Early Development and Parenting, Vol.

5 (4), 237-250 (1996)

Parenting Sensitivity, Parenta 1

Depression and Child Health:
The Mediational Role of Parental
Self-Efficacy
Douglas M. Teti*
University of Maryland Baltimore County, USA
Melissa A. O’Connell
University of Maryland Baltimore County, USA
Christine D. Reiner
University of Ma yland Baltimore County, USA

This paper discusses the theoretical role of parental self-efficacy, or

parents’ beliefs in their competence and effectiveness in the
parental role, as a mediator of relations between parent-child risk
and parental sensitivity. Evidence is marshalled fmm studies of
parenting in the contexts of maternal depression and child health
risk to support the premise that parent-child characteristics affect
parental sensitivity indirectly via their more direct impact on
parental feelings of efficacy, and that parenting efficacy represents
the ’final common pathway‘ in the prediction of parenting
sensitivity. Also considered in this working model are specific
social-contextual factors as independent contributors to parenting
efficacy and as possible moderators of relations between parent-
child characteristics and self-efficacy. Implications for intervention
are discussed. 01996 by John Wiley & Sons Ltd.
Early Dev. Parent. 5: 237-250,1996.
No. of Figures: 0. No. of Tables: 0. No. of References: 123.

Key mrds: parental self-efficacy; parenting sensitivity; maternal

depression; special needs children

This contribution explores the theoretical role of
parental cognitions, and in particular parental self-
efficacy, or parents’ beliefs about their own
competence in the parenting role, in fostering
sensitivity and competence in parenting. We begin
with a brief discussion of parental cognitions as
central determinants of parental behaviour. We
‘Correspondence to: Dr Douglas M. Teti, Department of
Psychology, University of Maryland Baltimore County, 1000
Hilltop Circle, Baltimore, MD 21228, USA.
then examine the role of parenting efficacy in the
prediction of parental sensitivityin two contexts:(1)
in parents sufferingfrom clinical depression, which
has been linked empirically to problematic
parenting and child developmental risk (Downey
and Coyne, 1990; Gelfand and Teti, 1990); and (2) in
parents of young children with special needs by
virtue of medical fragility (e.g. low birthweight or
prematurity) or identified developmental delay.
Interestingly, very little work has examined the
mediational role of parenting efficacy in the latter

CCC 1057-3593/96/040237-14$17.50 Received 16 December 1996

01996 by John Wiley & Sons, Ltd. Accepted 22 January 1996
238
context, despite the considerable challenges that
special needs children createfor their parents. These
two contextsare representativeof a broader array of
p a r e n t a l d risk factors that, we propose, should
debilitate parental sensitivity indirectly via their
more direct impact on parental self-efficacy. In
addition to this working model, we consider some
additional social-contextual predictors that, again,
we propose will impact parental sensitivity
indirectly, either by directly affecting parental self-
efficacyor by moderating relations between parent-
child risks and self-efficacy. In either case, we
advance the premise that parental self-efficacy is
the ’final common pathway‘ mediating relations
between parent-child characteristics, social-
contextual factors and parental sensitivity.
COGNlTIONS AND PARENTING
Despite the ‘cognitive revolution’ that has
dominated psychology over the past three
decades, the interface of cognition and parenting
has been addressed only recently (Maccoby and
Martin, 1983; Main et al., 1985; Miller, 1988; Sigel,
1985). Traditionally, parenting practices and
family interaction patterns have been explained
more in terms of learning and personality
processes, and although it is widely assumed
that cognition, emotion and behaviour are closely
intertwined, considerable debate exists over the
primacy of each (Goodnow, 1988). Consistent with
a transactional perspective on development
(Bandura, 1986; Goodnow, 1988; Sameroff, 1975),
there is evidence of complex interactive linkages
between multiple systems. For example, in some
circumstances, cognition is thought to drive
behaviour (Bandura, 1986; Teti and Gelfand,
1991). In others, cognitions are viewed as arising
from individual experiences with the environment
(Bandura, 1986; Goodnow, 1988). Finally, cognitive
appraisals of environmental events are seen as
intimately tied to action tendencies, which in turn
predispose emotion and behaviour (Frijda et al.,
1989). Curiously, social developmental theorists
have been more concerned with cognitive-
behavioural relations in children rather than in
parents. Attachment theorists (Ainsworth et al.,
1978; Bowlby, 1973; Bretherton, 1985; Crittenden,
1992; Sroufe, 1983; Sroufe and Fleeson, 1986), for
example, propose that children develop a
‘working model’ of their caregivers and
themselves, conceptualized as a set of affectively
laden cognitions or ’rules‘ regarding interpersonal
Early Dev. Parent. 5 237-250 (1996)
D. M . Teti, M . A. O‘Connell and C. D. Reiner
relationships, the content of which is shaped by
quality of care. These cognitive organizations are
seen as guiding the quality of ensuing behaviour
that young children exhibit towards caregivers
and peers and influencing the manner in which
subsequent information from significant others is
selected and interpreted (Main et al., 1985).
Systematic attempts to examine cognitive-
behavioural interfaces in parenting have emerged
in earnest only in the last decade (eg. Dix and
Grusec, 1983; Sigel, 1985), despite some early
attempts to identify cognitive mediators of
parental functioning (e.g. Emmerich, 1969).
Cognitions and emotions are now placed at the
heart of conceptualizations of parenting, with
cognitiveaffective organizations parents bring to
the dyadic setting viewed as causal to parenting
behaviour and as potentially open to modifiability
as parent-child relationships proceed. Attachment
theory and research, for example, has expanded to
incorporatethe effects of parental ’working models’
of relationships, believed to be rooted in (but not
necessarily veridical with) parents’ early
relationship histories, in parents’ propensities to
perceive children’s cues without distortion and to
respond to children sensitively and appropriately
(Bakermans-Kranenburgh and Van Ijzendoorn,
1993; Main et al., 1985; Van Ijzendoorn, 1992). Dix
and his colleagues (Dix and Grusec, 1983; Dix and
Lochman, 1990; Dix and Reinhold, 1991; Dix et al.,
1986, 1990) conceptualize parenting as a process
mediated by parental attributions about such
factors as the degree to which children are to be
held responsible for their actions, children’s
intentions and children’s social competence, all of
which are age- and gender-dependent. Dix (1991)
has presented a model of parenting that places
affective organizations at the centre of the parenting
process, conceptualized as a dynamic, reciprocal
interplay between emotional activation,
engagement and regulation. Although this model
places greater weight on the role of emotion rather
than cognition in organizing parenting behaviour,
cognitions (e.g. appraisal processes) are viewed as
central determinants of emotions, and both are thus
closely intertwined. Whether it is cognition or
emotion, however, that immediately precedes
parental responding at a given moment is a
theoretical issue that defies easy testing. We view
cognition, emotion and behaviour to be in constant
reciprocal interplay, and attempts to establish
primacy of any one over the others are fraught
with difficulty. In this paper, our discussion of
parental self-efficacy as a mediator of child
01996 by JohnWiley & Sons, Ltd.
Parental Self-Eficacy
outcomes operates from a level of analysis that
views cognitive appraisal processes as both
predictive of and responsive to affective states and
behaviour.
