutch) 97.5% 100% Mean age (SD) 53.6 (4.58) 59.2 (5.41) Currently employed 11.3% 23.3%
Mean hours per week (SD) 13.65 (10.15) 26.2 (13.69)
Mean years together (SD) 20.4 (4.8) 22.9 (4.2)
Mean education level (SD)3 4.3 (1.38) 4.2 (1.42)
Religious 47.2% 46.7%
Healthy parents (n) 68.7% (26) 31.3% (57)
Nationality (Dutch) 98.7% 100%
Mean age (SD) 55.73 (4.73) 56.75 (6.08)
Currently employed 38.5% 68.4%
Mean hours per week (SD) 25.83 (9.74) 39.58 (9.86)
Mean education level (SD) 4.12 (1.14) 4.09 (1.52)
Religious 57.7% 40.4%
Table 2. Types of Parental Chronic Medical conditions
Female Male
Mean illness duration (SD) 19.46 (8.64) 22.56 (14.69)
Disease type Muscle disease 13.2% (7) 20% (6) Rheumatism (n) 17% (9) 23.3% (7) Parkinson (n) 7.5% (4) 3.3% (1) Stroke (n) 5.7% (3) 16.7% (5) Paraplegia (n) 3.8% (2) 13.3% (4) Contusion (n) 7.5% (4) 3.3% (1) Multiple sclerosis (n) 39.6% (21) 13.3% (4) Gastrointestinal diseases (n) 5.7% (3) 3.3% (1) Diabetes (n) 0 (0) 3.3% (1)
Hypothesis 1
As predicted, adolescent girls significantly evaluated mother attachment as higher than father attachment, t(69) = -2.18, p = .032, see Table 3. In contrary to our hypothesis, adolescent boys significantly evaluated mother attachment as higher than father attachment, t(61) = -3.51, p = .001, d = .44. That is, all adolescents reported a better attachment to mothers compared to fathers.
Table 3. Paired t-tests results comparing the quality of attachment within groups of adolescents and parents
Mother attachment Father attachment IPPA IPPA
M SD M SD Effect
Sized
Adolescent girls 39.58 7.11 38.05 6.43 -.26
Adolescent boys 40.62 5.06 38.24 5.12 -.44
Attachment to girls Attachment to boys OKIV OKIV
Mothers 90.52 5.83 89.6 7.26 -.06
Fathers 88.45 8.23 86.13 8.87 -.06
Note. *p < .05. **p < .01. ***p < .001.
Table 4. Independent t-tests results comparing the quality of attachment between groups of adolescents and parents
Note. *p < .05. **p < .01. ***p < .001.
Hypothesis 2
As predicted, no significant difference was observed between mothers’ reports of attachment to girls and boys, t(38) = -.38, p = .70, see Table 3. Contrary to our hypothesis and similar to mothers, fathers reported a similar quality of attachment to boys and girls, t(17) = -.27, p = .98. That is, both mothers and fathers displayed an equal quality of attachment to boys and girls. Further analysis was made comparing mothers’ and fathers’ reports of attachment. Results from an independent t-test indicated that mothers displayed a higher quality of attachment to girls
Female Male M SD M SD Effect sized Adolescents IPPA Attachment to mother 39.58 7.11 40.62 5.06 -.17 Attachment to father 38.07 6.43 38.24 5.12 -.03 Parents OKIV Attachment to girls 90.52 5.83 88.45 8.23 -.33 Attachment to boys 89.6 7.26 86.13 8.87 -.04
compared to fathers, t(67) = -1.22, p = .005, see Table 3. However, no significant difference was observed between mothers and fathers in their attachment to boys, t(61) = -1.6, p = .091.
Hypothesis 3
Of the four Pearson correlations we conducted among same-sex and opposite-sex dyads, parents’ and adolescents’ reports of attachment significantly correlated with each other only when adolescents were girls, see Table 5. Results showed positive and significant correlations in mother-girl dyads, r(40) = .54, p < .001, and in father-mother-girl dyads, r(30) = .54, p = .002. That it, Parents’ and girls’ reports of attachment corresponded with each other, as they perceived the quality of their attachment in a similar way. In contrast to our hypothesis, no significant correlations were found in mother-boy dyads, r(44) = .23, p = .18, as well as in father-boy dyads, r(18) = .41, p = .092.
