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Why My Child?: Parental

Attributions for Children's
Special Needs1
Article in Journal of Applied Social Psychology July 2006

DOI: 10.1111/j.1559-1816.1999.tb02039.x
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Why My Child?:
Parental Attributions for Childrens Special Needs1
KRISTIN D. MICKELSON~ MINHNOI

WROBLE
Department of Health Care Policy Universiw of Pittsburgh
Harvard Medical School
VICKI s.
HELGESON
Carnegie Mellon Universiw
Although research exists on how attributions for traumatic life events are related to adjust-
ment, little has focused on parents attributions for their childrens special needs. Parents
were interviewed twice over 1 year about their attributions for their childrens special
needs. We used parents open-ended responses during the initial interview to construct a
ratings survey for the second interview. Parents of children with Downs syndrome made
attributions to genetic fluke, age, and fate/Gods will; parents of autistic children made
attributions to heredity and environment; parents of developmentally delayed children
made attributions to medical problems and stress during pregnancy. Self-blame attribu-
tions and attributions to the environment were related to worse adjustment, whereas attri-
butions to fatelGods will were related to better adjustment. Implications for family
interventions and physicians are discussed.
Receiving news that an infant or child has a cognitive disability often leads
parents to ask Why my child? This questioning triggers a search for meaning,
either in terms of what caused the disability or a reason for why it happened to
them in particular (Taylor, 1983). However, for nearly one third of children with
cognitive disabilities, there is no clear etiological reason for the disability
(Marsh, 1992). This uncertainty intensifies the search for a cause because peo-
ple have a difficult time accepting that no reason exists for a traumatic event.
Causal explanations, or attributions, provide a feeling of control and make the
world seem less random (Janoff-Bulman & Wortman, 1977). Parents may con-
struct their own causal attributions in order to make sense of the event. The
question then becomes which, if any, attributions are beneficial for a parents
adjustment.
Preparation of this article was supported by a National institute of Mental Health Training Grant
(T32-MH16806). We thank Chris Davis for his comments on an earlier draft.
Xorrespondence concerning this article should be addressed to Kristin D. Mickelson, who i s
now at the Department of Psychology, Kent State University, P.O. Box 5190, Kent, OH 44242-0001.
e-mail: kmickels@kent.edu.
1263
Journal of Applied Social Psychology, 1999,29,6,pp. 1263-1292

Copyright 0 1999 by V. H.Winston & S o n , Inc. All rights reserved.
1264 MICKELSON ET AL.
Although the literature on finding meaning in traumatic life events is quite

expansive (see Park & Folkman, 1997, for a review), not much exists on parental
attributions for childrens illnesses or special needs. This lack of research is sur-
prising, given that approximately 1 in every 100 parents has a child with some
type of cognitive delay.3 An understanding of these parents attributions and their
relation to adjustment could have important implications for interventions aimed
at improving family adaptation and functioning, as well as for the way physicians
respond to parents and their questions.
The primary purpose of the present study is to describe the causal attributions
made by parents of special-needs children. Because the particular type of special
needs may affect the nature of the attributions, we examine differences in the
attributions made by parents of children with various diagnoses. We also exam-
ine the relation of these attributions to parents adjustment. Finally, we examine
whether physician explanations are related to parents personal explanations for
their childrens special needs.
Diagnostic Differences in Attributions
Childhood cognitive disabilities in the general category of mental retardation

originate from biological and psychosocial problems during the prenatal and
early postnatal periods of development. Approximately one quarter of all cogni-
tive disabilities in children result from a biological interaction or abnormality
(Marsh, 1992). Other factors associated with cognitive disabilities in children
include nutrition, heredity, childhood diseases, environmental factors, embryonic
development alterations, and problems during pregnancy or birth (Marsh, 1992).
However, one third of these disabilities lack a clear etiological basis (Marsh,
1992). This uncertainty as to a specific cause gives parents a tremendous amount
of latitude to speculate about the reason for their childrens disability. Parents can
attribute the special needs to a variety of factors, including heredity, genetic
fluke, their age at conception, stress, their behavior during pregnancy, the envi-
ronment, or fateGods will.
In the present study, we compare attributions for three types of special needs:
Downs syndrome, autism, and developmental delays. The amount of informa-
tion available concerning the causes of these three diagnoses varies. Downs
syndrome, the most common condition associated with mental retardation
(Marsh, 1992), stems from genetic abnormalities during cellular divisions in the
early stages of development. Though the source of Downs syndrome is known,
3This estimate is based on the prevalence rates for mental retardation found in the American Psy-
chiatric Associations Diagnostic and Statistical Manual of Mental Disorders (4th ed.. 1994). However,
different rates are reported based on different definitions of mental retardation, methods of data collec-
tion, and populations studied. We chose the more conservative estimate; for instance, if we defined
mental retardation as a learning disorder, the estimates range from 2% to 10% in the population.
WHY MY CHILD? 1265
triggers for the initial malfunction during chromosomal division are relatively
obscure. One known risk factor is parents age at conception (Baumeister &
Baumeister, 1995; Campbell, 1987). Therefore, we predict that parents of chil-
dren with Downs syndrome will be most likely to make attributions to genetic
fluke or age at conception.
Unlike Downs syndrome, the cause of autism remains largely speculative.
Possible links have been suggested in recent literature between autism and expo-
sure to plastics manufacturing or other environmental toxins (Jensen, 1994),
obstetric or neonatal complications (Goodman, 1990), and a history of family
affective disorder (DeLong & Nohria, 1994). Although evidence suggests that
these variables may have a relation to autism, no direct causal links have been
established, and most physicians maintain that there is no known cause of autism.
Consequently, we cautiously predict that parents of children with autism will
make attributions to the environment and heredity.
Diagnosis of developmental delays requires a child to show significant defi-
cits in one or more developmental areas, such as language, social skills, or motor
development (Johnson, 1995). The causes of developmental delays tend to be
multiple; however, commonly cited factors include trauma during pregnancy,
birth, or infancy (Johnson, 1995). For example, there is a correlation between
developmental delays and drinking and smoking during pregnancy, lack of oxy-
gen at birth, failure to thrive, and abuse or neglect during infancy (Silver, 1991).
Thus, we predict that parents of children with developmental delays will be most
likely to make attributions to trauma during birth or infancy and behavior during
pregnancy or infancy.
To summarize, because knowledge of causality for the three diagnoses differs
greatly, parents attributions should differ according to the depth of causal under-
standing in the scientific community. For Downs syndrome, the mechanism pro-
ducing the disability is known (genetic abnormalities during cellular division),
but the reasons for its occurrence are still in question. We predict that parents of
children with Downs syndrome will make more attributions to genetic fluke and
age at conception than will other parents. We predict that parents of children with
autism will make more attributions to heredity and environment than will other
parents. Finally, for developmental delays, we predict that parents will make
more attributions to pre- or postnatal trauma or behaviors than will other parents.
Relation of Attributions to Adjustment
Discovering that a child has cognitive delays often is an unexpected and stress-
ful event for parents. As mentioned earlier, this discovery is further aggravated by
the uncertainty associated with the cause of the delays. Wong and Weiner (198 1)
found that following an unexpected, negative event, individuals generally engage
in an attributional search for a cause. Causal attributions may serve a protective
function, especially when there is a potential for recurrence of the event (Wong &
Weiner, 1981). Attributions of causality can reestablish control over an unexpected
situation (Kelley, 1967) and improve adaptational outcomes through perceived
control over recurrence (Janoff-Bulman, 1979; Tennen, Affleck, & Gershman,
1986). For parents of special-needs children, causal attributions may assure par-
ents that future children will be normal (Eiser, Havermans, & Eiser, 1995).
However, not all attributions are associated with a decrease in distress. In
general, the research on attributions and adjustment has been highly inconsistent.
Originally, external attributions (attributions to the situation, environment, or
another person) were predicted to be associated with better adjustment to trau-
matic events (e.g., less depression, distress, or anxiety) than internal attributions
(attributions to the self; see Mineka, Pury, & Luten, 1995, and Robins & Hayes,
1995, for reviews). For instance, among parents of children with cancer,
Bearison, Sadow, Granowetter, and Winkel (1993) found that parents who made
external attributions for the cause of their childrens cancer coped better (i.e.,
used more positive types of coping strategies, such as humor and seeking sup-
port, than negative types of strategies, such as denial and ruminating) than did
parents who made internal or no attributions. James and Kristiansen ( 1 995) found
that women who attributed the cause of their miscarriage to internal factors used
less adaptive coping strategies, such as self-criticism and withdrawal, and
adjusted worse to the miscarriage (as assessed on a composite index of stress,
depression, anxiety, and mood) than did women who made external attributions
to fate or Gods will. Researchers have argued that internal attributions are less
adaptive because of the self-blame associated with them (Kiecolt-Glaser & Will-
iams, 1987; Klonoff & Landrine, 1994; Weiner, 1985).
However, other studies have found that behavioral self-blame is related to
better coping than blaming others (e.g., Janoff-Bulman & Wortman, 1977) and
that other-blame attributions, in general, are related to mood disturbances
(Affleck, Allen, McGrade, & McQueeney, 1982; Affleck, McGrade, Allen, &
McQueeney, 1985) and impairments in emotional well-being and physical health
(Shapp, Thurman, & DuCette, 1992; see Tennen & Affleck, 1990, for a review).
And, in a final twist, Vieyra, Tennen, Affleck, Allen, and McCann (1 990) found
that both internal and external attributions were related to more distress (assessed
with the global symptom index [GSI] of distress), while Taylor, Lichtman, and
Wood (1984) found neither internal nor external attributions were related to a
combined measure of adjustment (i.e., self-reported adjustment, interviewers
ratings, and physicians ratings).
The inconsistency of these results may be related to the variety of stressors
examined. In other words, internal attributions may be more beneficial to
adjustment for some stressors, whereas external attributions may be more benefi-
cial for other stressors. Alternatively, research may be focusing on the wrong
dimension of attributions. Brown and Siege1 (1988) found that the controllability
WHY MY CHILD? 1267
dimension of attributions is more informative for understanding the link between