PARENTING EFFICACY AND
SENSITIVITY AMONG DEPRESSED
MOTHERS
Evidence is widespread that depressed mothers
hold decidedly negative cognitions about their
children and themselves. For example, depressed
mothers have more negative perceptions of their
children’s social competence and psychiatric
adjustment than do nondepressed mothers
(Fergusson et al., 1985; Forehand ef al., 1986; Fox
and Gelfand, 1994; Friedlander et al., 1986; Griest et
al., 1979; Pannaccione and Wahler, 1986; Rickard et
al., 1981; Rogers and Forehand, 1983; Schaughency
and Lahey, 1985; Webster-Stratton and Hammond,
1988), which may predispose such mothers to
overestimate the extent and seriousness of their
children’s problems (Rickard ef al., 1981).
Depressed cognitions may figure importantly in
accounting for the widespread documentation of
problematic parenting among depressed mothers.
The parenting of depressed mothers has
been variously characterized as insensitive, incom-
petent, apathetic and uninvolved, ineffective,
emotionally flat, disengaged, intrusive and angry
(Cummings and Davies, 1994; Gelfand and Teti,
1990; Goodman, 1992). In turn, children of
depressed parents are at risk for insecure
attachment, emotional dysregulation and psycho-
pathology (Cummings and Davies, 1994; Field,
1984; Murray, 1992; Radke-Yarrow et aI., 1985; Teti
ef al., 1995; Zahn-Waxler ef al., 1984).
Interestingly, researchers have only recently
begun to examine maternal self-efficacy beliefs in
relation to maternal behaviour (e.g. Davis, 1990;
Donovan and Leavitt, 1989; Gross and Conrad,
1992; Teti and Gelfand, 1991), despite Bandura’s
(1982, 1986) seminal formulations identifymg self-
efficacy as a central mediator of relations between
knowledge and behaviour. This belated application
is likely because self-efficacy theory originally
emerged from laboratory work that assessed self-
efficacy change as a function of deliberate
inductions of success or failure experience
(Bandura and Wood, 1989), positive and negative
moods (Kavanagh and Bower, 1985) or
performance-contingent feedback (Newman and
Goldfried, 1987). Bandura (1982,1986) and Bandura
01996 by JohnWiley & Sons, Ltd.
239
and Wood (1989) define self-efficacy beliefs as
judgments about one’s competency at a particular
task or in a particular setting. Bandura‘s (1986)
social-cognitive theory proposes that self-
efficacious individuals, who judge themselves as
competent and effective in a given task, are
expected to persist in their endeavours to achieve
success even in the face of rather formidable
obstacles, whereas self-inefficacious individuals
are expected to lack such tenacity and give up
prematurely, even though success is potentially
achievable. Further, relations between self-efficacy
beliefs and performance attainments are viewed as
bidirectional, in that how efficacious one feels at a
given task is also related to one‘s history of
successes and failures at that task. Although self-
efficacy is believed to be most strongly affected by
performance attainments, it is also susceptible to
other influences, such as affective state, vicarious
experiences (e.g. modelling) and social persuasion
from support figures.
Not surprisingly, depressed mothers of young
children report feeling less efficacious in the
parenting role than do nondepressed mothers
(Fox and Gelfand, 1994; Teti and Gelfand, 1991;
Teti et al., 1990). Depressed mothers’ self-inefficacy
as parents may derive from the propensity of sad
affect to foster negative, pessimistic, ruminative
thought processes about oneself and one’s
environment (Clark and Teasdale, 1982; Isen, 1984;
Teasdale and Fogarty, 1979) and to selectively
activate memories of failure experiences (Bower,
1981). Inefficacious mothers’ self-doubts in turn
should lead to insensitive parenting, marked by
impatience, rigidity and withdrawal.
Using 38 nondepressed and 48 clinically
depressed lower-middle to middle class mothers
and their first-year infants, Teti and Gelfand (1991)
specifically tested the hypotheses that (1)maternal
self-efficacy would relate positively to mothers’
behavioural competence (sensitivity) with their
infants, and (2) maternal self-efficacy would
mediate relations between maternal behavioural
competence and the predictor variables of severity
of depressive symptoms, infant temperamental
difficulty and social-marital supports. All mothers
were in therapy for their depression at recruitment
and had received DSM-III-R diagnoses of major
depression, dysthymia or adjustment disorder
with depressed mood from their therapists. Non-
depressed mothers were recruited from the same
neighbourhds as the depressed mothers.
Severity of depressive symptoms was assessed
with the Beck Depression Inventory (BDI; Beck ef
Early Dev. Parent. 5: 237-250 (1996)
240
al., 1961). Social-marital supports were measured
with a standardized composite score derived from
the marital harmony scales of Locke and Wallace
(1959) and Spanier (1976) and social support
subscales of the Interview Schedule for Social
Interaction (Henderson et al., 1981). The fussy-
difficultness subscale of the Infant Characteristics
Questionnaire (Bates et al., 1979) served to obtain
mothers’ perceptions of infant temperamental
difficulty. Maternal self-efficacy was examined
with a scale developed by the authors that
inquired about self-efficacy beliefs in nine
domains of parenting specific to mothers of first-
year infants (e.g. soothing, understanding baby’s
wishes, maintaining baby‘s attention), with a final
question that inquired about the women’s global
sense of self-efficacy as parents. A single score for
maternal self-efficacy was obtained by summing
the individual scores of the 10 items (alpha=0.86).
Finally, maternal behavioural competence was
derived from observations of mothers’ behaviour
in contexts of feeding and free play. Individual
dimensions of mothers’ behaviour rated by ‘blind’
observers were adapted from scales developed by
Zoll et al. (1984) and included sensitivity, warmth,
flatness of affect, disengagement and anger. These
ratings were adjusted so that higher scores always
reflected more competent behaviour and the 10
ratings (5 per context) were summed to create a
composite maternal behavioural competence index.
Interrater (Pearsonr=0.87 on 18dyads) and internal
reliability (alpha=0.86) on this composite was
adequate. As expected, maternal self-efficacy
beliefs correlated negatively with mothers’
depressive symptomatology and perceptions of
infant temperament, indicating that mothers felt
less efficacious as parents when their depression
levels were high and when they perceived their
infants as difficult. In addition, maternal self-
efficacy beliefs correlated positively with mothers‘
social-marital supports and with independent
observers’ judgements of their behavioural
competence with their infants. Subsequent
multiple regression analyses indicated that
maternal self-efficacy beliefs continued to predict
maternal behavioural competence even after the
other variables were statistically controlled (i.e.
maternal depressive symptomatology, social-
marital supports and perceptions of infant
temperament). In addition, relations of maternal
depressive symptoms, social-marital supports and
perceptions of infant temperament to maternal
behavioural competence were substantially
reduced when maternal self-efficacy beliefs were
Early Dev. Parent. 5: 237-250 (1996)
D.M. Teti, M. A. O‘Connell and C.D.Reiner
statistically controlled. Although these data are
correlational, they nevertheless suggest that
mothers‘ affective states and perceptions of their
social environments significantly influenced
maternal self-efficacy beliefs, which in turn
influenced parental sensitivity.
ADJUSTMENT AMONG PARENTS OF
SPECIAL NEEDS CHILDREN
The link between parental well-being and maternal
self-efficacy (e.g. Cutrona and Troutman, 1986; Teti
and Gelfand, 1991)among depressed mother-infant
dyads suggests that parental self-efficacy, and in
turn parenting sensitivity, may be especially
compromised when parents are faced with the
challenges and uncertainties attendant on rearing a
child with special needs. Unfortunately, the relation
of maternal self-efficacy to parental sensitivity and
competence has not been examined at length with
parents of special needs children. Most of the
published literature on the parents of special
needs children has focused on overall parental
adjustment and well-being.Such parents reportedly
experience high levels of anxiety (McGettiganet al.,
1994; Roman et al., 1995), depressive symptom-
atology (Bennett and Slade, 1991; Bristol et al., 1988;
McGettigan et al., 1994; Miller ef al., 1992; Roman et
al., 1995), psychological distress (Goldberg et al.,
1986), elevated discrete life stressors (Beckman,
1991; Friedrich and Friedrich, 1981; Hanson and
Hanline, 1990; Innocenti et al., 1992) and marital
discord (Cmicet al., 1983a; Friedrich and Friedrich,
1981).
