J Child Fam Stud DOI 10.

1007/s10826-013-9831-1

ORIGINAL PAPER

Aspects of Mothers Parenting: Independent and Specic Relations to Childrens Depression, Anxiety, and Social Anxiety Symptoms
Natalie M. Scanlon Catherine C. Epkins

Springer Science+Business Media New York 2013

Abstract Theories on childrens depression, anxiety, and social anxiety note aspects of parenting such as acceptance/ rejection and behavioral control. Despite these theoretical relations and high rates of comorbidity among childrens internalizing symptoms, no studies have examined multiple aspects of parenting and childrens symptoms of depression, anxiety, and social anxiety simultaneously. We examined mother- and child-reported mothers parenting behaviors (acceptance/rejection and behavioral control) and their combined, independent, and specic relations with childrens depression, anxiety, and social anxiety symptoms in a community sample of 124 motherchild dyads (children 1012 years old). Childrens report of maternal behavioral control was related to mothers report of childrens anxiety problems. Importantly, childrens report of mothers acceptance/rejection was an independent predictor of all three child-reported symptom types, and child- and/or mother-report of maternal acceptance/rejection was an independent predictor of mothers report of childrens anxiety and affective problems. After controlling for anxiety, social anxiety, and both together, childrens perceived maternal acceptance/rejection emerged as a specic and unique predictor of childrens depression symptoms. But, after controlling for depression, parenting behaviors were no longer related to childrens anxiety and social anxiety. Clinical and theoretical implications are discussed, as well as directions for future research. Keywords Childrens depressive symptoms Childrens anxiety Childrens social anxiety
N. M. Scanlon C. C. Epkins (&) Department of Psychology, Texas Tech University, Box 42051, Lubbock, TX 79409-2051, USA e-mail: catherine.epkins@ttu.edu

Maternal acceptance/rejection Maternal behavioral control

Introduction Depression, anxiety, and social anxiety are common psychological symptoms and disorders (American Psychiatric Association 2000; Kessler and Wang 2008) that often begin in childhood (Abela and Hankin 2008; Cartwright-Hatton et al. 2006; Kessler and Wang 2008; Rapee et al. 2009) and are quite impairing (Epkins and Heckler 2011; Muris and Meesters 2002). In addition, these subthreshold symptoms have similar correlates and outcomes as clinical diagnoses (see Epkins and Heckler 2011, for a review of depression and social anxiety symptoms; see Wood et al. (2003), for a review of anxiety symptoms). Importantly, these symptoms and disorders tend to co-occur (Chavira et al. 2004; Seligman and Ollendick 1998). This is especially true for the comorbidity of depression and social anxiety in particular, both for symptoms and disorders of depression and social anxiety (see Crawley et al. 2008; Essau et al. 1999; Viana et al. 2008). In fact, children with comorbid depressive and anxiety disorders, in comparison to anxiety-disordered youth without depression, have been found to have more social anxiety symptoms (ONeil et al. 2010). Aspects of parenting have long been theorized to be related to childrens adjustment, including their depression, anxiety, and social anxiety (see Epkins and Heckler 2011, for a review of depression and social anxiety; see Rapee 2012, for a review of anxiety). There is also substantial empirical support for the relations between parenting and childrens internalizing symptomatology, although few studies have examined aspects of parenting and multiple types of childrens internalizing symptoms simultaneously.

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Given the comorbidity of depression and anxiety, and especially between depression and social anxiety, examining relations between aspects of parenting and only one type of internalizing symptom results in little knowledge about whether various parenting constructs are independently related, or specically and uniquely related, to depression, anxiety, and/or social anxiety. In general, parenting behaviors may be viewed on continuums, one of which stems from PARTheory (Parental Acceptance and Rejection Theory; Rohner and Khaleque 2005) and is the acceptance-rejection continuum. Acceptance (as dened by such terms as warmth and support) lies at the positive end of the continuum, and rejection (as dened primarily by the lack of warmth or support, and criticism) lies at the opposite, negative end of the continuum. A second continuum of parenting behaviors is that of autonomy versus control. Autonomy-granting, on one end of the continuum, is more or less the allowance by parents of childrens age-appropriate freedom while control, on the other end of the continuum, is broadly dened as restriction or the lack of autonomy-granting (Drake and Ginsburg 2012). Theorists have also discussed two types of control; behavioral control and psychological control. Barber (1996) dened both types: Psychological control refers to control attempts that intrude into the psychological and emotional development of the childBehavioral control, in contrast, refers to parental behaviors that attempt to control or manage childrens behavior (p. 3296). Based on this denition, parents who are high in behavioral control attempt to directly control their childrens behavior by making rules and insisting that they are followed (Ballash et al. 2006; McLeod et al. 2007b). Parents who are high in psychological control, on the other hand, attempt to control childrens psychological development and typically do so by means of more covert methods than behavioral control (e.g., shaming, guilt induction, love withdrawal; Soenens and Vansteenkiste 2010). In this way, psychological control has been likened to criticism and a lack of emotional warmth, both of which are more in line with the construct of parental rejection (Settipani et al. 2013). Theoretically, parental rejection is related to childrens internalizing symptomatology, as Soenens and Vansteenkiste (2010) note, it seems likely that children of internally controlling [psychologically controlling or rejecting] parenting are more at risk for internalizing problems. These children would experience an inner conict between complying with their parents requests and pursuing their own personally endorsed goals. This inner conict would result in emotional distress (e.g., anxiety and depression) (p. 83). More specically, early family disruption implicated in interpersonal models of youth depression (Rudolph et al.