attributions and depression than is the internal/external dimension. However,
because it seems to be central to so much of the attribution research, we primarily
examine the internal/external dimension of attributions and its relation to adjust-
ment. Nevertheless, in view of the inconsistency of prior research, we do not
make specific predictions about whether external versus internal attributions
would be related to better adjustment.
Another limitation of prior research on attributions and adjustment is that
much of it is cross-sectional. Therefore, it is unclear whether attributions influ-
ence adjustment or whether adjustment influences the choice of causal attribu-
tions. Because our study is longitudinal, we are able to explore the causal relation
between attributions and adjustment. Adjustment is measured as perceived
stigma of having a special-needs child and depression. While depression is a
common adjustment outcome in attribution research, perceived stigma has not
been used previously as a measure of adjustment. However, we view perceived
stigma as a measure of the parents acceptance of the childs special needs and,
thus, a highly relevant adaptational outcome.
Physician Versus Personal Explanations
Beyond the possible diagnostic differences in causal attributions, other expla-

nations, particularly those provided by a physician, may affect parents personal
explanations about the cause of the special needs. Bearison et al. (1993) found
that even though parents of children with cancer were told by physicians that the
cause was unknown, 70% of parents still attributed their childrens cancer to a
specific cause. Others have found that even when an explanation is offered by
physicians, parents often develop their own secondary explanations (Dunn,
Clinton-Goldbach, Lasker, & Toedter, 1991). Among parents who miscarried,
Dunn et al. (1991) found that parents secondary explanations were more likely
to focus on fate and blaming the mother, compared to their primary explanations
which closely adhered to the physicians explanation.
In the present study, we examine whether receiving a physicians explanation
was related to parents having their own personal explanations. We also examine
the content of physicians and parents explanations to determine whether par-
ents explanations are similar to physicians, or whether parental explanations
focus more on fate or blaming the mother. Furthermore, we predict that receiving
an explanation from a physician should vary according to the scientific informa-
tion available for the three disabilities. Parents of children with Downs syn-
drome and developmental delays should be more likely to receive an explanation
from their physicians than should parents of children with autism. Finally,
because causal attributions have rarely been examined in light of physician
explanations, we explore the relation of physicians explanations to parents
desire for and agreement and satisfaction with the medical explanations. This
information will be crucial in developing effective interventions and counseling
for parents of special-needs children.
Method
Parents were recruited through local community health organizations and

from electronic bulletin boards on the Internet, and were interviewed twice over a
1-year period. During the initial telephone interview, we asked parents to identify
the cause of their childrens special needs. The responses to this open-ended
question were used to develop a set of 17 closed-ended responses. In the follow-
up questionnaire (12 months later), parents rated each of the 17 causes on a 5-
point Likert scale ranging from 1 (did not contribute at all) to 5 (contributed a
lot). At both time points, adjustment was assessed with measures of depressive
symptomatology and perceived stigma.
Participants
A total of 109 parents (77 women, 32 men) participated in the initial inter-
view. Of these parents, 76 (69.7%; 55 women, 21 men) completed the 1-year fol-
low-up survey. Parents who completed the follow-up survey differed from those
who did not in two ways: (a) they were more educated, and (b) they reported less
depression and less perceived stigma in the initial interview than those who did
not participate in the follow-up.
Eligibility for participation required that a parent have a child between birth
and 7 years of age at the initial interview, with a diagnosis of mental retardation,
autism, or developmental delays. In order to obtain independent data, only one
parent of each child was interviewed. Except for two individuals, all parents had
just one child with one of the above diagnoses. Of the two other parents, one had
triplets with autism ( 1 girl and 2 boys), and the other had identical twins and an
older child diagnosed with autism (all 3 children were boys). Except for one
adopted child, all children were the biological offspring of the parents.
The majority of parents were married or living with a partner (94%, n = 102),
only 3% ( n = 3) were divorced, and 4% ( n = 4)were single. The majority of par-
ents were Caucasian (90%, n = 98), 6% ( n = 7) were African American, 2% ( n =
2) were Hispanic, and 2% ( n = 2 ) were Asian American. The majority of parents
were employed full-time (51%, n = 56). The remainder were homemakers (23%,
n = 2 5 ) , employed part-time (1 1 %, n = I2), self-employed (6%, n = 6 ) , or cur-
rently unemployed (9/0, n = 10). With respect to education, 4% ( n = 4) had less
than a high-school education, 6% ( n = 7) completed high school, 27.5% ( n = 30)
had some college or vocational education, 35% ( n = 38) had completed a college
education, and 27.5% ( n = 30) had some postgraduate training. The unusually
high educational level of this sample was a result, in part, of the recruitment of
WHY MY CHILD? 1269
parents from the Internet. On average, there was one other child in the household
(52% [ n = 401 boys, 48% [ n = 371 girls) besides the child with special needs.
Among the special-needs children in the initial interview, 83 (73%) were
boys and 30 (27%) were girls. The ages of the children ranged from 3 months to
7 years, with a mean of 40.7 months (or about 3 years and 5 months). This distri-
bution of child gender is not unusual when dealing with special-needs children.
The greater prevalence of developmental disabilities among boys is probably a
result of gender-linked recessive conditions (Tyson & Favell, 1988) and societys
higher expectations for boys intellectual competence than for girls (Levinson &
Starling, 1981; Marsh, 1992; Tyson & Favell, 1988). Of the various diagnoses,
33% of the children had Downs syndrome, 3 1% had autism, 23% had develop-
mental delays, and 13% had other etiologies of cognitive delays (e.g., cerebral
palsy, fragile X syndrome, congenital hydrocephalus). Because this latter group
was heterogeneous, we excluded it from analyses that examined differences in
attributions and adjustment by diagnosis.
For the developmental age of the child, the parent either provided the most
recent overall developmental age or the breakdown of the childs developmental
age in five major areas (motor, expressive language, receptive language, social
skills, cognitive) as assessed by the childs doctor, therapist, or school district.
When only the breakdown was available, an average of the five areas was used as
the overall developmental age. (A child development coordinator at a local orga-
nization for mentally retarded citizens stated that this was a common procedure
used by child therapists to determine overall developmental age of a child.) To
determine the magnitude of the developmental delays, the childs chronological
and developmental ages were first converted into months, and the following for-
mula was used:
1 - (developmental age/chronological age).
On average, the children were delayed about 37% from their chronological age,
and the degree of delays ranged from negligible (newborns often do not show
signs of delays until after 6 months of age) to quite severe (83% delayed from
chronological age).
Recruitment of Participants
Parents were recruited through several local chapters of the Mental Health/
Mental Retardation agency, which registers all county children diagnosed with
significant delays, as well as from two local chapters of Arc (formerly known as
the Association for Retarded Citizens). Each organization mailed letters to eligi-
ble parents.
Letters contained the investigators phone number and an addressed, stamped
postcard for interested parents to return with their phone numbers and names on
the back. If a parent agreed to participate, the investigator obtained a mailing