These adjustment difficultiestypically commence
at the moment parents are faced with the news that
their baby is different, or at risk to become different,
from other children. Parents of mentally
handicapped children often initially feel ’stunned’,
‘numb’, ‘sad’, ’shock’ and ’regret’ when first
learning of their child’s diagnosis (Seideman and
Kleine, 1995).Further, mothers who give birth to a
child with serious medical complicationsmust deal
with the loss of the expected healthy infant (Solnit
and Stark, 1961)and adapt to the fact that the child
may not develop normally. Parents of medically
fragile children who require neonatal intensive care
services are often anxious about their child‘s
condition and survival, and about their ability to
care for the child after discharge from the hospital
(Pederson et al., 1987). Not surprisingly, the degree
of adjustment difficulties appears to relate
straightforwardly to the severity of neonatal risk
01996 by John Wiley & Sons, Ltd.
Parental SeZj-Eficacy
status. For example, Bennett and Slade (1991) found
that when infants were at greater risk, mothers
reported more difficulty in expressing affection
towards their infants. Similarly, they found that the
lower the infant’s birthweight, and the longer
the infant‘s hospitalization, the longer it took for
the mother to develop feelings of attachment to her
baby. Jeffcoateet al. (1979) reported that half of the
mothers of preterm infants in their sample did not
feel emotionally attached to their infants until at
least 2 months after the infants were born.
There is also the unfortunate tendency for some
parents of medically fragile or handicapped
children to experience guilt or self-blame about
their child’s condition. For example, some mothers
of premature infants feel they have failed in their
reproductive role by not carrying their babies to
term (Jeffcoate et al., 1979). Mothers of Down
syndrome children engage in self-blame more
often that do mothers of developmentally normal
children (Rodrigueef al., 1990),perhaps because the
genetic aetiology of Down syndrome predisposes
parents to feel responsiblefor their child’s condition
(Goldberg et al., 1986).
Parents of medically at-risk children report
significant disruption in their parental roles if the
child must be hospitalized in the neonatal intensive
care unit (NICU) (Miles et al., 1992). Parents’
inability to bring their child home from the
hospital right away makes it difficult for parents
to feel as if the child is truly theirs (Jeffcoate et al.,
1979). It may also be difficult for parents to really
feel that they are the child’s parents when nurses
and doctors are primarily responsible for seeing to
the child’s care. Despite the fact that NICU practices
have changed within the last two decades such that
parents are now encouraged to help care for their
infants on site, some problems make it more
difficult for the parents to become involved with
their infant. For example, parents are often unable to
hold infants who are on respirators. Additionally,
mothers may be unable to breast-feed infants who
are in the NICU and to visit their children frequently
because they live significant distances from the
hospital.
PARENTING EFFICACY AMONG
PARENTS WITH SPECIAL NEEDS
CHILDREN
Although surprisingly little research has targeted
relations between parenting efficacy and
individual differences in parenting quality
01996 by John Wiley & Sons, Ltd.
241
among parents of special needs children, we
would expect that the adjustment difficulties
parents experience in relation to the birth of a
special needs child, and to the difficulties these
children create as a function of the severity of their
conditions, would impact directly upon parental
feelings of efficacy, the quality of their parenting,
and in turn the extent of individual differences in
the developmental outcomes of these children.
Indeed, long-term, persistent difficultieshave been
found to pose problems for parenting efficacy and
the parent-child subsystem. In one of the few
studies to assess parental self-efficacy among
parents of developmentally delayed children,
Crnic et a2. (1983a) reported that mothers of such
children reported greater depressive and
dysphoric effects, more preoccupation with the
child, lowered feelings of parental efficacy (i.e.
sense of competence), less enjoyment of the child
and greater possessiveness.
Interestingly, parents faced with uncertainty
about the developmental outcome of their
children (e.g. being suspected of cerebral palsy,
but not manifesting symptoms to a sufficient
degree to warrant a clear diagnosis) may
experience greater adjustment difficulties, and
parental inefficacy, than parents of children with
a clear-cut diagnosis. In a study by Goldberg (1983,
as cited in Goldberg et al., 1986), mothers of
children with Down syndrome were found to be
less stressed than mothers of children whose delay
was related to unknown aetiologies. Goldberg et a2.
(1986) suggested that parents of children with
Down syndrome had more time to adjust to child-
related difficulties than parents of children with
developmental delay because they knew about the
child’s diagnosis relatively early and could
prepare accordingly. These parents would thus
be expected to experience less negative
adjustment, and greater feelings of parental
efficacy, than would parents whose children had
developmental delays that became manifest more
gradually and for whom the prognosis for such
developmental problems might be more uncertain.
The Competent Parent-Child Dyad
It is theoretically likely that feelings of efficacy in
both parents and children may be adversely
affected in the context of child risk status or
handicap. In her seminal paper, Goldberg (1977)
notes that parents of children who experience
difficulty reading or responding to the other can
lead to ‘incompetent’ parent-infant dyads which
Early Dev. Parent. 5 237-250 (1996)
242
can foster feelings of inefficacy in both partners.
Parental self-efficacy is predicated upon the
parents’ ability to appropriately read, interpret
and respond to the infant’s cues. Thus, infants
whose signals are clear and unambiguous should
lead to parental feelings of efficacy, especially if
parents in turn are able to witness the effectiveness
of their efforts in responding to infant signals.
Children who signal poorly, perhaps because of
immature and/or developmentally delayed or
compromised nervous systems, would make it
more difficult for parents to read and respond
appropriately, ultimately fostering parental
feelings of inefficacy. Children’s feelings of
efficacy, in turn, are predicated on their
caregivers’ ability to respond appropriately to
their bids for food, comfort and attention, which,
to a great degree, is likely to be a function of the
child’s ability to provide the parent with clear,
readable signals (and on the parent’s state of
motivation to respond to such signals, which may
be compromised by parental depression). A
‘competent‘ parent-child dyad is thus one in
which the child’s social cues are readable and
interpretable, and in turn are responded to
contingently and appropriately by the parent.
Parents of premature infants tend to be less
actively involved with their babies than parents of
full-term infants. Parents of premies have been
found to make less body contact with their babies,
spend less time face-to-face with their infants,
smile at their infants less, touch them less and talk
to them less (Goldberg, 1978). Given the difficulty
these parents may have understanding their
infant‘s cues, they may be more prone to develop
feelings that they are less competent parents. In a
review of studies of parents’ interactions with
developmentally disabled and at-risk children,
Mitchell (1987) proposed explanations for why
some of these parent-child interactions tend to be
dysfunctional. He notes that not only is it important
to consider the role of the plwnature infant in
interactions, but also the role of the ’premature
parent’ (Als ef al., 1979, as cited in Mitchell, 1987).