2008) include parenting behaviors characterized by less acceptance and more rejection and behavioral control, thereby leading to negative self-evaluations on the part of the child. Khaleque (2012), in fact, explained that all humans need warmth, acceptance, and other positive responses from their primary caregivers. Without these positive responses and interactions, much can go wrong in the childs development that pertains to emotional stability (Rohner 1986/1999). For instance, if children perceive their caregivers to be rejecting and lacking in acceptance, they will likely develop negative thoughts and feelings about themselves and the future, which are symptoms of depression. Negative thoughts about the self are also in line with social anxiety, which involve excessive self-consciousness and worries about being judged harshly by others (American Psychiatric Association 2000). Similar to youth depression, parental rejection and overprotection are also implicated in models of youth social anxiety (Kearney 2005; Rapee and Spence 2004). Moreover, Ollendick and Benoit (2012) have proposed a parentchild interactional model of youth social anxiety which includes parental rejection and overprotection (likely in the form of behavioral control), in addition to less acceptance. Thus, parental rejection and behavioral control are also implicated in models of childrens social anxiety, due to the very selffocused and interpersonal nature of these parenting constructs. As with theories of youth depression and social anxiety, theories of general anxiety have focused on similar aspects of parenting. Ginsburg and Schlossberg (2002), drawing upon past models of youth anxiety, primarily focus on certain anxiety-enhancing parenting behaviors such as over-control (both behavioral and psychological), overprotection, lack of warmth, criticism, and rejection. Clearly, rejection is associated with increased conict in the parentchild relationship, which may lead to a lack of self-competence and self-worth on behalf of the child and therefore more anxiety (Ginsburg and Schlossberg 2002; Rapee 1997). Additionally, the perception of parents as rejecting often leads children to believe that the world is unfriendly, hostile, or dangerous (Rohner 1986/1999), which are symptoms of more general anxiety. Finally, lack of parental warmth (associated with increased rejection) may create disruption and distress in a childs development (Chorpita and Barlow 1998), as well as a lack of support or afliation, both of which may increase a childs level of anxiety (Drake and Ginsburg 2012). However, the consequences of less acceptance and more parental rejection (i.e., lack of self-competence and selfworth; lack of support or afliation) are likely more so related to childrens depression and social anxiety symptoms versus anxiety symptoms more generally. Thus, most

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developmental and theoretical models of youth anxiety focus primarily on parental behavioral control, rather than on acceptance/rejection (Chorpita and Barlow 1998; Drake and Ginsburg 2012; Hudson and Rapee 2009; Rapee 2001). For example, children whose parents assume control over everything likely do not develop a strong sense of mastery or self-efcacy, both of which are related to anxiety (Chorpita and Barlow 1998). Although parental behavioral control may be well-intentioned, it often results in an increased perception of threat and a decreased perception of control on the part of the child. Thus, children learn that many situations are anxiety-provoking and cannot be handled, so their learned response is increased anxiety and avoidance (Hudson and Rapee 2009) rather than mastery and condence (Drake and Ginsburg 2012; Settipani et al. 2013). The implication in many of these theoretical models of youth depression, anxiety, and social anxiety is that it is childrens perceptions of parenting behaviors that have the strongest relations with their overall development (and internalizing symptoms more specically). For the most part, childrens perceptions of parenting behaviors are more salient with regard to relations to internalizing symptoms. Thus, from both a theoretical (Rohner 1986/ 1999) and empirical perspective (Fentz et al. 2011; Greco and Morris 2002; Hale et al. 2006; Khaleque 2012; Khaleque and Rohner 2002a), childrens perceptions of parenting behaviors are important to consider, above and beyond parents report of their own parenting behaviors. Empirically, youth depression has been found to be related to parental acceptance/rejection (Burkhouse et al. 2012; Dallaire et al. 2006; Schwartz et al. 2012; Sheeber et al. 2007). In fact, a meta-analysis (McLeod et al. 2007a) found that the construct of parental rejection (more specically, aversive behaviors and lack of warmth) was most strongly related to childrens depression. However, none of the studies mentioned above controlled for comorbid anxiety or social anxiety symptoms. Likewise, studies have found parental acceptance/ rejection to be related to youth anxiety (Drake and Ginsburg 2011; Ginsburg et al. 2004a; Hale et al. 2006; Hudson et al. 2009; Hudson and Rapee 2001; Siqueland et al. 1996) and social anxiety (Knappe et al. 2012), but none of these studies have controlled for comorbid depression. With regard to parental behavioral control, relations have been found with youth anxiety (Drake and Ginsburg 2011; Ginsburg et al. 2004a; Hudson and Rapee 2001; McLeod et al. 2007b; Muris and Merckelbach 1998; Wood et al. 2003) and social anxiety (Knappe et al. 2012; Rork and Morris 2009; Rubin et al. 1999). Again, however, none of these studies controlled for comorbid depressive symptoms. There is some empirical support for the relation between parental behavioral control and youth depression

(or self-criticism more specically; Koestner et al. 1991), in addition to behavioral control being related to childrens internalizing problems more generally (Mills and Rubin 1998). A few noteworthy studies have examined aspects of parenting and multiple types of internalizing symptoms simultaneously. These studies have had mixed results though, owing somewhat to different methodologies as well as to the investigation of family variables more broadly (Johnson et al. 2005; Starr and Davila 2008) as opposed to behavioral control and acceptance/rejection more specically. In terms of behavioral control, some studies found a signicant relation between childrens anxiety (Beesdo et al. 2010) or social anxiety (Greco and Morris 2002) symptoms and parental behavioral control, even after controlling for comorbid youth depression. Moreover, youth with comorbid depression and anxiety disorders, in comparison to anxiety-disordered youth without depression, have been found to report more family dysfunction in general, but these two groups did not differ on perceptions of parental behavioral control (ONeil et al. 2010). Thus, theoretically and empirically, parental behavioral control seems to hold more specic relations with childrens anxiety versus depression symptoms. In terms of parental acceptance/rejection, some studies have found that signicant relations between acceptance/ rejection and childrens anxiety (Fentz et al. 2011), and social anxiety (Hutcherson and Epkins 2009), become nonsignicant when controlling for depression symptoms. In contrast, some studies found a signicant relation between childrens depression and parental acceptance/rejection, even after controlling for youth anxiety (Beesdo et al. 2010) and social anxiety (Hutcherson and Epkins 2009) symptoms. Therefore, empirically (Greco and Morris 2002; Hutcherson and Epkins 2009), youth social anxiety and general anxiety appear to have similar relations to parental acceptance/rejection. Thus, parental behavioral control and acceptance/rejection seem to be related to childrens depression, anxiety, and social anxiety. However, there seem to be stronger relations between parental acceptance/rejection and youth depression, and between parental behavioral control and youth anxiety. Indeed, in a recent review on youth anxiety, Rapee (2012) stated, Although other parenting styles such as criticism or lack of warmth may also play a role in anxiety, their inuence on anxiety specically has been less consistently established (p. 74). Furthermore, it is also important to examine youth social anxiety because there is some evidence that the parenting constructs of overprotection, rejection, and low warmth are associated with adolescents social anxiety disorder but not other anxiety disorders (Knappe et al. 2012).