address and sent a consent form explaining the study, confidentiality of the
responses, and contact information for the primary investigator. Of approxi-
mately 600 letters, 54 parents (approximately go/,) responded with a call or post-
card. Of these parents, 2 decided not to participate and 2 were not eligible (child
was too old; foster parent to child). One interview was terminated because the
parent did not understand the questions, and 5 parents were unreachable (discon-
nected telephone, no telephone number, not home after five contact attempts).
The remaining 44 (81%) parents agreed to participate in the study. and the initial
interview was successfully completed.
In addition to the mailing of letters, parents were also recruited through elec-
tronic groups on the Internet. A brief description of the study and eligibility
requirements was posted twice during a 3-month interval on four UseNet
groups: netnews.alt.education.disabled, netnews.alt.support.dev-delays,netnews.
bit.listserv.autism, and netnews.bit.listserv.down-syn.Interested parents were
asked to reply directly to the post, at which point a more detailed message about
the studys purpose. confidentiality, and participation was sent privately to the
interested parent. If a parent agreed to participate, further contact was made elec-
tronically to schedule a day and time for the initial interview. After this contact,
the consent form was mailed to the parent. It is not possible to determine how
many parents were reached by the Internet groups. These groups are transmitted
nationally as well as internationally. Approximately 95 replies were received via
the Internet groups. Of these replies, 65 parents (68%) were contacted and inter-
viewed. Of the remaining 30 replies, two thirds were eligible parents with whom
an interview was not able to be scheduled after three contact attempts. and the
other one third were either ineligible parents (i.e., child was too old) or profes-
sionals inquiring about the study.
Analyses revealed that parents recruited from the Internet significantly dif-
fered from parents recruited through local community organizations on five
demographic variables. First, 3 1 of the 32 fathers interviewed for the study were
recruited from the Internet. Second, parents from the Internet were more likely to
have autistic children, whereas parents from the local community organizations
were more likely to have developmentally delayed children; no difference was
found for Downs syndrome. Third, parents from the Internet were more edu-
cated than were parents from the local community organizations. Fourth, parents
from the Internet were older than were parents from the local community organi-
zations. Finally, the children from the Internet were older than were those from
the local community organizations.
We acknowledge that our sample is biased as a result of our combined recruit-
ing from the Internet and from local community organizations. Although this sam-
pling is a limitation, we view our study as a usehl starting point because very little
research has been conducted on parental attributions for childrens special needs.
WHY MY CHILD? 1271
Interview Procedure
The initial interview (Time 1, TI) was conducted by telephone and lasted
approximately 45 min. After a brief introduction, parents were asked to provide
demographic information, including parents age, education, and employment, as
well as information about the childs diagnosis, age at diagnosis, and develop-
mental age. The initial interview assessed perceived stigma and depressive symp-
tomatology. Attributions of causality for the childs special needs were obtained
through an open-ended question.
The follow-up interview (Time 2, T2) was conducted by mail approximately
12 months after the initial interview. Parents who had not returned the question-
naire after 2 weeks were phoned or electronically mailed a reminder to return the
survey as soon as possible. In the follow-up survey, parents were asked to update
demographic information regarding changes in employment, marital status, and
developmental age of the child. Perceived stigma and depression were reassessed
in the 12-month follow-up. Attributions were assessed in the follow-up question-
naire with a ratings survey constructed from responses to the open-ended ques-
tion in the initial interview. We also added several open-ended questions to
explore the relation between physician explanations and parents personal expla-
nations for the childs delays.
Instruments
Attributions. In the initial interview ( T l ) , parents were asked what they

believed was the main cause (or causes) of their childrens special needs. Parents
were encouraged to express their personal beliefs about how or why their chil-
dren came to have special needs. Only 6 parents from the sample of 109 parents
(5.5%) could not identify a cause for the special needs. Almost one quarter of the
parents (24.8%, n = 27) gave more than one cause for the special needs.
Responses to this open-ended question were coded using a system constructed
from prior illness attribution research (Bearison et al., 1993; Klonoff & Landrine,
1994). A total of 10 dichotomous categories were formed: 5 internal attributions
(heredity; stress; age; self-blame, e.g., behavior during pregnancy; punishment
by God), and 5 external attributions (genetic fluke; fate/Gods will; environment;
infectiondimmunizations; trauma during pregnancy, delivery, or infancy). Two
raters coded the responses, and a third rater settled any disagreements. Interrater
reliability was high (a= .82).
In the follow-up questionnaire (T2), parents were asked to rate, on a 5-point
scale, the extent to which they believed that each of 17 causes may have
contributed to their childrens special needs (1 = did not contribute at all, 3 =
contributed somewhat, 5 = contributed a lor). The list of 17 causes was based
mostly on the 10 categories derived from open-ended questions at T 1. We added
items by making finer distinctions within some categories. For example, attribu-
tion to age was assessed with two items: own age and spouses age.
Depression. The Center for Epidemiologic Studies Depression Scale (CES-
D; Radloff, 1977) was included in both interviews to assess the parents current
level of depressive symptomatology. Cronbachs alpha for the CES-D was high
in both interviews (T1 : a = 3 9 ; T2: a = .90). The items were summed to obtain a
score of depressive symptomatology, with higher scores indicating more depres-
sive symptoms.
Perceived stigma. Perceived stigma associated with the childs diagnosis was
assessed with an eight-item measure adapted from two previously used measures
(Crandall, 1991; Levinson & Starling, 1981; see Appendix A for instrument).
Scores on Items 3 and 5 were reversed. The items were summed to obtain a
perceived stigma score for each parent, with higher scores indicating a greater per-
ceived stigma. The eight items had a Cronbachs alpha of .76 at TI and .77 at T2.
Physician andpersonal explanation. At T2, parents were asked a set of open-
and closed-ended questions about physician and personal explanations for the
special needs. Parents were first asked if a doctor, specialist, nurse, or other
healthleducation professional had provided an explanation about the cause( s) of
the special needs. If a parent answered Yes, he or she was then asked to briefly
describe the explanation. Next, parents were asked to rate their satisfaction with
the physician explanation on a 7-point scale (-3 = very dissatisfied, 0 = neither
satisfied nor dissatisfied, +3 = very satisfied) and the extent to which they agreed
with the explanation (-3 = strongly disagree, 0 = neither agree nor disagree, +3 =
strongly agree). All parents, regardless of whether they reported receiving an
explanation from their physician, were asked to rate on a 7-point scale the extent
to which they had wanted an explanation about the cause of the childs special
needs (-3 = not at all, 0 = somewhat, +3 = very much). Finally, parents were
asked if they had their own personal explanation (whether or not they agreed
with or received one from the physician). If a parent had a personal explanation,
he or she was asked to briefly describe it. Because these questions regarding phy-
sician and personal explanations were asked at the beginning of the survey, the
closed-ended attributions were rated near the end of the survey so that they
would not. influence parents open-ended responses.
Results
Development of Attribution Categories
Our first step was to determine whether the 17 causal attributions rated at T2
could be used to derive clear attribution categories. Principal components anal-
ysis was used on the 17 items, followed by varimax r ~ t a t i o n An
. ~ eigenvalue
40blique rotations revealed the same factor pattern.