Parents may not be ready to deal with a special
needs child, and may lack knowledge about how to
read the child’s signals. Mitchell also suggests that
difficulties arise when parents must be separated
from the infant during the initial hospitalization
period; hence, opportunitiesfor developingoptimal
interactionalstrategies may be quite limited. These
interactional difficulties may foster feelings of
parental inefficacy and helplessness. Mitchell
furtherproposes that interactional difficulties may
Early Dev. Parent. 5: 237-250 (1996)
D. M. Tefi,M. A. O’Connell and C. D. R e i w
arise because parents view their developmentally
delayed or at-risk child as vulnerable when, in fact,
the child may be developing normally. He reviews
studies in which infants who are randomly labelled
as premature are rated by mothers (Stem and
Hildebrandt, 1986, as cited in Mitchell, 1987) and
by college students (Miller and Ottinger, 1986, as
cited in Mitchell, 1987) to be less alert and
responsive social partners, less enjoyable to
interact with and less attractive, and are treated
more delicately than infants who are randomly
labelled as full-term. Thus,expectancybiases about
the premature infant may influence parenting even
in the absence of identifiable developmental
problems.
A mother’s belief about her effectiveness as a
parent can influence how much and what she
attends to, the effort expended in raising her child
and her emotional reactions to her child’s
behaviour (Mash and Johnston, 1990). Further,
parenting is influenced by what parents consider
their child to need, which is a function of past
experience with that child, the child’s clarity of
communication and social signalling and the
child’s developmental status. When that child is
medically compromised and/or developmentally
delayed, communicative effectiveness may be
dramatically decreased. In turn, parents may
provide their child with less age-appropriate
stimulation and structure, with negative
consequences for development. On this note,
parents of mentally retarded children who had
doubts about their parenting abilities and of their
capacity to adapt to their children’s condition
reported more child-rearing problems than did
parents who expressed confidence in their
parenting skills (Friedrich et al., 1985).
PARENTAL SELF-EF’FICACY AND THE
SOCIAL CONTEXT
Importantly, children of depressed mothers and
children with a given special need experience
variable developmental outcomes (Conrad and
Hammen, 1993; Goldberg et al., 1986; Radke-
Yarrow and Brown, 1993; Teti et al., 1990).Reasons
for these individual differences are complex.
Formulations addressing individual differences
among children of depressed parents, which
usually target socioemotional developmental
outcomes more than cognitive outcomes, centre
around risk factors that increase children’s
vulnerability to psychopathology (e.g.
01996 by JohnWiley & Sons, Ltd.
Parental Self-Eficacy
'constitutional ' factors such as low intelligence) or
resilience factors that buffer children against the
negative effects of inadequate caregiving
environments (e.g. social competence with peers)
(Cicchetti and Aber, 1986; Conrad and Hammen,
1993; Garmezy, 1987; Rutter, 1987). Individual
differences among special needs children have
(interestingly) targeted cognitive developmental
outcomes more often than socioemotional
outcomes, with differences in socioeconomic
status and severity of children's illness or
condition most often cited as explanations (Blair
and Ramey, 1997; Pearl, 1993). However, the direct
link between parental self-efficacy and parental
competence (Teti and Gelfand, 1991)suggests that
variation in the long-term outcomesof children who
are at risk, due to parental psychopathology,
medical fragility or developmental delay, is an
important function of individual differences in
parental appraisals of themselves and their
children, in keeping with a model of cognitive
mediation.
Thus far we have developed a working model of
relations in which parental feelings of efficacy are
predictable from knowledge of risk factors
inherent in the parent (e.g. parental
psychopathology, problematic developmental
history) and in the child (e.g. prematurity/low
birthweight, developmental delay), and where
parental self-efficacy in turn should be the 'final
common pathway' in the prediction of parental
sensitivity. Parenting efficacy, however, is
complexly determined, and in addition to
parent-child risks we now in particular consider
the role of two (of potentially many) aspects of
parents' social context in the prediction of
parenting efficacy. The first of these is infant
temperamental difficulty, which has alternatively
been conceptualized as a risk factor inherent in the
child (e.g. Belsky, 1984) but which we discuss as a
social-contextual risk because (a) it is not
necessarily associated with child health status
(Gennaro e f al., 1992), and (b) as a construct that
is measured predominantly from parental report,
it functions as an important psychosocial stressor
in the context of parent-child relations. The second
is the quality of social-marital supports, which
should affect parental self-efficacy via the
influences of social persuasion and modelling
(Bandura, 1986), and via the provision of
encouragement, emotional support and respite
care. As we discuss, it is theoretically plausible to
consider these two predictors alternatively as
'main effect' determinants of parental efficacy or
81996 by John Wiley & Sons, Ltd.
243
as moderators of relations between parent-child
risks and parenting efficacy.
Infant Temperament
Although variously conceptualized, temperament
in infancy is generally believed to be genetically
based and can be operationally defined by such
dimensions as emotionality, activity, predictability
of daily cycles and rhythms, adaptability to novel
environmental stimuli and sociability (Bates et al.,
1979; Buss and Plomin, 1975; Carey and McDevitt,
1978; Goldsmith et al., 1987; Rothbart, 1981;
Thomas and Chess, 1977). A fussy, active, slow-
to-adapt, unpredictable baby may be challenging
for any mother, who might then develop negative
perceptions of the baby and of herself as a parent.
As discussed earlier, Goldberg (1977) has argued
that mothers' self-appraisalsof their effectivenessin
the caregivingrole (i.e. maternal feelings of efficacy)
should be fostered by infants who are easy to
manage and predictable. Conversely, self-
appraisals of ineffectiveness would be expected if
mothers are faced with babies who are chronically
fussy, difficult to read and unpredictable. That
infant temperamental difficulty can and should be
considered a 'main effect' determinant of parental
self-efficacy is evidenced by findings from several
sources emphasizing infant temperament's
negative relation to maternal self-efficacy (Cutrona
and Troutman, 1986; Davis, 1990; Deutsch e f aL,
1988; Gross and Conrad, 1992; Teti and Gelfand,
1991). Temperamentally difficult babies, by
definition, are those who are difficult to soothe,
less 'readable' and signal poorly, and thus these
findings lend support to Goldberg's (1977) and to
Bandura's (1982, 1986) formulations, which view
self-efficacy beliefs as based on performance
attainments. Teti and Gelfand (1991) propose that
maternal self-efficacyis crucial to an understanding
of the construct of 'goodness-of-fit' between parent
and child characteristics(Thomas and Chess, 1977).
Indeed, relations between infant temperamental
difficulty and maternal responsivity are incon-
sistent, with some studies showing increases,
decreases or no effect of infant temperament on
maternal behaviour (Crockenberg, 1986). One
explanation for these inconsistencies is that
difficult infant temperament may impact the
parenting behaviour of different mothers
differently, depending on mothers' initial levels
of selfefficacy. A woman with a difficult baby but
with high levels of maternal self-efficacy would be
expected to try harder, to make better use of her
Early Dev. Parent. 5: 237-250 (1996)
244
personal and social resources to achieve a
successful, harmonious relationship with her
infant, than would a woman with an equally
difficult baby but with low maternal self-efficacy.
The first woman might view her baby as ‘feisty,
vigorous and full of life’; the second might view
her baby as ‘noisy, tiresome and difficult’.
In addition to conceptualizing infant
temperamental difficulty as a ‘main effect‘
determinant of parenting efficacy, however, Teti
and Gelfand (1991) discuss the putative role of
infant temperament as a moderator of relations
between parental depression and self-efficacy.