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The purpose of this study is to extend past research by examining specic aspects of parenting (acceptance/rejection and behavioral control) and all three types of childrens internalizing symptoms (depression, anxiety, and social anxiety) simultaneously. This will allow for a test of existing theoretical models and an examination of the independent, as well as specic and unique, relations between various aspects of parenting and childrens depression, anxiety, and social anxiety which are currently not well known (see Epkins and Heckler 2011 for a review; Gere et al. 2012). We hypothesized, based on theory and past research, that low acceptance, high rejection, and high behavioral control would be related to increased childrens depression, anxiety, and social anxiety symptoms. With regard to independent relations, we hypothesized that low maternal acceptance/high rejection would be more strongly and independently related to childrens depressive symptoms relative to maternal behavioral control. On the other hand, behavioral control would be more strongly and independently related to childrens anxiety and social anxiety symptoms relative to maternal acceptance/rejection. We include both mother- and child-reports of parenting to assess if childrens perceptions of parenting behaviors are more independently related to their internalizing symptoms (c.f., Khaleque 2012). Importantly, with regard to specic and unique relations, after controlling for depression, we predicted that maternal acceptance/rejection would no longer be related to childrens symptoms of anxiety and social anxiety. But, after controlling for anxiety and social anxiety symptoms, we expected that acceptance/rejection would remain related to childrens depression. We also predicted that maternal behavioral control would no longer be related to childrens depression symptoms after controlling for anxiety and social anxiety, but that behavioral control would remain related to anxiety and social anxiety symptoms after controlling for depression.

SD = .93 years). After Institutional Review Board approval, mothers and children were recruited through community events and activities such as camps, back-toschool events, sports, various seasonal events, etc. Only one child per household was allowed to participate, mothers had to be legal guardians of the children, and the participating children and their mothers were entered into a rafe to win one of ten $15 gift cards. The majority of the children were identied by their mothers as Caucasian (66.9 %), although a substantial percentage (33.1 %) was identied as being of a different ethnicity: Hispanic (17.7 %), Black (10.5 %), Asian (1.6 %), and Other (3.2 %). Using Hollingsteads Index (1975), the majority of families socioeconomic status (SES) levels fell into category 4 (44.1 %) and category 5 (23.2 %), thereby reecting a middle-upper level of SES. According to mother-report, 10.5 % of the children had been diagnosed with a psychological disorder in the past, and 18.5 % had a current diagnosis. With regard to treatment, 22 % of the children had previously been in some type of therapy/counseling (not including medication) and 9 % were at the time of the study. For the mothers, 21 % had been diagnosed with a psychological disorder in the past, and 17 % had a current diagnosis. With regard to treatment, 47 % of the mothers had previously been in some type of therapy/counseling (not including medication) and 10.5 % were at the time of the study. Procedure When permission to recruit at local community events was granted, caregivers (primarily mothers) were approached about participating in the study. If they were interested in participating (or at least agreed to be contacted about participating), mothers provided their name and contact information. Typically, they were telephoned within 1 week of providing their contact information for the study. If they then agreed to participate, they scheduled a time (approximately 1 h) for themselves and their children to complete the measures either at the laboratory or in their home (79.8 % of the motherchild dyads completed the measures in their homes). Procedures were identical in the home and lab settings. Written informed consent from the mothers and assent from the children were obtained prior to participation in the study. Mothers and children independently completed two randomly-ordered packets of measures; one packet contained measures about themselves and the other contained measures about the other (the order of administration of these packets was counterbalanced across child sex).

Method Participants The sample consisted of 124 motherchild dyads (94.4 % biological mothers) from the community. Seven children were not biologically related to their mothers, but all but one of them had lived with their mother for a period of at least 5 years, if not for their entire life. The majority of mothers (72 %) were married, and approximately half of the child participants were girls (50.8 %). Children ranged in age from 10 to 12 years (M age 10.75 years,

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Childrens Symptom Measures Beck Depression Inventory for Youth (BDI-Y) The BDI-Y (Beck et al. 2005) is a commonly-used and well-validated measure that assesses depressive symptoms. The BDI-Y contains 20 items, and responses for each item range from 0 (Never) to 3 (Always), with a higher score reecting more severe depression symptoms. The internal consistency has been found to exceed .90 in a number of samples (Beck et al. 2005; Stapleton et al. 2007). Good testretest reliability (r = .79.92) was demonstrated with a sample of 105 children (ages 718) over a period of 78 days (Beck et al. 2005). Convergent validity has been demonstrated with questionnaire measures as well as diagnostic interviews (Beck et al. 2005; Stapleton et al. 2007). Discriminant validity has also been demonstrated as youth diagnosed with depressive disorders have been found to have higher BDI-Y scores than youth with anxiety disorders, other disorders, and no disorders (Beck et al. 2005; Stapleton et al. 2007). The BDI-Y had good internal consistency in the current sample (a = .93). Beck Anxiety Inventory for Youth (BAI-Y) The BAI-Y (Beck et al. 2005) consists of 20 items that assess childrens fear, worry, and physiological aspects of anxiety. Like the BDI-Y, items are rated on a scale from 0 (Never) to 3 (Always), with a higher score reecting more anxiety symptoms. Good internal consistency (a s ranging from .89 to .91) and 1 week testretest reliabilities (rs ranging from .77 to .93) in 7 to 14-year-old youth have been demonstrated (Beck et al. 2005). Convergent and divergent validity have been demonstrated with questionnaires as well as diagnostic interviews (Beck et al. 2005). The BAI-Y had good internal consistency in the current sample (a = .91). The Social Anxiety Scale for Children-Revised (SASC-R) The SASC-R (La Greca 1999) is a 22-item self-report measure designed for completion by preadolescent children. It is comprised of 18 items (and 4 ller items) that are each rated on a 5-point Likert scale ranging from 1 (not at all) to 5 (all of the time). Adequate convergent validity has been demonstrated between total scores on the SASC-R and the Social Phobia and Anxiety Inventory for Children (SPAI-C), with Pearson correlation coefcients ranging from .63 to .81 (Epkins 2002; Morris and Masia 1998). Divergent validity has also been demonstrated between the two measures (Sanna et al. 2009) with the SASC-R able to distinguish between boys and girls with and without social phobia. Finally, predictive validity has also been