WHY MY CHILD? 1273
greater than 1 .O was adopted for factor extraction. Six factors emerged. All but
one of the factors made conceptual sense. The last factor was composed of two
items (genetic fluke, punishment by God) which were not interpretable. Two
other items (environment, behavior during pregnancy) did not tit conceptually
with the factors that they loaded onto and cross-loaded with this last unstable
factor. Among these four items, two (punishment by God, behavior during
pregnancy) did not have sufficient variability (means were 1.23 and 1.24, respec-
tively) and were discarded from subsequent analyses. We decided to examine the
other two items (genetic fluke, environment) separately.
A second principal components analysis on the remaining 13 items revealed
five factors, each consisting of two to four items. As shown in Table 1, all vari-
ables loaded .63or greater on one factor, and there were no cross-loadings above
.40. These factors, followed by the percentage of variance accounted for, are:
(a) natural/medical, 25.3%; (b) fate/Gods will, 15.8%; (c) stress, 12.0%; (d) age
at conception, 11.5%; and (e) heredity, 8.8%. Attribution scores were computed
by taking the mean of a parents ratings on the individual items comprising the
attribution category rather than by creating factor scores. Unit weighting of items
increases the ability of these results to generalize to future studies. Thus, a total
of seven attributions were analyzed at T2: the five factors, (a) naturaVmedical,
(b) fate/Gods will, (c) stress, (d) age at conception, (e) heredity; and the two
individual attribution items, (f)genetic fluke, and (g) environment.
Background Variables
Because distribution of the three main diagnoses differed for parents recruited
through the Internet versus those recruited through local community organiza-
tions, we tested whether recruitment differences emerged for attributions. A
MANOVA was performed with recruitment method as the between-groups factor
and causal attributions as the within-groups factor. A significant interaction of
recruitment by attribution appeared for the 10 open-ended responses at TI,F(9,
945)= 4.22, p < .OOl, and for the seven attribution categories at T2, F(6, 426) =
3.39,p < .O I , suggesting that the two groups of parents differed in the attributions
that they made for their childrens special needs. In addition, recruitment was
related to one of the adjustment measures at TI.Parents recruited from the Inter-
net perceived greater stigma with their childrens special needs ( M = 21.37,SD =
6.88)than did parents recruited from local community organizations ( M = 18.43,
SD = 6.37),F( 1, 107) = 5.08,p < .05. Consequently, we controlled for recruit-
ment in all subsequent analyses.
The three diagnostic categories differed in the severity of delay, F(2, 86) =
10.16, p < .OO I . Children with Downs syndrome had a lower percentage of delay
(26%) than did children with autism (43%) and children with developmental
delays (40%). Severity was related to two attributions at T1: (a) those making an
Table 1
Principal Components Analysis of T2 Causal Attributions

Attribution 1 2 3 4 5
Natural/medical
Medical problem during pregnancy or
childbirth .81
Medical error .69
Premature birth .64
Result of viruses, infections, immunizations .63
Fate/Gods will
Fate/destiny .9 1
Gods will .74
Chancehck .68
Stress
Something your spouse did during pregnancy .91
Stress during pregnancy .40 .79
Age
Your age at childs conception .92
Your spouses (or other parents) age at
conception .89
Heredity
Inherited from your family .88
Inherited from your spouses (or other parents)
family .83
attribution to fatelGods will had children with a lower percentage of delay (29%)
than those not making this attribution (39%), F( 1, 9 9 ) = 5.67, p < .05, and
(b) those making an attribution to genetic fluke had children with a lower per-
centage of delay (30%) than those not making this attribution (40%), F( 1, 9 9 ) =
6.96,p < .05. At T2, greater severity was correlated with less attribution to age at
conception, 4 6 8 ) = -.29, p < .05, and more attribution to natural/medical reasons,
r ( 6 8 ) = .24, p < .OS. In addition, severity was related to one of the adjustment
measures. Severity was marginally related to depression at T1, r( 101) = .19, p =
.06, and significantly related to depression at T 2 , r(68) = .24, p < .05. Therefore,
severity, in addition to recruitment strategy, was controlled for in all subsequent
analyses.
WHY MY CHILD? 1275
We also examined whether parent gender or child gender influenced causal

attributions. There were no significant parent gender or child gender differences
in the open-ended responses at T1 or the attribution ratings at T2. Thus, we col-
lapsed across parent gender and child gender. Other variables thought to be
related to attributions also were examined. Presence of other children and time
since diagnosis were not related to parental attributions or adjustment at TI or
T2. As one would expect, older parents were more likely to attribute the special
needs to age than were younger parents. Analyses controlling for these variables
revealed a similar pattern of results.
Diagnostic Dgferences in Attributions
A primary purpose of this study was to examine differences in causal attribu-

tions across the three diagnoses. A MANCOVA was performed with diagnosis as
the between-groups factor, the 10 T1 attributions as the within-groups factor, and
recruitment and severity as the covariates. Because the other diagnostic cate-
gory contained a range of diagnoses that made interpretation difficult, we only
used the three categories of Downs syndrome ( n = 36, 39.1%), autism ( n = 34,
37.0%), and developmental delays ( n = 22, 23.9%) in these analyses. No main
effect of diagnosis was found at T1. suggesting that one group was not more
likely to endorse all of the attributions than the other two groups. However, a sig-
nificant interaction of diagnosis by attribution appeared at T1, F( 18. 765) = 6.44.
p < .001, suggesting that there were diagnostic differences in the specific attribu-
tions made by parents. A similar MANCOVA was conducted at T2, with diagno-
sis as the between-groups factor, the seven attribution categories at T2 as the
within-groups factor, and recruitment and severity as the covariates. Again, there
was no main effect of diagnosis at T2, but there was a significant interaction
between diagnosis and attribution, F( 12, 336) = 9.92, p < .001. Consequently, we
performed separate ANOVA on each of the attributions at both T1 and T2.
Attributions at TI. The means for the 10 attributions identified at T1 are
shown in Table 2 for the three diagnoses. To facilitate understanding of the
means, they are not adjusted for the covariates. The means can be interpreted as
the percentage of parents who gave this response. Because parents could give
more than one response, the sum of the columns exceeds 100%. We performed
post hoc comparisons on the three groups to determine which ones differed; to
reduce chance significant findings, we adopted a more conservative alpha (p <
.01).
The most common explanations given for Downs syndrome were fatelGods
will (56%) and genetic fluke (50%). In addition, these parents were significantly
more likely than parents of autistic or developmentally delayed children to
attribute the cause to fate/Gods will, but only marginally more likely to attribute
the cause to genetic fluke (p = .07). Parents of children with Downs syndrome
Table 2
Diagnostic Differences in TI Open-Ended Attributions
External attributions
Genetic fluke 35 SO, .29, .18,
Fate/Gods will 28 56, .15b .05b
Trauma .12 .03, .03b .41,
Infections .07 .06, .06, .09,
Environment .07 .oo, .15, .05,
Internal attributions
Heredity .20 .06b .41, .09b
Self-blame .08 .06, .06, .14,
Stress .03 .oo, .03, .09,
Age .04 .08, .03, .oo,
Punishment by God .o 1 .03, .oo, .oo,
No attribution .05 .oo, .09, .09,
Note. Common subscripts indicate that means do not significantly differ across the col-
umns a t p < .01. These numbers can be interpreted as the percentage of parents who gave a
particular response (e.g., 35% of parents gave a genetic fluke reason for their childrens
special needs). Because parents could give more than one reason, the sum of the columns
exceeds 100%. Italicized numbers represent the most frequent attributions for each diag-
nosis.
agecause the other diagnosis group includes a variety of diagnoses (e.g.. cerebral palsy,
fragile X syndrome, congenital hydrocephalus), we excluded them from these analyses.
made few of the other attributions. Contrary to our prediction, only 8% of these
parents mentioned age at conception.
The most common attribution for autism was heredity (41%). As predicted,
parents of autistic children were more likely to attribute the cause to heredity
than were parents of children with developmental delays or Downs syndrome.
The second most frequently endorsed cause was genetic fluke (29%). The third
and fourth causes were environment and fate/Gods will, each of which was men-
tioned by 15% of parents. We predicted that environment would be a more com-
mon attribution for these parents, as compared to the other two groups. Although
WHY MY CHILD? 1277
environment was mentioned more often by parents of autistic children than by