Depressed mothers report lower levels of self-
efficacy than do non-depressed mothers (Fox and
Gelfand, 1994; Gross and Rocissano, 1988; Teti and
Gelfand, 1991), and thus depressed mothers as a
group are more vulnerable to perceiving a
temperamentally difficult baby negatively and to
developing performance deficits in mothering. The
combination of maternal depression and infant
difficulty may create problems for parent-hild
relations and child development that exceed that
which would be predictable from a purely additive,
‘main effect’ model of relations. In support of this,
Teti and Gelfand (1991) reported in multiple
regression analyses that severity of maternal
depressive symptoms (mothers’ BDI scores) and
perceptions of infant difficulty scores interacted in
predicting mothers‘ feelings of efficacy. Maternal
self-efficacy was highest (predicted mean=29.38)
among mothers whose depressive symptoms were
relatively mild and who saw their infants as
temperamentally easy. Intermediate self-efficacy
scores were obtained from mothers who reported
high levels of depressive symptoms but who
perceived their infants as easy (predicted
mean=20.63), and from mothers who reported
low levels of depressive symptoms but who saw
their infants as difficult (predicted mean=26.28).By
contrast, maternal self-efficacy was lowest
(predicted mean=13.01), and lower than would
have been expected from a purely additive model
of relations among these variables, in mothers who
reported high levels of depressive symptomatology
and who perceived their infants to be difficult.
Thus, the ‘double jeopardy’ combination of
moderate-severe depression and a perceived
difficult baby may place mothers at substantially
higher risk for parenting disturbances with their
babies than the presence of either risk factor alone.
The relation between temperament and children
with special needs is equivocal. On the one hand,
there is evidence to suggest that the temperaments
Early Dev. Parent. 5 237-250 (1996)
D. M . Teti, M . A. O‘Connell and C. D. Reiner
of special needs children, in particular premature/
low birthweight children, are more difficult than
those of low-risk children (Goldberg, 1978;
MedoffCooper, 1986), which in turn can be
exacerbated by medical complications at birth
and during the early postnatal period (Field et
al., 1978). Premature infants are often less
responsive to social stimulation and less alert
than full-term infants (Bakeman and Brown, 1980;
Cmic et al., 1983c; Field, 1977; Honig, 1984), and
their cries have been found to be risk predictors for
developmental disabilities (Honig, 1984).
However, other studies comparing the
temperaments of 4-to-8-month-old preterm vs
full-term infants found no group differences
when using parent report (Oberklaid et al.,
1986b). Further, Gennaro et al. (1992) reported
that differences in temperamental difficulty
among medically fragile and full-term infants
could not be accounted for from knowledge of
infants’ medical risk status.
The importance of taking stock of children‘s
temperaments, and their putative impact on
parenting efficacy independently of children’s
special needs status, is underscored by these
data. Caring for a special needs child in and of
itself may create parental feelings of uncertainty
and helplessness. The social cues of the premature
infant, for example, can be unpredictable, vague
and age-inappropriate, creating special challenges
for parents and negative consequences for self-
appraisals of parenting. When this child is also
temperamentally difficult, the negative effects on
parenting efficacy and sensitivity may be
profound, and perhaps to a degree greater than
that predictable from a purely additive model
alone. Whether these relations conform to an
additive model or a model in which
temperament is conceived as a moderator of
relations between children’s special needs status
and parenting efficacy is an issue worthy of
exploration.
Social-Marital Supports
The quality of instrumental and emotional support
experienced by parents represents a second social-
contextual influence on mother-child relations in
infancy and early childhood. Mothers with low
social support and with unhappy marriages
behave less optimally with their infants than do
mothers with adequate support networks and
happy marriages (Cox et al., 1989; Crnic et al.,
01996 by John Wiley & Sons, Ltd.
Parenfal Se5f-Eficacy
1983b; Crockenberg and McCluskey, 1986;
Goldberg and Easterbrooks, 1984).
Like infant temperament, social-marital supports
should affect maternal functioning via their impact
on maternal percepts and feelings. Self-efficacy
theory (Bandura, 1982,1986) suggests that support
from intimates will directly affect mothers’ self-
efficacy via modelling influences (e.g. learning
about successful child care routines by watching
competent relatives and friends) and positive
consequences in the form of encouragement and
praise. This position receives support from several
studies that have reported positive relations
between quality of social-marital supports and
mothers’ self-efficacy (Davis, 1990; Donovan and
Leavitt, 1989; Teti and Gelfand, 1991).However, we
also view social-marital supports as a potentially
important moderator of relations between parent-
child risks and parenting efficacy. In an important
study, Crockenberg (1981) found that young
temperamentally difficult infants were sig-
nificantly more likely to become securely attached
to their mothers when their mothers’ levels of social
support were high than when they were low. It is
reasonable to expect that mothers prone to
depression but whose marriages and support
networks are adequate would tend to have more
positive perceptions of themselvesand their infants,
and would be more behaviourally competent with
their infants than would depression-pronemothers
with inadequate supports. Similarly, it is plausible
that social-marital supports may moderate
relations between children’s special needs status
and parenting efficacy, reducing this association
when social-marital supports are high and/or
increasing it when low. Again, we believe these
moderator relations can and should be empirically
tested.
IMPLICATIONS FOR INTERVENTION
Parenting cognitions, and in particular parental
self-efficacy, should be important targets for
intervention, and thus professionals should
become aware of the parental self-efficacy beliefs
as they are shaped by parental well-being,
children’s special needs status and the social
context. Professionals such as paediatricians or
psychologists to whom parents have ready access
during the initial transition to parenthood or during
a depressive episode are in a position to assist
parents and their intimate support figures through
the provision of information about the child’s
61996 by John Wiley & Sons, Ltd.
245
medical status, the parent’s emotional state,
potential problem areas in the parent-child
relationship and developmental outcomes.
Psycho-educational interventions with the goal of
fostering parental self-efficacy and parenting
sensitivity should make every effort to include
both parents, and not just mothers, when working
with two-parent households, and/or to include
other intimate support figures who are significant
to mothers (e.g. the baby’s grandmother) if working
with single-parent households. In the context of
parental depression, intimate support figures‘
awareness of the debilitating nature of dep-
ression, its association with marital discord and
difficulties in child care, and its responsiveness to
drug therapy, psychotherapy and social support
from intimates should enable support figures to
be more successful at ’objectifying’ parental
depression and to support the depressed parent,
both instrumentally and emotionally, in seeking
treatment for her/his illness and in daily activities,
including child care (Beardslee et al., 1992; Gelfand
and Teti, 1990). Similarly, interventions targeting
parents of special needs children should aim to
educate intimate support figures as well as the
primary caregiver about a child’s specific
condition, prognosis, difficulties to be expected
in child care and individual child strengths, which
in turn should assist support figures in their ability
to provide parents with more concrete and useful
assistance. In both cases, the appropriate
involvement of support figures is expected to
foster parents’ sense of well-being with positive
consequences being feelings of parental efficacy
and effective parenting.
Interestingly, the specific role of professional
supports in fostering parenting efficacy and
parenting sensitivity has received comparatively
little systematic attention. A recently completed
home-based intervention study of clinically
depressed mothers of infants, however,
emphasizes the role of professionals as both
educators and support figures in the lives of
depressed women and their children (Gelfand ef
al., 1996). The intervention aimed to improve the
quality of depressed mother-infant relationships
and was delivered weekly over a 9-12-month
period by trained, registered public health nurses
beginning when infants were in their first year of
life. This intervention was designed from a social-
cognitive, psycho-educational theoretical frame-
work, and it was not uncommon for intervention
mothers to remark that they looked forward to the
nurses’ visits because of both the information and
Early Dev. Parent. 5: 237-250 (1996)
246
the support that the nurses provided. Relative to
depressed control mothers, intervention mothers
showed a significant decrease in severity of
depressive symptoms and daily hassles and their
children were less likely to develop avoidant/
defended attachments. Reductions in depressive
symptoms in the full sample in turn were associated
with increases in mothers’ self-efficacy beliefs,
mothers’ responsivity towards their children and
children’s interest in and involvement with their
mothers, and decreases in parenting stress.