Table 5. Pearson Correlations of Parent Attachment between Adolescents and Parents with CMC
Ill fathers OKIV Ill mothers OKIV .54** .54*** Adolescent girls IPPA .41 .23 Adolescent boys IPPA
Note. IPPA = Inventory of Parent and Peer Attachment. OKIV- Parent-Child Interaction Questionnaire
Discussion
This study sought to investigate sex differences in the perceived quality of parent attachment between adolescents and parents in families affected by CMC. As expected, adolescent girls showed a higher quality attachment to mothers compared to fathers, which is consistent with the main body of literature (Buist et al., 2002; Starrels, 1994). Unexpectedly, adolescent boys displayed a higher quality of attachment to mothers compared to fathers. Our second hypothesis was partly supported, as both mothers and fathers reported an equal quality of attachment to boys and girls. Further analysis showed that mothers displayed a higher quality of attachment to girls than fathers did, yet the effect was small-sized. Lastly, positive correlations between parents’ and adolescents’ reports of attachment were found only in dyads with adolescent girls, whereas dyads consisted of boys showed incongruences.
Our first hypothesis that adolescents will report a higher quality of attachment to their same-sex parent than to their opposite-sex parent was partly supported, as all adolescents reported a better attachment to mothers compared to fathers, with medium and small effect sizes for boys and girls, respectively. Literature suggests a possible explanation for why the quality of attachment to mothers was perceived higher by adolescents. According to the theory of attachment by Bowlby (1982), infants have an innate inclination called “monotropy” to permanently attach to a single and primary caregiver, who is mostly the mother (Gomez, & McLaren, 2007). Respectively, previous studies among Western cultures found that mothers are prone to be the primary attachment figure for both sexes (Evans et al., 2007; Freeman, & Brown, 2001; Guarnieri, Smorti, & Tani, 2015; Haigler, Day, & Marshall, 1995; Ma, & Huebner, 2008; Paterson et al., 1994).
Furthermore, during times of adversity, mothers seem to remain available for their children (Kerns, Klepac, & Cole,1996; Lieberman, Doyle, & Markiewicz, 1999). Correspondently, Fitch, Bunston, and Elliot (1999) found that boys of mothers with CMC experienced an improvement in the quality of attachment. Taken together, our results can be explained by the assumption that mothers are the main attachment figure for children from infancy until adolescence. Moreover, it is possible that mothers affected by CMC may have greater concerns regarding the influence of their illness on their children, which in turn, improve the quality of parent attachment.
Our second hypothesis was confirmed only for mothers, who reported an equal quality of attachment to boys and girls. This finding is consistent with the main body of literature, which
concluded that mothers are responsible for parenting their children regardless of their sex (Aldous et al., 1998; Shearer, Crouter, & McHale, 2005). Similar to mothers, fathers’ quality of attachment to boys and girls did not significantly differ. The lack of significance may derive from our small sample size of fathers (30 fathers of 18 boys and 30 girls), which may have influenced our ability to achieve significant results (VanVoorhis & Morgan, 2007). More specifically, according to VanVoorhis et al. (2007), in order to obtain an adequate power, t-tests should include at least 30 subjects in each dyad. Therefore, a larger sample size might have increased the probability to detect sex differences in fathers’ attachment patterns.
Our third hypothesis was partly supported, as parents’ and adolescents’ reports of attachment positively and significantly correlated with each other only when adolescents were girls (i.e. mother-girl, father-girl). In contrast to our prediction, discrepancies in parents’ and adolescents’ reports of attachment were found in parent-boy dyads (i.e. mother-boy, father-boy). Welsh, Galliher, and Powers (1998) suggested that correspondence in perceptions may represent one’s closeness to his/her parents, while discrepancies in perceptions may represent one’s developing autonomy. Based on this notion, as adolescent girls were found to be highly connected to their parents for support and warmth (Gorrese, et al., 2012), one can expect to find similarities between girls’ and parents’ perceptions of attachment. Similar to our findings, Shapiro (2004) found that mother-daughter dyad was the most correspondent one of all, while the father-daughter dyad had a higher correspondence compared to father-son dyad (Shapiro, 2004). According to Shapiro (2004), fathers’ tendency to idealize the relationship with their children in order to promote family cohesion may lead to socially desirable answers, resulting in a higher correspondence between fathers and girls.