other parents, the difference was not significant.
The most common attribution for developmental delays was trauma (41%).
Consistent with our prediction, parents of children with developmental delays
were more likely to attribute the cause to trauma during pregnancy, birth, or
infancy than were parents of children with autism or Downs syndrome. The sec-
ond most frequently named attribution was genetic fluke (18%). Self-blame was
the third most frequently named attribution (14%). In line with our prediction,
self-blame was mentioned more frequently by parents of developmentally delayed
children than by the other two groups, but the difference was not significant.
In summary, the most common attributions at TI for the three diagnoses tend
to fit with the available evidence for the causes of Downs syndrome, autism, and
developmental delays. In addition, there were clear differences in the attributions
by diagnosis that generally confirmed our predictions. One attribution commonly
made by parents of Downs syndrome children did not fit with the available evi-
dence; these parents frequently mentioned fatelGods will as a cause for their
childrens Downs syndrome. Also, although there were attributional differences
among the three groups of parents, genetic fluke was a prominent attribution
made by all parents.
Attributions at TZ.Table 3 presents the mean level of endorsement for the
seven attribution categories at T2. Because it does not obscure the interpretation
of the data, we report the means adjusted for the effects of the two covariates.
Significant (p < . O l ) post hoc diagnostic differences appeared for five of the
seven attribution categories (all except fate/Gods will and age at conception).
We also examined the extent to which there were differences across the seven
attributions within a diagnosis. Multiple comparisons across the seven categories
within each group hrther capitalize on chance significant findings. Therefore, to
reduce Type I errors, we adopted a more conservative alpha (p < . O O l ) for this
second analysis.
The most frequently endorsed cause for Downs syndrome was genetic fluke,
and this cause was rated significantly higher than the other six causes. The sec-
ond most frequently endorsed cause was fate/Gods will, and the third was age at
conception. These three top attributions for parents of children with Downs syn-
drome are consistent with the T1 results. Comparisons across the three diagnoses
revealed that parents of children with Downs syndrome were more likely to
attribute the cause to genetic fluke than were the other two groups of parents.
Also, there was a marginal, but not significant, tendency for parents of children
with Downs syndrome to endorse fate/Gods will more strongly as a cause than
among other parents.
The top four attributions endorsed by parents of children with autism were
genetic fluke, fate/Gods will, heredity, and environment, respectively. Among
these four attributions, only two significantly differed in endorsement: genetic
Table 3
Diagnostic Differences in T2 Attribution Ratings

Downs Developmental
Totala syndrome Autism delays
( N = 66) ( n = 26) ( n = 24) ( n = 16)
External attributions
Genetic fluke 3.75 4.79, 2.96, 2.93,
Fate/Gods will 2.72 3.11, 2.68, 2.00,
Environment 1.68 1.39b 2.21, 1.42,b
NaturaVmedical 1.48 0.94, 1.76, 2.08,
Internal attributions
Heredity 1.92 1.28b 2.60, 2.04,
Age 1.54 1.69, 1.40, 1.48,
Stress 1.34 0.98, 1.51,b 1.75,
Nore. Common subscripts indicate that means do not significantly differ across the col-
umns at p < .01. Means are adjusted for the effects of the two covariates: recruitment and
severity of delays.
agecause the other diagnosis group includes a variety of diagnoses (e.g., cerebral palsy,
fragile X syndrome, congenital hydrocephalus), we excluded them from these analyses.
fluke was more strongly endorsed than was environment. However, all four attri-
butions were endorsed more strongly than were natural/medical, stress, and age.
These results are similar to our TI findings for parents of children with autism.
Comparisons with the other two diagnoses found that parents of autistic children
were more likely than were other parents to make attributions to environmental
causes and heredity, but only significantly more likely than parents of children
with Downs syndrome.
For parents of developmentally delayed children, the top three attributions
were genetic fluke, natural/medical, and heredity. Genetic fluke and naturalimedi-
cal significantly differed from age and environment; no other significant differ-
ences were found. The mean level of endorsement was relatively low across the
seven categories. Comparisons across the three diagnoses found that parents of
developmentally delayed children were more likely to attribute the cause to natu-
ralimedical reasons and to stress during pregnancy than were the other two groups,
but only significantly more likely than parents of children with Downs syndrome.
In summary, our findings for diagnostic differences in attributions were
similar for T1 and T2. As in T I , genetic fluke was the most strongly endorsed
WHY MY CHILD? 1279
attribution for all parents in T2. The attribution ratings at T2,however, revealed
more distinctions between the three groups of parents than the T1 open-ended
responses. In T2, most of the significant differences were found between Downs
syndrome and the other two groups; few differences were found between autism
and developmental delays.
Relation of Attributions to Adjustment
The second goal of this study was to examine the relation of causal attribu-
tions to adjustment. Adjustment was measured as perceived stigma and depres-
sion. There was only one diagnostic difference in adjustment (controlling for
recruitment and severity): Parents of children with Downs syndrome were less
depressed at TI ( M = 8.82,SE = 1.74)than were parents of children with autism
( M = 14.96, SE = 1.88)and parents of children with developmental delays ( M =
15.40,SE = 2.37),F(2, 85) = 3.64,~ < -05. There were no diagnostic differences
in depression at T2 or in perceived stigma at TI or T2. Analyses controlling for
diagnosis revealed the same pattern of results. Therefore, we chose not to control
for diagnosis in the following analyses.
Adjustment at TI. The relation of causal attributions to TI adjustment were
examined with multiple linear regression (controlling for recruitment and sever-
ity) where all of the attributions were entered simultaneously into the equation.
To reduce the chances of obtaining spurious correlations, we only examined attri-
butions named by at least 5% of the parents (see column 1 of Table 2). Only one
attribution was associated with T1 perceived stigma: Those attributing their chil-
drens special needs to fatelGods will reported less perceived stigma than did
those not making this attribution ( b = -5.13, t = -2.75,~ < .01; R2 = .21). None of
the attributions were related to TI depression.
Adjustment at T2. As before, we analyzed the seven T2 attributions using
multiple linear regression to predict T2 adjustment. Recruitment method and
severity were entered on the first step, and the seven attribution categories were
entered in the second step. Two attributions predicted greater perceived stigma:
environment ( b = 1.87,t = 2.44,~ < .05) and heredity ( b = 2.67,t = 3.37,~< .01;
overall R2 = .39).Two attributions predicted greater depression: environment
( b = 3.60,t = 3.04,p < .01) and stress during pregnancy ( b = 3.33,t = 2.02,p <
.05; overall R2 = .34).
Change in Adjustment Over Time
To determine whether causal attributions affected adjustment over time, we

examined the relation of T1 attributions to T2 adjustment controlling for TI
adjustment using multiple linear regression. In the first step, we entered recruit-
ment and severity; in the second step, we entered TI adjustment (i.e., perceived
stigma or depression); and in the third step, we entered the seven TI attributions.
Only one TI attribution was related to a change in depression over time. Making
an attribution to fate/Gods will predicted a decrease in depression over time ( b =
-7.96, t = -2.66, p < .05; overall R2 = .39). None of the TI attributions predicted
an increase or decrease in perceived stigma over time. However, one TI attribu-
tion was a marginally positive predictor of both adjustment measures over time:
self-blame (depression: b = 8.02, t = 1.90, p = .06; perceived stigma: b = 4.12, t =
1.89, p = .07).
To summarize, two internal attributions (heredity and stress during preg-
nancy) and one external attribution (environment) were related to worse adjust-
ment at T2. Only one attribution was related to better adjustment: Making an
attribution to fate/Gods will was related to less perceived stigma at TI and to
decreased depression over time.
Personal Versus Physician Explanation
At T2, we added a series of questions exploring the relation between physi-