demonstrated for the SASC-R (Reijntjes et al. 2007). Good internal consistency for the SASC-R total score (a = .91) was demonstrated in the current sample. Child Behavior Checklist (CBCL) The CBCL (Achenbach and Rescorla 2001) is completed by parents and it assesses childrens behavioral problems. The DSM-Oriented Affective Problems and Anxiety Problems scales were used in this study. As Achenbach and Rescorla (2001) describe, these scales comprise items that were judged by experts as being very consistent with the respective DSM-IV diagnostic categories. Like the empirically-derived CBCL scales, the CBCL DSM-Oriented scales were also normed on national samples with respect to child age and gender, and T-scores were used in the current study. In demographically-matched referred and nonreferred samples, internal consistency of the Affective and Anxiety Problems scales has been demonstrated (alphas = .82 and .72, respectively), as has 8-day testretest reliability (rs = .84 and .80, respectively; Achenbach and Rescorla 2001). The Affective and Anxiety Problems DSMOriented scales have also been found to: (1) discriminate between referred children and demographically-matched nonreferred children; and (2) be related to interview administered DSM-IV checklists (rs = .63 and .43, respectively) and the presence or absence of professionally assessed clinical diagnoses in each category in a clinical sample (point biserial rs = .39 and .45, respectively; Achenbach and Rescorla 2001). Parenting Measure Parental Acceptance and Rejection/Control Questionnaire (PARQ/Control) The PARQ/Control (Rohner and Khaleque 2005) is comprised of the standard 60-item PARQ, in addition to a 13-item control subscale. Both the Parent PARQ/Control and the Child PARQ/Control forms were used in this study. The standard PARQ yields an overall Total score of parental acceptance/rejection and includes items such as, My mother does not really love me; my mother lets me know I am not wanted. The control subscale yields a separate score and includes items such as, My mother is always telling me how I should behave; my mother believes in having a lot of rules and sticking to them. Each form (i.e., Parent and Child) uses a four-point Likerttype scale, and responses to items range from Almost always true to Almost never true. Total scores on the standard PARQ range from 60 to 240, with lower scores indicating an accepting parenting style, and higher scores indicating a more rejecting style. Scores on the control

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subscale range from 13 to 52, with higher scores reecting more restrictive or strict behavioral control. Meta-analyses and numerous other studies support the reliability, validity, and factor structure of the Child and Parent PARQ in a wide-range of diverse samples (Khaleque and Rohner 2002a, b; Rohner and Khaleque 2005). The Parent PARQ Total Score has acceptable 3-week testretest reliability (r = .84; McGuire and Earls 1993) and internal consistency (alphas ranging from .78 to .90 in diverse samples; Khaleque and Rohner 2002b). The Child PARQ Total Score also has good internal consistency (alphas ranging from .69 to .95) and testretest reliability up to 10 years (Khaleque and Rohner 2002a, b). Both the Parent and Child PARQ Total Scores had good internal consistency in the current study (a = .92, a = .93, respectively). Regarding the Control subscale, adequate internal consistency was demonstrated in a meta-analysis with alphas across the informant versions ranging from .49 to .91, with a weighted mean alpha coefcient of .73 (Rohner and Khaleque 2003). Rohner and Khaleque (2003) also reported alphas on the Child version ranged from .49 to .81 and on the Parent version ranged from .62 to .74; with weighted mean alphas for the Child and Parent versions reported to be .71 and .69, respectively. Construct validity has also been established across ve culturally distinct samples, with factor analyses nding two correlated yet distinct factors: strictness and permissiveness (Rohner and Khaleque 2003). Internal consistency for both the Parent and Child Control subscales in the current study was as = .62 and .67, respectively.

Table 1 Means and standard deviations on mothers and childrens measures Measure M-REJECTION M-CONTROL C-REJECTION C-CONTROL C-DEPRESSION C-ANXIETY C-SOCIAL ANXIETY M-ANXIETY M-AFFECTIVE M 85.38 39.81 94.10 37.60 11.85 (47.93) 16.30 (49.90) 41.94 54.04 54.44 SD 13.36 4.01 22.05 5.54 8.08 (10.41) 9.11 (10.70) 13.74 5.84 6.29 Skewness .64 -.30 1.13 .18 1.06 .81 .63 1.66 1.75 Kurtosis -.07 .20 .97 -.02 .99 .64 .26 2.02 2.87

M-REJECTION = mother report of maternal acceptance/rejection; M-CONTROL = mother report of maternal control; C-REJECTION = child report of maternal acceptance/rejection; C-CONTROL = child report of maternal control; C-DEPRESSION = scores on the BDI-Y; C-ANXIETY = scores on the BAI-Y; C-SOCIAL ANXIETY = scores on the child-reported SASC-R; M-ANXIETY = scores on the Anxiety Problems subscale of the CBCL; M-AFFECTIVE = scores on the Affective Problems subscale of the CBCL