The role of professional supports in shaping
parental perceptions of and behaviour towards
their children may be especially relevant for
parents of special needs children because of the
singularly important role that obstetricians,
neonatologists, paediatricians, psychologists,
nurses and social workers can play in providing
crucial information to parents about children’s
medical condition, prognosis and potential impact
on the parenting subsystem. It seems reasonable
to expect that professional supports may be
especially important to parental feelings of
efficacy during the initial stages of adjustment to
a special needs child, and perhaps even more
critical in the early stages of parenting than
quality of support provided by intimates. Cmic
et al. (1986) found that satisfaction with
professional support was a better predictor of
satisfaction with parenting than support from
intimates, friends and the community 1 month
after infant discharge from the NICU. Satisfaction
with professional support also moderated the
relation between stress and satisfaction with
parenting and was related to more positive
maternal affect during mother-infant interaction.
The importance of professional supports is again
highlighted in an important psycho-educational
intervention study designed to foster development
among low-birthweight infants (Achenbach et al.,
1990, 1993; Rauh et al., 1988). The intervention
involved 11 sessions, the first seven of which took
place during infants’ final week in the NICU and
the last four of which were delivered at home over
the first 3 months of life. During these sessions, a
trained paediatric nurse provided information to
parents (typically mothers, although fathers were
included if available) about children’s
developmental status and individual infant
strengths in domains of autonomic and motor
functioning,state regulation and social interaction
and play. Intervention parents reported higher
scores on measures of parenting confidence and
satisfaction (constructs closely related to parenting
Early Dev. Parent. 5 237-250 (1996)
D.M. Teti, M. A. O’Connell and C.D.Reiner
efficacy) than did control parents, and their
children had higher intellectual development
scores than did control infants at 3, 4, 7 and 9
years of age (no findings regarding mother-child
interaction were reported).
Direct evidence for improved parenting as a
result of professional support comes from a study
by Affleck et al. (1989), who randomly assigned
mothers who had infants in the NICU to a
professional support intervention or to a control
condition. The intervention was based on a
consultation model in which nurses visited
mothers in the home to help these mothers make
the transition from hospital-to-home care after
infant discharge. The consultation model was
distinct from parent training models or infant
cumculum models in that the mothers directed
which issues about their child or about parenting
were to be emphasized. Results indicated that 6
months after infant discharge from the NICU,
mothers who expressed a high need for support
prior to interventionexperienced improved feelings
of personal control over child health and
developmental outcomes, increased feelings of
parenting competence, and were rated highly by
the nurse consultant as being sensitive and
responsive to infant cues. However, the
intervention appeared to worsen the adjustment
among mothers who expressed a low need for
support.
Affleck et al. (1989) proposed that mothers who
expressed a high need for support were those who
had difficulty obtaining support from family
members and friends, and thus were more likely
to benefit from professional support than were ’low
need‘ mothers. ‘High need‘ mothers actively
requested information, advice, instruction and
reassurance about their child and about
themselves as parents from the nurse consultants,
in contrast to ‘low need‘ mothers. ’Low need‘
mothers, by contrast, may have been given
information about their babies that the mothers
did not actively seek out or want. In turn,this may
have drawn ’low need‘ mothers’ attention to
problems about which they initially had less
concern. This may have disrupted any favourable
attitudes the ‘low need’ mothers may have had
initially about their children’s condition and
impaired their adjustment to parenting.
These studies attest to the power of ongoing,
accurate, sensitive and appropriately tailored input
from professionals. Such input can assist stressed,
beleagured parents in developing a clearer and
more objective understanding of their infants (and
01996 by John Wiley & Sons, Ltd.
Paren fa1 Self Efficacy
of themselves, in terms of parent risks) and foster
feelings of parental efficacy,parental sensitivityand
children’s cognitive and social development over
the long term.
CONCLUSIONS
In this paper we advanced the premise that the
impact of parent-childand social-contextualfactors
on parental sensitivity is mediated by parental
feelings of efficacy, which serve as the ’final
common pathway’ in the prediction of parental
sensitivity. Although the construct of self-efficacyin
clinical experimental research is well established
(Bandura, 1986), its importance as a determinant of
parenting behaviour, and as a primary target of
intervention in its own right, is still evolving.This is
a positive trend and one that we hope continues.
REFERENCES
Achenbach, T. M., Howell, C. T., Aoki, M. F. and Rauh,
V. A. (1993). Nine-year outcome of the Vermont
Intervention Program for low birth weight infants.
Pediatrics, 91, 45-55.
Achenbach, T. M., Phares, V., Howell, C. T., Rauh, V. A.
and Nurcombe, B. (1990). Seven-year outcome of the
Vermont Intervention Program for low-birthweight
infants. Child Development, 61, 1672-1681.
Affleck, G., Tennen, H., Rowe, J., Roscher, B. and
Walker, L. (1989). Effects of formal support on
mothers’ adaptation to the hospital-to-home
transition of high-risk infants: the benefits and costs
of helping. Child Development, 60, 488-501.
Ainsworth, M. D. S., Blehar, M. C., Waters, E. and Wall,
S. (1978). Patterns of Attachment: A Psychological Study of
the Strange Situation. Hillsdale, NJ: Erlbaum.
Bakeman, R. and Brown, J. V. (1980). Early interaction:
consequences for social and mental development at
three years. Child Development, 51, 437-447.
Bakermans-Kranenburgh,M. J. and Van Ijzendoorn,M. H.
(1993). A psychometric study of the Adult Attachment
Interview: reliability and discriminant validity.
Developmental Psychology,29,870-879.
Bandura, A. (1982). Self-efficacy mechanisms in human
agency. American Psychologist, 37, 122-147.
Bandura, A. (1986). Social Foundations of Thought and
Action: A Social-Cognitive Theory. Englewood Cliffs, NJ:
Prentice-Hall.
Bandura, A. and Wood, R. (1989). Effect of perceived
controllability and performance standards on self-
regulation of complex decision making. Journal of
Personality and Social Psychology, 56,805-814.
Bates, J. E., Freeland, C. A. and Lounsbury, M. L. (1979).
Measurement of infant difficultness. Child
Development, SO, 794-803.
01% by John Wiley & Sons, Ltd.
247
Beardslee, W. R., Hoke, L., Wheelock, I., Rothberg, P. C.,
van de Velde, P. and Swatling, S. (1992). Initial
findings on preventive intervention for families with
parental affective disorders. American Journal of
Psychiatry, 149, 1335-1340.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. and
Erbaugh, J. (1961). An inventory for measuring
depression. Archives of General Psychiatry, 4, 561-571.
Beckman, P. J. (1991). Comparison of mothers’ and
fathers’ perceptions of the effect of young children
with and without disabilities. American Journal on
Mental Retardation, 95(5), 585-595.
Belsky, J. (1984). The determinants of parenting: a
process model. Child Development, 55, 83-95.
Bennett, D. E. and Slade, P. (1991). Infants born at risk
consequences for maternal post-partum adjustment.
British Journal of Medical Psychology, 64, 159-172.
Blair, C. and Ramey, C. T. (1997). Early intervention for
low-birth-weight infants and the path to second-
generation research. In M. J. Guralnick (Ed.), The
Effectiveness of Early Intervention. Baltimore: Paul H.