cian explanations and parents personal explanations. Neither recruitment nor
severity were related to whether a parent reported receiving an explanation from
the physician or had their own personal explanation. We also examined whether
the amount of time since diagnosis influenced parents recall of the physician
explanation. Analyses revealed that time since diagnosis was not related to recall
of receiving a physician explanation, nor was time since diagnosis related to
agreement or satisfaction with the physician explanation. Analyses controlling
for time since diagnosis revealed the same pattern of results. Thus, we chose not
to control for time since diagnosis in the following analyses.
Half of the parents (50.7%) reported receiving some sort of explanation from
their doctor, a specialist, or other health care/education professional about the
cause(s) of their childrens special needs. In addition, slightly over half of the
parents (53.3%) had a personal explanation for their childrens special needs,
regardless of whether they received one from their physician. A chi square of
physician by personal explanation revealed that parents who reported receiving
an explanation from their physician were less likely to have their own personal
explanation (3 1.6%) than were parents who reported not receiving a physician
explanation (75.7%), ~ ( 1 , N = 75) = 14.65, p < .001. These results suggest that
the provision of an explanation by ones physician may reduce a parents need to
come up with his or her own explanation.
Furthermore, if physicians are more likely to provide explanations for cases
in which the cause is clearer, then, based on the prior results, we should find that
parents of children with Downs syndrome will not only be more likely than
other parents to report receiving a physician explanation but also less likely to
WHY MY CHILD? 1281
report having a personal explanation. Indeed, our analyses reveal that parents of
children with Downs syndrome were more likely to report receiving an explana-
tion from their physician (72.0%) than were parents of developmentally delayed
(43.8%) and autistic (25.0%) children, x2(2, N = 65) = 1 0 . 9 7 , ~< .01. And, con-
versely, parents of children with Downs syndrome were less likely to have their
own personal explanation (32.0%) than were parents of developmentally delayed
(62.5%) and autistic (70.8%) children, ~ ~ (N2=,65) = 8.07, p < .05.
Next, we examined the content of parents personal explanations in light of
the physician explanation. Only 14.5% of parents ( n = 11) reported both receiv-
ing a physician explanation and having their own personal explanation. For this
group of parents, physician explanations focused on a specific medical cause
(e.g., not enough oxygen at birth, premature birth; 45.5%) or genetic fluke
(45.5%). Only one physician explanation (9%) stated that there was no known
cause for the special needs.5 An examination of these parents personal explana-
tions revealed that 36% gave the same explanation as did the physician. Eighteen
percent gave a medical cause that was different from the physician explanation,
Another 18% of parents blamed the mother, 9% blamed the doctor, and 9%
blamed the child. The final 9% cited fatelGods will as an explanation. Thus, par-
ents personal explanations were either similar to the physician explanation or
focused on blame; but contrary to Dunn et al. (1991), the blame was not just on
the mother. Also unlike Dunn et al. (1991), we did not find that these parents
personal explanations focused on fate/Gods will.
As is evident from these results, receiving a physician explanation does not
necessarily mean that parents agree with or are satisfied with the explanation. In
order to examine these issues, we asked parents to what extent they desired,
agreed with, and were satisfied with the physician explanation. All three scales
ranged from -3 (did not want an explanation at all, strongly disagree, very dissat-
isfied) to +3 (very much wanted an explanation, strongly agree, very satisfied).
On the whole, parents who reported receiving an explanation from their physi-
cian agreed with that explanation ( M = 2.08, SD = 1.44) and were somewhat sat-
isfied with it ( M = 1.63, SD = 1.78). Furthermore, parents reported a moderate
desire for an explanation from their physician ( M = 1.78, SD = 1.69), regardless
of whether or not they received a physician explanation. Additional analyses
revealed that although parents who received a physician explanation reported
desiring one more ( M = 2.05, SD = 1.45) than did parents who did not receive a
physician explanation ( M = 1.49, SD = I.88), the difference was not significant.
SAlthough only one physician is reported to have said that no known cause existed for the special
needs, it is extremely likely that many parents who reported not receiving a physician explanation
were actually told by their physicians that no known cause existed. It is unclear why this one parent
interpreted the statement of no known cause as an explanation, while the majority of parents pre-
sumably did not.
Finally, severity was inversely associated with agreement, r(37) = -.34, p < .05,
and satisfaction, r(37) = -.34,p c .05, suggesting that parents with more severely
disabled children were less likely to agree with and be satisfied with the physi-
cian explanation. However, there were no significant differences between the
three diagnoses in satisfaction or agreement with the physician explanation or in
the extent to which parents desired an explanation from their physician.
In our last set of analyses, we examined the relation of physician and personal
explanations to adjustment. Because recruitment and severity were related to
adjustment, we controlled for both in the following analyses. Receiving an expla-
nation from ones physician was not associated with depression or with perceived
stigma. Having a personal explanation, however, was associated with perceived
stigma (but not with depression). Parents who had a personal explanation per-
ceived greater stigma ( M = 20.66, SE = 0.98) than did parents who did not have a
personal explanation (A4 = 16.7 1, SE = 1.04), F( 1, 66) = 7.52, p < .01, perhaps
indicating that feelings of shame and embarrassment are related to a greater con-
cern for finding a causal explanation.
As one would expect, greater satisfaction and agreement with the physician
explanation were both related to less perceived stigma, 433) = -.37, p < .05, and
4 3 3 ) = -.36,p < .05, respectively. Neither, however, was related to depression. In
the final analysis, the extent to which a parent desired a physician explanation
(regardless of whether or not one was given) was marginally related to greater
perceived stigma, r(64) = .22, p = .08, but not to depression.
Discussion
The results of our study, although preliminary, make several contributions to