Results Preliminary Analyses Table 1 contains the means, standard deviations, skewness, and kurtosis values for all mother and child measures. Childrens self-reported depression and anxiety T-scores on the BDI-Y and BAI-Y in our sample are consistent with those for community samples, as reported in the instrument manual (Beck et al. 2005). Mothers reports on childrens DSM-Oriented Affective and Anxiety problems on the CBCL were also consistent with T-scores for non-referred samples of boys and girls (Achenbach and Rescorla 2001). Childrens social anxiety on the SASC-R in our sample was similar to other similar-aged school (La Greca 1999; Reijntjes et al. 2007) and community (Epkins 2002) samples. Regarding mothers and childrens overall acceptance/rejection scores on the PARQ, in the US, most scores typically fall between 90 and 110 with youth having higher scores than parents (Rohner and Khaleque 2005). Thus, our

sample is similar to others. Additionally, mothers and childrens scores on the control subscale lie in between moderate control (2739) and rm control (4045; Rohner and Khaleque 2005). Outliers on the measures and subscales were identied, and these scores were set to one unit higher (or lower) than the next highest (or lowest) score in the dataset, as recommended by Tabachnick and Fidell (2007). Additionally, the assumptions of linearity, homoscedasticity, and normality of errors were all examined. On the normal probability plot of the residuals, points fell along the diagonal line and skewness and kurtosis values were all between -3 and 3; thus, the assumption of normality of errors was met. Regarding linearity, scatterplots of the predicted standardized values and actual standardized residuals were examined. This assumption too was met, as most of the points clustered around the imaginary line drawn at zero. Finally, with regard to homoscedasticity, variability in scores for one variable was approximately the same at all values of another variable, as the data met the assumption of normality of errors. This was further supported by examining the scatterplots of predicted standardized values and actual standardized residuals (Tabachnick and Fidell 2007). The correlations among the parenting scales and childrens symptom measures can be found in Table 2. As seen in Table 2, neither mother- nor child-reported maternal behavioral control was signicantly related to either

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J Child Fam Stud Table 2 Correlations among parenting subscales and childrens internalizing symptoms Measure 1. M-REJECTION 2. M-CONTROL 3. C-REJECTION 4. C-CONTROL 5. C-DEPRESSION 6. C-ANXIETY 7. C-SOCIAL ANXIETY 8. M-ANXIETY 9. M-AFFECTIVE 1. .04 .11 .23** .16* .16* .10 .28*** .25** -.09 .05 -.01 -.02 -.01 .04 .01 .28*** .38*** .37*** .27*** .21** .14 .13 .12 .14 .16* .08 .85*** .67*** .13 .20* .72*** .20* .17* .12 .17* .58*** 2. 3. 4. 5. 6. 7. 8. 9.

M-REJECTION = mother report of maternal acceptance/rejection; M-CONTROL = mother report of maternal control; C-REJECTION = child report of maternal acceptance/rejection; C-CONTROL = child report of maternal control; C-DEPRESSION = scores on the BDI-Y; C-ANXIETY = scores on the BAI-Y; C-SOCIAL ANXIETY = scores on the child-reported SASC-R; M-ANXIETY = scores on the Anxiety Problems subscale of the CBCL; M-AFFECTIVE = scores on the Affective Problems subscale of the CBCL * p \ .05; ** p \ .01; *** p \ .001

informants report of childrens symptoms with one important exception: child-reported maternal behavioral control was signicantly related to mother-reported child anxiety problems on the CBCL. In our main analyses, we controlled for potentially important demographic variables that past research nds are often related to childrens internalizing symptoms and parenting behaviors (c.f., Anderson and Mayes 2010; Beck et al. 2005; DeaterDeckard et al. 2011; La Greca 1999). We controlled for childrens race (i.e., Caucasian vs. Non-Caucasian), family SES, childrens sex, treatment status for both children and mothers (i.e., past or current treatment vs. none), and mothers relationship to children (i.e., biological vs. nonbiological). Main Analyses We examined the independent and specic relations of both child- and mother-reported maternal acceptance/ rejection and behavioral control to each of childrens depression, anxiety and social anxiety symptoms, both before and after controlling for comorbid symptoms. Hierarchical multiple regression analyses were conducted where control variables (childrens sex, ethnicity, relationship to mother, family SES, and both child and mother therapy status) were entered in step one. Then, the four parenting constructs were entered simultaneously in step two. In controlling for comorbid symptoms, the comorbid symptoms were entered in step two and the parenting constructs simultaneously entered in step three. We examine statistical signicance and report effect sizes regarding the magnitude of signicant unique relations; with sr2 of .01, .09, and .25 indicating small, medium, and large effect sizes (Cohen et al. 2003).

Childrens Self-Reported Symptoms As shown in Table 3, after entering the six control variables in step one, when considered together in step two, aspects of mothers parenting were related to childrens depression symptoms, and only child-reported maternal acceptance/ rejection was an independent predictor (sr2 = .14, a medium effect size). Likewise, regarding childrens anxiety, when considered together in step two, aspects of mothers parenting were related to childrens anxiety, and only childreported maternal acceptance/rejection was an independent predictor (sr2 = .11, a medium effect size; see Table 3). For the regression on social anxiety, in step 2, aspects of mothers parenting considered simultaneously were not, as a group, signicantly related to childrens social anxiety, yet child-reported maternal acceptance/rejection was an independent predictor of social anxiety in the nal model (sr2 = .04, a small to medium effect size). In all three regressions, race was a signicant control variable, with non-Caucasian children reporting more internalizing symptoms than Caucasian children. After considering the effects of the six control variables, the four parenting variables collectively accounted for an additional 17, 13, and 6 % of the variance in childrens selfreported depression, anxiety, and social anxiety symptoms, respectively. Importantly, more child-reported maternal rejection was signicantly and independently associated with children self-reporting more depression, anxiety, and social anxiety symptoms, with larger effect sizes for childrens depression and anxiety (sr2 = .14 and .11, respectively) compared to childrens social anxiety (sr2 = .04). Neither child-perceived nor mother-reported maternal behavioral control emerged as a signicant or independent predictor of childrens self-reported symptoms, and these

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J Child Fam Stud Table 3 Hierarchical regressions examining parenting behaviors predicting childrens report of depression, anxiety, and social anxiety Predictor Depression R Step 1 Child treatment Mother treatment Relationship Child race Child sex SES Step 2 M-REJECTION C-REJECTION M-CONTROL C-CONTROL .24 .17 6.15*** .06 .41*** .01 .05 .14
2

Anxiety DF 1.55 .06 -.02 -.07 .27** -.05 .04 .21 .13 4.72*** .07 .36*** -.03 .03 .11 .05 b sr
2