Brookes, pp. 77-97.
Bower, G. H. (1981). Mood and memory. American
Psychologist, 2, 129-148.
Bowlby, J. (1973). Attachment and Loss. Vol.2. Separation.
New York: Basic Books.
Bretherton, I. (1985). Attachment theory: retrospect and
prospect. In I. Bretherton and E. Waters (Eds), Growing
Points of Attachment Theory and Research. Monographs of
the Society for Research in Child Development, 50 (nos. 1-
2, Serial No. 209), 167-193.
Bristol, M. M., Gallagher, J. J. and Schopler, E. (1988).
Mothers and fathers of young developmentally
disabled and nondisabled boys: adaptation and
spousal support. Developmental Psychology 24(3),
441451.
Buss, A. H. and Plomin, R. (1975). A Temperament Theory
of Personality. New York Wiley.
Carey, P. H. and McDevitt, S. C. (1978). Revision of the
Infant Temperament Questionnaire. Pediatrics 61,
735-739.
Cicchetti, D. and Aber, L. (1986). Early precursors of
later depression: an organizational perspective. In L.
Lipsitt and C. Rovee-Collier (Eds), Advances in Infancy,
vol. 4. Norwood, NJ: Ablex Press, pp. 87-137.
Clark, D. M. and Teasdale, J. D. (1982). Diurnal variation
in clinical depression and accessibility of memories of
positive and negative experiences. Iournal of Abnormal
Psychology, 91, 87-95.
Conrad, M. and Hammen, C. (1993). Protective and
resource factors in high- and low-risk children: a
comparison of children with unipolar, bipolar,
medically ill, and normal mothers. Developmental and
Psychopathology, 5, 593-608.
Cox, M. J., Owen, M. T., Lewis, J. M. and Henderson,
V. K. (1989). Marriages, adult adjustment, and early
parenting. Child Development, 60, 1015-1024.
Crittenden, P. (1992). Attachment in the preschool years.
Development and Psychopathology, 4, 209-241.
Crnic, K. A., Friedrich, W. N. and Greenberg, M. T.
(1983a).Adaptation of families with mentally retarded
children: a model of stress, coping, and family
Early Dev. Parent. 5: 237-250 (1996)
248
ecology. American Journal of Mental Deficiency, 88(2),
125-138.
Crnic, K. A., Greenberg, M. T., Ragozin, A. S., Robinson,
N. M. and Basham, R. (1983b). Effects of stress and
social support on mothers and premature and full-
term infants. Child Development, 54, 209-217.
Cmic, K. A., Greenberg, M. T. and Slough, N. (1986).
Early stress and social support influences on mothers’
and high-risk infants’ functioning in late infancy.
Infant Mental Health Journal, 7(1), 19-33.
Crnic, K. A., Ragozin, A. S., Greenberg, M. T., Robinson,
N. M. and Basham, R. B. (1983~).Social interaction and
developmental competence of preterm and full-term
infants during the first year of life. Child Development,
54,1199-1210.
Crockenberg, S. B. (1981). Infant irritability, mother
responsiveness, and social support influences on the
security of infant-mother attachment. Child
Development, 52,857-865.
Crockenberg, S. B. (1986).Are temperamental differences
in babies associated with predictable differences in
caregiving? In J. V. Lerner and R. H. Lerner (Eds),
Temperament and Social Interaction in Infants and Children.
San Francisco: Jossey-Bass,pp. 53-73.
Crockenberg, S. and McCIuskey, K. (1986). Changes in
maternal behavior during the baby’s first year of life.
Child Development, 57, 746-753.
Cummings, E. M. and Davies, P. T. (1994). Maternal
depression and child development. Journal of Child
Psychology and Psychiatry, 35, 73-112.
Cutrona, C. E. and Troutman, B. R. (1986). Social
support, infant temperament, and parenting self-
efficacy: a mediational model of postpartum
depression. Child Development, 57, 1507-1518.
Davis, A. L. (1990). Clarifying the role of maternal self-
confidence in maternal interactional competence.
Paper presented at the 7th International Conference
on Infant Studies, Montreal, CA, April.
Deutsch, F. M., Brooks-Gunn, J., Fleming, A., Ruble,
D. N. and Stangor, C. (1988). Information-seeking and
maternal self-definition during the transition to
motherhood. Journal of Personality and Social
Psychology, 55,420-431.
Dix, T. (1991). The affective organization of parenting:
adaptive and maladaptive processes. Psychological
Bulletin, 110, 3-25.
Dix, T. and Grusec, J. (1983). Parental influence
techniques: an attributional analysis. Child
Development, 54,645-652.
Dix, T. and Lodunan, J. (1990). Social cognition and
negative reactions to children: a comparison of
mothers of aggressive and nonaggressive boys.
Journal of Social and Clinical Psychology, 9, 418438.
Dix, T. and Reinhold, D. P. (1991). Chronic and
temporary influences on mothers’ attributions
for disobedience. Merrill Palmer Quarterly, 37,
251-271.
Dix, T., Reinhold, D. P. and Zambarino, R. J. (1990).
Mothers’ judgment in moments of anger. Merrill
Palmer Quarterly, 36, 465-486.
Dix, T., Ruble, D. N., Grusec, J. E. and Nixon, S. (1986).
Social cognition in parents: inferential and affective
Early Dev. Parent. 5: 237-250 (1996)
D. M. Teti, M. A. O’Connell and C. D. Reiner
reactions to children of three age levels. Child
Development, 57,879494.
Donovan, W. L. and Leavitt, L. A. (1989). Maternal self-
efficacy and infant attachment: integrating physiology,
perceptions, and behavior. Child Development, 60,
460-472.
Downey, G. and Coyne, J. C. (1990). Children of
depressed parents: an integrative review.
Psychological Bulletin, 108, 50-76.
Emmerich, W. (1969). The parental role: a functional-
cognitive approach. Monographs of the Society for
Research in Child Development, 34 (No.8, Serial
NO.132), 1-71.
Fergusson, D. M., Honvood, L. J., Gretten, M. E. and
Shannon, F. T. (1985). Family life events, maternal
depression, and maternal and teacher descriptions of
child behavior. Pediatrics, 75, 30-35.
Field, T. M. (1977). Effects of early separation, interactive
deficits, and experimental manipulation of mother-
infant face-to-face interaction. Child Development, 48,
763-771.
Field, T. M. (1984). Early interactions between infants
and their postpartum depressed mothers. Infant
Behavior and Development, 7,517-522.
Field, T., Hallock, N., Ting, G., Dempsey, J., Dabiri, C.
and Shuman, H. H. (1978). A first-year follow-up of
high-risk infants: formulating a cumulative risk index.
Child Development, 49, 119-131.
Forehand, R., Lautenschlager, G. J., Faust, J. and Graziano,
W. G. (1986). Parent perceptions and parent-child
interactions in clinic-referred children: a preliminary
investigation of the effects of maternal depressive
moods. Behavior Research and Therapy, 24,73-75.
Fox, C. R. and Gelfand, D. M. (1994). Maternal depressed
mood and stress as related to vigilance, self-efficacy,
and mother-child interactions. Early Development and
Parenting, 3, 233-243.
Friedlander, S., Weiss, D. S . and Traylor, J. (1986).
Assessing the influence of maternal depression on the
validity of the Child Behavior Checklist. Journal of
Abnormal Child Psychology, 14, 123-133.
Friedrich, W. N. and Friedrich, W. L. (1981).
Psychosocial assets of parents of handicapped and
nonhandicapped children. American Journal of Mental
Deficiency, 85(5), 551-553.