the attribution literature and raise some interesting questions about the adaptive
significance of attributions. First, few prior studies have examined the causal
attributions of parents for their childrens special needs. We found that parents
attributions largely corresponded with the available scientific literature. Second,
few longitudinal studies exist on whether attributions change over time; we found
that parents endorsed the same types of attributions at both times of assessment.
Third, we identified the relevant causal attribution categories from the population
aMicted with the stressor rather than from researchers a priori notions of which
attributions might be relevant, In the past, attributions considered important to
individuals afflicted with the stressor have not always been taken into account.
Furthermore, we employed two distinct methodologies for examining parental
attributions (open-ended responses and ratings), while most studies utilize only
one method. We found similar results across the two methodologies. Finally, we
explored the connection between physician explanations and parental explana-
tions. This aspect of the attribution process has received little attention by prior
researchers, which is surprising considering that physicians are the ones parents
WHY MY CHILD? 1283
will most likely seek out first to explain the cause of their childrens special
needs/illness. Although our results are preliminary and exploratory, we believe
that with rigorous replication these findings could have important implications
for the provision of services to families with special-needs children, as we dis-
cuss later.
Diagnostic Differences in Attributions
In general, parental attributions fit with existing evidence about the specific
disabilitys etiology, but the results for the open-ended responses were more
clearly in line with predictions than the ratings. In the open-ended response, par-
ents spontaneously mentioned the attribution categories most supported by the
literature. Yet, when parents were provided with a list of potential causes during
the follow-up interview, the category most strongly endorsed by all parents was
genetic fluke. It appears that, at least for this sample, parents of special-needs
children acknowledge the randomness of the event. This may partially explain
why fatelGods will was also endorsed highly by all parents in the ratings survey;
parents may be trying to make some sense of this randomness (Janoff-Bulman &
Wortman, 1977). Furthermore, the fact that both of these attributions conjure up
images of uncontrollable and unpreventable causes may reflect the genuine
uncertainty and lack of understanding about the true causes of childrens dis-
abilities.
Although genetic fluke and fate/Gods will were strongly endorsed by all par-
ents, these two attributions, along with several others, differed by diagnosis. Par-
ents of children with Downs syndrome most frequently made attributions to
genetic fluke, fate/Gods will, and age at conception at both TI and T2, and
tended to endorse these categories more frequently than did other parents. We
predicted that these parents would make attributions to genetic fluke and age at
conception based on the medical literature concerning the etiology of Downs
syndrome. Age was endorsed substantially less than was genetics, most likely
because not all of the parents who had children with Downs syndrome were
older. Although fatelGods will was not predicted to be an important attribution,
it was among the two highest attributions made at both TI and T2, and was men-
tioned more frequently by parents of children with Downs syndrome than by
other parents at T1.
Why do these parents believe that their children are gifts from God or that it
was meant to be? The most obvious explanation is that these parents, especially
those who make an attribution to fate/Gods will, are more religious than are
other parents. While we did not have a direct measure of religiosity in our inter-
view, we had an indirect measure: frequency of attending religious services. If we
assume that attending religious services reflects, to some degree, religiosity of an
individual, then parents of Downs syndrome children and those who attribute
their childrens special needs to fate/Gods will should be more likely to attend
religious services than other parents or those who do not make this attribution,
respectively. Our analyses did not find any significant differences in religious
service attendance at T1 or T2 between the three groups of parents, or between
those making a fate/Gods will attribution and those not making such an attribu-
tion. Thus, we can tentatively rule out that parents of Downs syndrome children
made the fate/Gods will attribution because they were more religious than other
parents, or that the fate/Gods will attribution is simply a measure of religiosity.
Another explanation for why these parents make the fatelGods will attribu-
tion may have to do with the fact that the cause ascribed to Downs syndrome is a
random one. Parents learn from physicians or other specialists that Downs syn-
drome is due to a chromosomal malformation. However, other than age at con-
ception, the reason why this malformation occurs is unknown. Hence, parents are
provided with a genetic-fluke attribution but are left to speculate about the reason
behind it. According to Janoff-Bulman and Wortman ( 1 977), this type of expla-
nation is stressful because it makes the world seem random. Therefore, parents
may choose to view Downs syndrome as predetermined by God or fate in order
to make it, and the world, seem less random.
Alternatively, the attribution to fate/Gods will may reflect these parents
acceptance of the event. If so, parents of children with Downs syndrome who
make this attribution should be less distressed than other parents. As mentioned
in the Results, parents of children with Downs syndrome were less depressed at
T1 than were other parents. In a post-hoc analysis, we examined whether the fate/
Gods will attribution could account for the diagnostic difference in depression.
Analyses controlling for the T1 attribution to fate/Gods will showed that this
attribution reduced the diagnostic difference in T 1 depression to nonsignificant
(from p < .05 t o p = .08). Thus, one reason why parents of children with Downs
syndrome are less depressed at TI than are other parents is that they are more
likely to make an attribution to fatelGods will than are parents of autistic or
developmentally delayed children. Given all of these possible explanations,
future research is needed to understand why parents of children with Downs syn-
drome have the fate/Gods will attribution more readily available than do other
parents.
The most common attributions for parents of autistic children (at both TI and
T2) were heredity, genetic fluke, fate/Gods will, and environment. Moreover, in
line with the available evidence on possible causes of autism, these parents made
attributions to heredity and environment more than did other parents. Although
physicians are careful to point out that they do not know specifically what causes
autism, it appears that parents, possibly through research and dialogue with other
parents, focused on these two of the many possible causes. The two attributions
appear to be on opposite ends of the blame continuum; namely, an attribution
to the environment can be seen as blaming others (e.g., local companies who
WHY MY CHILD? 1285
pollute the drinking water or government agencies who fail to enforce environ-
mental regulations), while an attribution to heredity blames the self. Moreover, it
is unclear where these attributions fall on the controllability continuum; both
attributions can be construed as controllable or uncontrollable. Assuming that
parents were unaware of the hereditary or environmental risks prior to becoming
pregnant, these attributions are uncontrollable. On the other hand, in terms of
future children, attributions to heredity and the environment are controllable
because parents can choose to move to a safer area (environment) or not to con-
ceive (heredity). As suggested by Brown and Siege1 ( I 988), an individuals per-
ception of control over the occurrence of the event may moderate the relation of
internal/external attributions to adjustment. Yet, because we do not know
whether these parents were focusing on the occurrence or recurrence of the event,
we cannot determine whether or how perceived control plays a role in the rela-
tion. Future research needs to assess parents perceived controllability of various
attributions and to examine whether parents are considering the current situation
alone or hture pregnancies when making these attributions.
Finally, parents of children with developmental delays made attributions to
medical trauma, genetic fluke, heredity, and stress during pregnancy at both TI
and T2. In addition, they made attributions to medical trauma and stress during
pregnancy more than did other parents. Although there are multiple causes of
developmental delays, our results suggest that these parents may focus on a spe-
cific incident that occurred during pregnancy or birth to explain the delays. As
with parents of autistic children, these parents may also be thinking of future
children when making these attributions. Both of these attributions are controlla-
ble in future pregnancies, either by reducing stress or by changing doctors or hos-
pitals. It would be interesting to examine in a future study whether parents with
these attributions make a concerted effort to reduce their stress or change their
physician for the next pregnancy.
Attributions and Adjustment
Fate/Gods will was the only attribution related to less distress, and it also
was the only attribution that predicted decreased depression over time. Three
attributions were related to increased distress: heredity, stress during pregnancy,
and the environment. Whereas the former two are internal attributions, the latter
is an external attribution. Our results are consistent with Downey, Silver, and
Wortman (1990) who found that both types of attributions were related to greater
distress. Thus, it may be that blaming anything is maladaptive. However, based
on this argument, we would need to interpret why blaming fate/Gods will was
related to better adjustment. One interpretation considers the distinction between
what Kruglanski ( 1975) termedfunctional attributions (i.e., physicaUmedica1
reasons) and derivative or ultimate attributions (i.e., Why my child in
particular?). Perhaps those who are concerned with the functional causes of a
stressor have not yet accepted it, whereas those who have moved beyond the
functional to the ultimate cause are Concerned with the meaning of the event for
their lives (Taylor, 1983). Because of the preliminary nature of these results,
future research is needed to replicate these findings and to test the validity of
these interpretations.
One area for future research to examine is whether parents who attribute the
special needs to fate/Gods will are less concerned with the medical (or func-
tional) reasons behind the special needs than are parents who do not make this
ultimate attribution, or, alternatively, whether some parents (such as those with
Downs syndrome children) are able to move to ultimate attributions sooner than
are other parents because they have specific medical reasons available to them
from the beginning that others do not. Related to the latter idea, longitudinal
studies could examine, first, whether parents initially focus on functional attribu-
tions and shift to ultimate attributions over time and, second, how this change
might be related to their adjustment and coping.
Physician Explanations
Few previous studies have examined the role of physician explanations in the
attribution process. We proposed that how and whether a physician explains the
cause of the special needs to parents could influence parents explanations and
adjustment. Only half of the parents in our study reported receiving an explana-
tion from their physicians. Analyses also revealed that these parents were also
less likely to have their own personal explanation than were parents who reported
not receiving a physician explanation. Furthermore, we found that parents of
children with Downs syndrome were more likely to report receiving a physician
explanation and less likely to have their own personal explanation than were par-
ents of autistic or developmentally delayed children.
These preliminary results are consistent with the idea that physicians may be
more likely to provide explanations when causes are clearer and parents would,
subsequently, be less likely to generate their own explanations. However, an
alternative explanation may be that parents of children with autism and develop-
mental delays are less likely to remember or understand the physicians explana-
tion because the list of potential etiologies for these two diagnoses is much
broader and more complex than for Downs syndrome. Because we are measur-
ing parents recall of physician explanations, we cannot state with certainty that
their recall is veridical with the physicians actual behavior. Thus, although our
finding suggests that receiving an explanation from ones physician may decrease
a parents need to search for his or her own causal explanation, future research
needs to gather information from the physicians and the parents about the provi-
sion of medical explanations.
WHY MY CHILD? 1287
We also considered that receiving a physician explanation may influence