In contrast, as adolescent boys exhibit independent behaviors in attempt to develop their autonomy and separation from parents (Feder et al., 2007), one can expect to find discrepancies in parent-boys dyads. According to Steinberg (1988), boys’ distancing behaviors reduce the quality of parent attachment and more specifically, its cohesion. Hence, our results can be accounted for boys’ developing individuality, which may lead to a lower quality of parent attachment, as well as a low correspondence with parents' perceptions. Although discrepancies in parent-child relationships are often adaptive as they contribute to adolescents' developing individuality (Ohannessian et al., 2000), they can also become maladaptive due to a family stressor (Conway, 2011). In the study of Pelton et al. (2001), which examined discrepancies among families with
mothers affected by HIV, results showed bigger discrepancies in mother-child perceptions of relationship compared to healthy mothers, as well as higher levels of adjustment difficulties (Pelton et al., 2001). Hence, within the context of parental illness, it is possible that boys of families affected by CMC are prone to experience higher levels of discrepancies with their parents. These discrepancies, together with parents' tendency to idealize parent-child bond, may account for the lack of congruence found between boys’ and parents’ reports of attachment in our study.
This study has several limitations. First, our study consisted of a low number of fathers, which may have affected our ability to receive significant results. According to Field (2009), a small sample size may negatively affect the validity of the statistical conclusions as it can lead to a type II error, which occurs when a study fails to reveal an effect that exists in reality. Second, for all participants, the quality of parent attachment was measured with self-report questionnaires, which may have bias results due to respondents’ wish to be portrayed in a positive light (Podsakoff, & Organ, 1986). Third, a major limitation in our study derives from not controlling the family cluster effect, which refers to the similarities in responses of subjects from the same family (Sieh, et al., 2012). Not accounting for dependencies between family members might have led to an overestimation of effects. Another major limitation of our study emerges from adolescents’ wide age range (10-20 years), as the quality of parent attachment changes throughout adolescence, depending on adolescents’ age (Choi, Hutchison, Lemberger, & Pope, 2012). That is, a wide age range represents different qualities of parent attachment, making our results less accurate. Lastly, the capability to generalize our conclusions to other cultures may be limited, as the majority of participants in our study were Dutch, and as such, may differ in the quality of parent attachment compared to other cultures (Agishtein & Brumbaugh, 2013).
Taken our limitation into account, future research should consist of a larger sample size of ill fathers, and categorized age range of adolescents in order to get a clearer view on the quality of parent attachment in different phases of adolescence. Moreover, future studies should account for the family cluster effect by using multilevel analyses in order to control for similarities between members of the same family (Sieh et al., 2012). Finally, including a control group of adolescents of healthy families in future studies can enhance the knowledge regarding the effect of parental illnesses, in addition to sex, on the quality of parent attachment.
In conclusion, this study found either moderate or small effects of sex on the perceived quality of parent attachment among families affected by CMC. Our results indicated that
adolescents displayed a higher quality of attachment to mothers compared to fathers, while parents equally evaluated the quality of attachment to boys and girls. In addition, positive associations between adolescents’ and parents’ perceived quality of attachment were significant only in dyads consisting of girls, while discrepancies in reports were found in dyads consisting of boys. Despite the significance of our results, they should be interpreted with caution, as they may not have an effect in reality due to minor differences between adolescents’ scores. Nevertheless, as parent attachment is likely to act as a protective factor in light of parental illness (Sieh et al., 2012), clinicians should target relationships that are characterized with a low quality or correspondence, particularly those of boys with their parents, and integrate them into therapy in order to facilitate a better adjustment. Furthermore, it is possible that family therapy will be effective in raising family cohesion and thus, increase the quality of attachment between its members.
References
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