Social anxiety
2

DR .07

DR .08

DF 1.65

sr

R2 .12

DR2 .12

DF 2.50*

sr2

.07

.08

-.01 -.02 .02 .29** -.05 .02 .17 .06 2.01 .06

-.12 .04 -.04 .33** -.14 -.01 .03 .22* -.03 .08 .04 .08

Betas reported are at the step in which the variable was entered. Child/mother treatment = treatment status (past or current treatment vs. none); relationship = mothers relationship to children (biological vs. non-biological); child race = Caucasian versus non-Caucasian; SES = socioeconomic status of family; M-REJECTION = mother report of maternal acceptance/rejection; C-REJECTION = child report of maternal acceptance/rejection; M-CONTROL = mother report of maternal control; C-CONTROL = child report of maternal control * p \ .05; ** p \ .01; *** p \ .001

parenting constructs did not contribute much to the regressions. Childrens Self-Reported Symptoms, Controlling for Comorbid Symptoms Table 4 presents the above results after also controlling for comorbid symptoms in step 2. With regard to childrens depression, after controlling for childrens anxiety in step 2, aspects of mothers parenting considered simultaneously were not, as a group, signicantly related to childrens depression in step 3, yet child-reported maternal acceptance/rejection remained a specic and unique predictor of childrens depression in the nal model (sr2 = .01, a small effect size). After controlling for childrens social anxiety in step 2, when considered together in step three, aspects of mothers parenting were signicantly related to childrens depression, and only child-reported maternal acceptance/ rejection was a specic and unique predictor (sr2 = .06, a small to medium effect size). After controlling for both childrens anxiety and social anxiety in step 2, childreported maternal rejection remained a specic and unique predictor in the nal model (sr2 = .01, a small effect size). Thus, more child-reported maternal rejection was specically and uniquely related to children reporting more depressive symptoms after controlling for demographic variables and their anxiety (sr2 = .01), their social anxiety (sr2 = .06) and both their anxiety and social anxiety (sr2 = .01).

As anticipated, a different pattern emerged on anxiety and social anxiety, as seen in Table 4. After controlling for childrens depressive symptoms in step 2, the parenting variables collectively were, as a group, not related to childrens anxiety or to their social anxiety (both DR2 = .00). Moreover, none of the four parenting variables (including behavioral control) were specic or unique predictors of childrens anxiety or social anxiety after controlling for childrens depression symptoms in the nal models (see Table 4). Mother-Reported Childrens Affective and Anxiety Problems Similar analyses were conducted on mother-reported child affective and anxiety problems on the CBCL. After controlling for the six relevant demographic variables, the four parenting constructs considered together were not signicantly, as a group, related to mother-reported child affective problems in step 2, yet mother-reported maternal acceptance/rejection was an independent predictor in the nal model (sr2 = .04, a small to medium effect; see Table 5). After controlling for mother-reported child anxiety problems in step 2, the parenting constructs considered as a group in step 3 were not signicantly related to mother-reported child affective problems, and no parenting variables were found to be specic or unique predictors (see Table 5). With regard to mother-reported child anxiety problems on the CBCL, as seen in Table 5, child treatment was a

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J Child Fam Stud Table 4 Hierarchical regression analyses examining parenting behaviors predicting childrens report of depression, anxiety, and social anxiety (controlling for comorbid symptoms) Predictor Depression (controlling for anxiety) R Step 1 Child treatment Mother treatment Relationship Child race Child sex SES Step 2 Anxiety Step 3 M-REJECTION C-REJECTION M-CONTROL C-CONTROL Predictor .70 .02 1.49 .00 .14* .03 .03 Depression (controlling for social anxiety) R Step 1 Child treatment Mother treatment Relationship Child race Child sex SES Step 2 Social anxiety Step 3 M-REJECTION C-REJECTION M-CONTROL C-CONTROL .54 .07 4.09** .04 .28*** .03 .00 .06 .48 .40 88.27*** .67*** .40
2 2

Predictor sr
2

Anxiety (controlling for depression) R2 D R2 .08 DF 1.65 -.01 -.02 .02 .29** -.05 .02 .69 .69 .61 .00 225.79*** .81*** .26 .03 .03 -.04 -.01 Social anxiety (controlling for depression) R2 D R2 .12 DF 2.50* -.12 .04 -.04 .33** -.14 .01 .50 .50 .38 .00 88.27*** .64*** .23 .00 -.06 -.04 .05 .38 .08 b sr2 .61 .06 b sr2

DR .07

DF 1.55

.07

Step 1 .06 -.02 -.07 .27** -.05 .04 .05 Child treatment Mother treatment Relationship Child race Child sex SES Step 2 .61 Depression Step 3 M-REJECTION .01 C-REJECTION M-CONTROL C-CONTROL Predictor sr
2

.08

.69

.61

225.79*** .82***

DR .07

DF 1.55

.07

Step 1 .06 -.02 -.07 .27** -.05 .04 .05 Child treatment Mother treatment Relationship Child race Child sex SES Step 2 Depression Step 3 M-REJECTION C-REJECTION M-CONTROL C-CONTROL

.12

Betas reported are at the step in which the variable was entered. Child/mother treatment = treatment status (past or current treatment vs. none); relationship = mothers relationship to children (biological vs. non-biological); child race = Caucasian versus non-Caucasian; SES = socioeconomic status of family; M-REJECTION = mother report of maternal acceptance/rejection; C-REJECTION = child report of maternal acceptance/rejection; M-CONTROL = mother report of maternal control; C-CONTROL = child report of maternal control * p \ .05; ** p \ .01; *** p \ .001

signicant control variable, with mothers reporting more anxiety problems for children with past or current (vs. no) treatment. The four parenting variables considered together in step 2 were signicantly related to childrens anxiety problems, and both child- and mother-reported maternal acceptance/rejection were independent predictors (sr2 = .03 and .04, respectively; both small to medium effect sizes). Here, more child- and mother-reported maternal rejection were signicantly associated with mothers reporting more anxiety problems in children. However, after controlling for

mother-reported child affective problems in step 2, the parenting constructs considered simultaneously in step 3 were not signicantly related to mother-reported child anxiety problems, and no parenting variables were specic or unique predictors. Finally, it is important to note that although childreported maternal behavioral control was signicantly correlated with mothers reporting more anxiety problems in children (reported above), maternal behavioral control (according to either mother- or child-report) did not emerge as an independent (much less a specic or unique) predictor