adjustment because it lessens an individuals personal search for explanations.
Although receiving a physician explanation was not related to adjustment, having
a personal explanation was related to greater distress. This finding is consistent
with a number of recent studies that have shown that concern with finding a
causal explanation is related to poor adjustment (e.g., Downey et al., 1990; Shapp
et al., 1992). According to Downey et al. (1990), the need to find a causal expla-
nation may not be as adaptive as was once believed. They found that parents who
were concerned with assigning an attribution to the death of their child were
more distressed than parents who were not concerned with making an attribution
for the death. According to Shapp et al. (1992, p. 302), who found similar results
in their study of parents of special-needs children, concern with finding a causal
explanation may indicate that these parents are having a more difficult time
adjusting to this condition than are parents who do not express as much concern.
In conjunction with the idea that the need for a causal explanation may not be
adaptive, as stated earlier, we found that parents of children with Downs syn-
drome were more likely to report receiving a physician explanation and less
likely to have their own personal explanation than were other parents. In addi-
tion, parents of children with Downs syndrome were less depressed than were
other parents at TI. Although we could not directly test whether the T2 diagnos-
tic difference in physician explanation was related to the TI diagnostic difference
in depression, it seems possible that the two results may be connected. If so, this
would offer additional support for the idea that receiving a physician explanation
may be beneficial for adjustment because it lowers a parents concern with find-
ing a causal explanation.
Although the physician explanation results were not surprising, it raises the
question of whether distress is affected over time by receiving a physician expla-
nation, by a parents agreement or satisfaction with the physician explanation, or
by a parents concern with finding a causal explanation. Because these items
were only assessed at T2, we were not able to examine the direction of causality.
This issue would be interesting to pursue in fiiture research.
To conclude, these results, albeit preliminary, may have important implica-
tions for family interventions if they can be replicated and expanded on in future
research. Our study suggests that a childs diagnosis may be related not only to
the type of attributions that parents make, but also to the likelihood that physi-
cians will provide an explanation to parents. Furthermore, there is tentative evi-
dence to suggest that these diagnostic differences in attributions and physician
explanation may be related to adjustment to having a child with special needs. If
our findings are replicated in observational studies of physician and parent inter-
actions, one possible implication of these results would be for how physicians
handle parents initial questions. Although an exact cause may not be known, if
physicians provide parents with some information about the etiology of the
special needs, even if it is simply to state that the cause was a genetic fluke, it
may help to decrease their need for a causal explanation and, consequently, their
distress. One potential application of these findings would be to develop family
interventions that help parents to cope with the ambiguity of the situation, to pro-
vide information to the extent that it is available, and to encourage acceptance of
the situation when information is unavailable.
L irnitatio ns
When evaluating the results of our study, it is important to consider the limi-
tations in the studys design and procedures that may qualify our conclusions.
First, as stated earlier, our sample was not representative. We recruited parents
from two extremely different sources (local community organizations and Inter-
net support groups). This recruitment yielded two samples that differed on sev-
eral demographic characteristics. Most importantly, all but one of the fathers in
our study were recruited from the Internet. This imbalance may account for the
lack of gender differences in parents attributions. Although we controlled for
recruitment in all of the analyses, the results still need to be interpreted with cau-
tion. However, we feel that the dearth of research on the attributional process of
parents with special-needs children makes these results interesting and worth-
while. In addition, the findings present a starting point from which future
research can benefit.
A second limitation concerns the difference between those who responded to
the 12-month follow-up interview and those who did not. Parents who responded
to the follow-up interview were less depressed and stigmatized and better edu-
cated than were those who did not participate in the follow-up interview. This
difference may account for the lack of self-blame in the follow-up, as compared
to the initial interview. In addition, the longitudinal attribution-adjustment results
may have been attenuated because the most distressed individuals were not in the
follow-up sample.
Our study examined the attributional process of parents of children with spe-
cial needs-a stressor that has received relatively little attention from attribution
researchers. We found that parental attributions varied according to the existing
etiological evidence for Downs syndrome, autism, and developmental delays.
However, a few unexpected results were found. First, parents of children with
Downs syndrome were more likely to make attributions to fate/Gods will than
were other parents. Second, although parents of children with Downs syndrome
were more likely than were other parents to make a genetic-fluke attribution, all
parents highly endorsed this attribution, suggesting that, to some extent, they
acknowledge the randomness of the situation. Third, although the internal/exter-
nal dimension of attributions has been a primary focus of prior research, our
preliminary results suggest that the distinction between functional and ultimate
attributions also may be relevant to understanding the attribution-adjustment
relation. Finally, parents recall of receiving an explanation from a physician
appeared to be an important factor in whether parents felt the need to search out
their own explanation for the event. Furthermore, this finding suggests that par-
ents of children with special needs might benefit from periodic discussions with
physicians about existing etiological evidence. This discussion would not only
acknowledge parents need to answer the question Why my child? but also
might direct their search to potentially more adaptive attributions (e.g., ultimate
vs. functional). However, given the preliminary nature of these results and the
complexity of the relation between attributions and adjustment, before recom-
mending any specific interventions, we first suggest replication of these results in
a more comprehensive and representative study.
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Appendix
Parents were asked to indicate on a 5-point scale how true or false the follow-
ing statements were for them ( 1 = definitelyfalse, 3 = neither true nor false, 5 =
definitely true):
I . I feel that I am odd or abnormal because of my childs special needs.
2. There have been times when I have felt ashamed about having a child with
special needs.
3 . I never feel self-conscious about my childs special needs.
4. People treat me differently when they find out that I have a child with spe-
cial needs.
5 . I never feel embarrassed about my childs special needs.
6 . People look down on me because I have a child with special needs.
7. I have found that people say negative or unkind things about me behind
my back because I have a child with special needs.
8. I have been excluded from social gatherings because I have a child with
special needs.
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Why My Child?: Parental

Article in Journal of Applied Social Psychology July 2006

Test of Weathering Hypothesis on Disparities in Low Birth

The user has requested enhancement of the downloaded file.

KRISTIN D. MICKELSON~ MINHNOI

Journal of Applied Social Psychology, 1999,29,6,pp. 1263-1292

Although the literature on finding meaning in traumatic life events is quite

Diagnostic Differences in Attributions

Childhood cognitive disabilities in the general category of mental retardation

Relation of Attributions to Adjustment

dimension of attributions is more informative for understanding the link between

Physician Versus Personal Explanations

Beyond the possible diagnostic differences in causal attributions, other expla-

Parents were recruited through local community health organizations and

the back. If a parent agreed to participate, the investigator obtained a mailing

Attributions. In the initial interview ( T l ) , parents were asked what they

Development of Attribution Categories

40blique rotations revealed the same factor pattern.

Principal Components Analysis of T2 Causal Attributions

We also examined whether parent gender or child gender influenced causal

Diagnostic Dgferences in Attributions

A primary purpose of this study was to examine differences in causal attribu-

Diagnostic Differences in TI Open-Ended Attributions

environment was mentioned more often by parents of autistic children than by

Diagnostic Differences in T2 Attribution Ratings

Relation of Attributions to Adjustment

Change in Adjustment Over Time

To determine whether causal attributions affected adjustment over time, we

Personal Versus Physician Explanation

At T2, we added a series of questions exploring the relation between physi-

The results of our study, although preliminary, make several contributions to

Diagnostic Differences in Attributions

Attributions and Adjustment

We also considered that receiving a physician explanation may influence

Dunn, D. S., Clinton-Goldbach, K. R., Lasker, J. N., & Toedter, L. J. (1991).

Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for

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