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J Child Fam Stud Table 5 Hierarchical regression analyses examining parenting behaviors predicting mothers report of childrens affective and anxiety problems (including controlling for comorbid symptoms) Predictor Affective problems R Step 1 Child treatment Mother treatment Relationship Child race Child sex SES Step 2 M-REJECTION C-REJECTION M-CONTROL C-CONTROL Predictor .11 .06 1.81 .23* .13 .02 -.04 Affective problems (controlling for anxiety problems) R Step 1 Step 2 Comorbid problems Step 3 M-REJECTION C-REJECTION M-CONTROL C-CONTROL .35 .01 .51 .12 .03 -.01 -.05
2 2

Anxiety problems DF 1.05 .17 .08 .02 -.01 .04 -.06 .20 .04 .08 2.67* .21* .19* .06 .03 Anxiety problems (controlling for affective problems) R2 .13 .39 .57*** .28 .41 .03 1.33 .10 .12 .05 .05 D R2 .13 .26 DF 2.80* 48.56*** .52*** .26 b sr2 .04 .03 b sr
2

DR .05

R2 .13

D R2 .13

DF 2.80*

sr2

.05

.24* .17 .02 .04 .03 -.02

.05

DR .05 .28

DF 1.05 48.56***

sr

.05 .33

Betas reported are at the step in which the variable was entered. Child/mother treatment = treatment status (past or current treatment versus none); relationship = mothers relationship to children (biological vs. non-biological); child race = Caucasian versus non-Caucasian; SES = socioeconomic status of family; M-REJECTION = mother report of maternal acceptance/rejection; C-REJECTION = child report of maternal acceptance/rejection; M-CONTROL = mother report of maternal control; C-CONTROL = child report of maternal control * p \ .05; ** p \ .01; *** p \ .001

of childrens anxiety problems in the regression analyses, and behavioral control did not contribute much to the regressions.

Discussion Although aspects of parenting have long been theoretically and empirically linked to childrens internalizing symptoms (Epkins and Heckler 2011; Rapee 2012), few studies have examined multiple types of internalizing symptoms or multiple aspects of parenting in the same study. No studies have examined multiple aspects of parenting and childrens symptoms of depression, anxiety, and social anxiety in the same study, despite similar parenting constructs noted in theoretical models for all three of these symptoms and high rates of comorbidity (Chavira et al. 2004; Seligman and Ollendick 1998), especially among depression and social

anxiety (Crawley et al. 2008; Essau et al. 1999; ONeil et al. 2010; Viana et al. 2008). This results in little knowledge about the specicity of various aspects of parenting to depression, anxiety, and social anxiety. We extended past research by examining the independent, as well as specic and unique, relations among aspects of mothers parenting behaviors (as assessed by both motherand child-report) and all three types of childrens internalizing symptoms. Consistent with theories of depression (Rudolph et al. 2008), anxiety (Ginsburg and Schlossberg 2002), and social anxiety (Ollendick and Benoit 2012), we found that childrens perceived maternal acceptance/rejection was related to each of childrens self-reported symptoms of depression, anxiety, and social anxiety; and mother-reported acceptance/rejection was related to childrens selfreported depression and anxiety. Additionally, mothers report of acceptance/rejection was related to mothers

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report of childrens affective problems, and both mothers and childrens report of acceptance/rejection was related to mothers report of childrens anxiety problems. Furthermore, childrens report of behavioral control was related to mothers report of childrens anxiety problems, although behavioral control was neither an independent nor a specic predictor of childrens depression, anxiety, or social anxiety symptoms. In some respects, our ndings on behavioral control are inconsistent with previous research (Chorpita and Barlow 1998; Drake and Ginsburg 2012; Ginsburg and Schlossberg 2002; Hudson and Rapee 2009; Rapee 2001) that includes parental behavioral control in models of childrens anxiety. However, it is also important to consider that there was only one measure of this construct. Although the control subscale of the PARQ/Control has demonstrated good reliability and validity, recent studies (Settipani et al. 2013; Soenens and Vansteenkiste 2010) have pointed to the difculty of measuring this construct and differentiating it from psychological control (which is more akin to parental rejection). A recent study that looked at both behavioral and psychological control actually found a stronger relation between childrens anxiety symptoms and parental psychological control versus behavioral control (Wijsbroek et al. 2011). Future studies would therefore benet from incorporating other measures of behavioral control, including other selfreport measures as well as observations and interviews. Finally, it is also possible that parental behavioral control simply is not an independent or specic predictor of childrens anxiety (Gere et al. 2012), but future studies on anxiety and other comorbid symptoms are needed regarding behavioral control and childrens internalizing symptoms. In line with the few empirical studies that have investigated various parenting constructs in relation to multiple youth internalizing symptoms (Beesdo et al. 2010; Hutcherson and Epkins 2009), we found support for the construct of maternal acceptance/rejection being independently, as well as specically and uniquely, related to childrens depression symptoms. We even extended past work by controlling for comorbid symptoms of anxiety, social anxiety, and both anxiety and social anxiety symptoms together, and childrens perceived maternal rejection remained signicantly related to childrens self-reported depression symptoms. Also in line with past studies (Fentz et al. 2011; Hutcherson and Epkins 2009), the relations between childrens perceived maternal rejection and childrens self-reported symptoms of anxiety and social anxiety became non-signicant when controlling for childrens comorbid depression symptoms. Additional theoretical implications may be gleaned from the current study. For example, the construct of maternal rejection (akin to maternal psychological control; Soenens and Vansteenkiste 2010) was related to all three types of

internalizing symptoms in children but more so to depression and anxiety, rather than social anxiety. Thus, relations between parental acceptance/rejection and childrens social anxiety may only emerge when children also have comorbid depression. Similarly, aspects of parenting (as a group) did show relations with childrens self-reported depression and anxiety, as well as mothers report of childrens anxiety problems, but those relations may only be implicated in models of childrens social anxiety if there are comorbid depression symptoms. It is important to note here that although child-reported maternal behavioral control was related to mothers report of childrens anxiety problems, behavioral control did not contribute much to parenting in the regression analyses. Important clinical implications may also be gleaned from the current study. An improved understanding of the independent, as well as specic and unique relations, between various aspects of parenting and childrens depression, anxiety, and social anxiety symptoms would help inform childrens treatment. A recent review of eleven randomized controlled trials found mixed results for the efcacy of parenting components in treatments for childrens anxiety (Breinholst et al. 2012). However, the authors note that one explanation for these mixed results is that treatments are not including the parenting constructs most relevant to childrens symptoms (e.g., acceptance/ rejection as demonstrated in the current study), so more research is needed to identify the specic aspects of parenting that should be targeted. Furthermore, even if various aspects of parenting are not strongly related to childrens internalizing symptoms (McLeod et al. 2007a, b), they may still be relevant to childrens treatment outcome and eventual symptom reduction. For example, Festen et al. (2013) sought to examine the parenting constructs that might predict treatment outcome for anxiety-disordered youth. They found that less perceived maternal warmth (assessed pre-treatment) was related to a less favorable treatment outcome for anxious youth. Therefore, even if certain parenting constructs (e.g., behavioral control) do not seem to be directly related to childrens internalizing symptoms, they may play a key role in childrens treatment outcomes. We must recognize the potential limitations of the current study. As mentioned above with regard to the construct of behavioral control, we relied solely on self-report measures for all of the symptoms and parenting constructs, and we found that childrens report of aspects of parenting were primarily related to their self-reported symptoms. On the one hand, this is an important nding as it indicates that childrens perceptions of parenting behaviors (particularly acceptance/rejection) are more independently related to their internalizing symptoms, relative to mothers report of parenting behaviors (Fentz et al. 2011; Festen et al. 2013;

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Greco and Morris 2002; Hale et al. 2006; Khaleque 2012; Khaleque and Rohner 2002a). However, by not including other methods of measurement (e.g., observations, interviews, etc.), we may have had inaccurate self-reports of negative parenting behaviors (which can often happen, particularly with mothers; Rohner and Khaleque 2005) and of childrens symptoms. Thus, future studies should include more observational measures in addition to others reports such as those of fathers and other primary caregivers whose parenting behaviors have a substantial impact gels and Perotti 2011; Greco and Morris on children (Bo 2002). The oversimplied classication of childrens race (Caucasian vs. all others) is also a limitation of the current study. Different racial and ethnic groups might experience and display symptoms and parenting behaviors differently (Deater-Deckard et al. 2011; Stewart et al. 2012), so by including race as merely Caucasian versus all others, these important differences are collapsed and minimized. Additionally, although we controlled for current and past treatment status for both mothers and children, we failed to control for mothers psychopathology. This is an important variable to consider when examining childrens internalizing symptomatology, as it is implicated in theoretical models of depression, anxiety, and social anxiety and has been found to be directly related to childrens symptoms or, at the very least, interacting with other environmental factors (such as parenting) related to childrens symptoms (see Drake and Ginsburg 2012; Epkins and Heckler 2011, for a review). Our sample size also precluded analysis of any gender differences, though we recognized child sex as an important demographic variable and controlled for it in the main analyses. Thus, the examination of racial/ethnic differences, sex differences, and the inclusion of parental psychopathology are all important avenues for future research in this area. Community children were sampled, and future studies might examine similar questions in clinical samples where stronger relations between parenting constructs and childrens internalizing symptoms might emerge. Finally, long-term prospective studies (ideally with more observational measures) are needed to assess the relations among various aspects of parenting (i.e., acceptance/rejection, behavioral control, and others) and childrens symptoms of depression, anxiety and social anxiety over time. Indeed, stemming from interpersonal and self-determination theories (Rudolph et al. 2008; Soenens and Vansteenkiste 2010) as well as Rapees (2001) developmental model of anxiety, there is some empirical support for reciprocal or bidirectional relations between aspects of parenting and childrens depression (Branje et al. 2010; Hipwell et al. 2008), anxiety (Ginsburg et al. 2004b; Hudson et al. 2009; Settipani et al. 2013; Silverman et al. 2009; Wijsbroek et al. 2011),

and social anxiety (Van Zalk and Kerr 2011). Thus, future longitudinal studies would allow for the elucidation of parenting constructs as antecedents, correlates, or consequences of childrens symptoms. In addition to parenting constructs, theoretical models of childrens internalizing symptoms have also implicated certain biological vulnerabilities such as genetics or temperamental factors, in addition to other psychosocial vulnerabilities such as various learning experiences and peer victimization. Some studies have found these to be moderators of the relation between parenting constructs and childrens internalizing symptoms (see Epkins and Heckler 2011, for a review; Kiff et al. 2011). Our results, nonetheless, indicate that perceived maternal rejection is related to childrens self-reported depression, anxiety, and social anxiety symptoms (more so to depression and anxiety). Furthermore, mothers report of rejection was related to mothers report of childrens affective problems, and both mothers and childrens report of rejection was related to mothers report of childrens anxiety problems. Importantly, childrens perceived maternal rejection remained a specic and unique predictor of childrens selfreported depressive symptoms after controlling for comorbid symptoms. Thus, the construct of perceived parental acceptance/rejection is an important one to consider in treatments for childrens depression. Finally, although childrens report of maternal behavioral control was related to mothers report of childrens anxiety problems, behavioral control was neither an independent nor a specic predictor of childrens internalizing symptoms. Behavioral control may possibly be an important aspect of parenting to consider, particularly in treatments for childrens anxiety, but more research employing different methods and methodologies should be conducted in order to fully elucidate this construct with respect to childrens internalizing symptoms.
Acknowledgments This paper is based, in part, on the masters-level research project of the rst author, directed by the second author. We thank David Heckler, Matt Carroll, Shannon Kelly, and Jessica Clark for assistance with data collection and data management.

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