Friedrich, W. N., Wilturner, L. T. and Cohen, D. S. (1985).
Coping resources and parenting mentally retarded
children. American Journal of Mental Deficiency, 90(2),
130-139.
Frijda, N. H., Kuipers, P. and ter Schure, E. (1989).
Relations among emotion, appraisal, and emotional
action readiness. Journal of Personality and Social
Psychology, 57,212-228.
Garmezy, N. (1987). Stress, competence, and
development: continuities in the study of
schizophrenic adults, children vulnerable to
psychopathology, and the search for stress-resistant
children. American Journal of Orthopsychiatry, 57,
159-174.
Gelfand, D. M. and Teti, D. M. (1990). The effects of
maternal depression on children. Ctinical Psychology
Review, 10,329-353.
01996 by John Wiley & Sons, Ltd.
Parental Self-Eficacy
Gelfand, D. M., Teti, D. M., Seiner, S. A. and Jameson,
P. B. (1996). Helping mothers fight depression:
evaluation of a home-based intervention program for
depressed mothers and their infants. Journal of Clinical
Child Psychology, 25, 406-422.
Gennaro, S., Medoff-Cooper, B. and Lotas, M. (1992).
Perinatal factors and infant temperament: a
collaborative approach. Nursing Research, 41, 375-377.
Goldberg, S. (1977). Social competence in infancy: a
model of parent-infant interaction. Merrill Palmer
Quarterly, 23(3), 163-177.
Goldberg, S. (1978). Prematurity: effects on parent-infant
interaction. Journal of Pediatric Psychology, 3(3), 137-144.
Goldberg, W. and Easterbrooks, M. A. (1984). Role of
marital quality in toddler development. Developmental
Psychology, 10, 504-514.
Goldberg, S., Marcovitch, S., MacGregor, D. and
Lojkasek, M. (1986). Family responses to
developmentally delayed preschoolers: etiology and
the father’s role. American journal of Mental Deficiency,
90(6), 610-617.
Goldsmith, H. H., Buss, A. H., Plomin, R., Rothbart,
M. K., Thomas, A., Chess, S., Hinde, R. A. and McCall,
R. B. (1987). Roundtable: what is temperament? Four
approaches. Child Development, 58, 505529.
Goodman, S. H. (1992). Understanding the effects of
depressed mothers on their children. In E. F. Walker,
R. H. Dworkin and 8. A. Cornblatt (Eds), Progress in
Experimental Personality and Psychopathology Research.
New York: Springer, pp. 47-109.
Goodnow, J. J. (1988). Parents’ ideas, actions, and
feelings: models and methods from developmental
and social psychology. Child Development, 59, 286-320.
Griest, D. L., Wells, K. C. and Forehand, R. (1979). An
examination of predictors of maternal perceptions of
maladjustment in clinic-referred children. Journal of
Abnormal Psychology, 88, 277-281.
Gross, D. and Conrad, B. (1992). A longitudinal model of
maternal confidence and maternal mental health
during toddlerhood. Paper presented at the 8th
International Conference on Infant Studies, Miami,
FL, May.
Gross, D. and Rocissano, L. (1988). Maternal confidence
in toddlerhood: its measurement for clinical practice
and research. Nurse Practitioner, 13, 19-29.
Hanson, M. J. and Hanline, M. F. (1990). Parenting a
child with a disability: a longitudinal study of parental
stress and adaptation. Journal of Early Intervention,
14(3), 234-248.
Henderson, S., Byme, D. G. and Duncan-Jones, P. (1981).
Neurosis and the Social Environment. Sydney: Academic
Press Australia.
Honig, A. S. (1984). Risk factors in infants and young
children. Young Children, 39(4), 60-73.
Innocenti, M. S., Huh, K. and Boyce, G. C. (1992).
Families of children with disabilities: normative data
and other considerations on parenting stress. Topics in
Early Childhood Special Education, 12(3), 403427.
Isen, A. M. (1984). Toward understanding the role of
affect in cognition. In R. Wyer and T. Srull (Eds),
Handbook of Social Cognition. Hillsdale, NJ: Erlbaum,
pp. 179-236.
01996 by John Wiley & Sons,Ltd.
249
Jeffcoate, J. A., Humphrey, M. E. and Lloyd, J. K. (1979).
Role perception and response to stress in fathers and
mothers following pre-term delivery. Sociaf Science 6
Medicine 13A, 139-145.
Kavanagh, D. J. and Bower, G. H. (1985). Mood and seif-
efficacy: impact of joy and sadness on perceived
capabilities. Cognitive Therapy and Research, 9,
507-525.
Locke, H. and Wallace, K. (1959). Short marital-
adjustment and prediction tests: their reliability and
validity. Marriage and Family Living, 21, 251-255.
Maccoby, E. E. and Martin, J. P. (1983). Socialization in
the context of the family: parent-child interaction. In
E. M. Hetherington (Ed.), P. H. Mussen (Series Ed.),
Handbook of Child Psychology: Vol.4. Socialization,
Personality, and Social Development. New York Wiley,
pp. 1-101.
Main, M., Kaplan, N. and Cassidy, J. C. (1985).
Security in infancy, childhood and adulthood: a
move to the level of representation. In I. Bretherton
and E. Waters (Eds), Growing Points of Attachment
Theory and Research; Monographs of the Society for
Research in Child Development, 50 (Nos. 1-2, Serial
No. 209), 66-104.
Mash, E. J. and Johnston, C. (1990). Determinants of
parenting stress: illustrations from families of
hyperactive children and families of physically
abused children. Journal of Clinical Child Psychology,
19(4), 313-328.
McGettigan, M. C., Greenspan, J. S., Antunes, M. J.,
Greenspan, D. I. and Rubenstein, S. D. (1994).
Psychological aspects of parenting critically ill
neonates. Clinical Pediatrics, 33(2), 77-82.
Medoff-Cooper, B. (1986). Temperament in very low
birth weight infants. Nursing Research, 35(3),
139-143.
Miles, M. S, Funk, S. G. and Kasper, M. A. (1992).
The stress response of mothers and fathers of
preterm infants. Research in Nursing 6 Health, 15,
261-269.
Miller, A. C., Gordon, R. M., Daniele, R. J. and Diller, L.
(1992). Stress, appraisal, and coping in mothers of
disabled and nondisabled children. Special Issue:
The0ry-Driven Research in Pediatric Psychology: 1.
Journal of Pediatric Psychofogy, 17(5), 587-605.
Miller, S. A. (1988). Parents’ beliefs about children’s
cognitive development. Child Dmelopment, 59,259-285.
Mitchell, D. R. (1987). Parents’ interactions with their
developmentally disabled or at-risk infants: a focus for
intervention. Australia and New Zealand Journal of
Developmental Disabilities, 13(2), 73-81.
Murray, L. (1992). The impact of postnatal depression on
infant development. Iournal of Child Psychology and
Psychiatry, 33, 543-561.
Newman, C. and Goldfried, M. R. (1987). Disabusing
negative self-efficacy expectations via experiences,
feedback, and discrediting. Cognitive Therapy and
Research, 11, 401417.
Oberklaid, F., Prior, M., Nolan, T., Smith, P. and Flavell,
H. (1986a). Temperament in infants born prematurely.
Annual Progress in Child Psychiatry and Child
Development , 386-396.
Early Dev. Parent. 5: 237-250 (1996)
250
Oberklaid, F., Prior, M. and Sanson, A. (1986b).
Temperament of preterm versus full-term infants.
Developmental and Behavioral Pediatrics, 7(3), 159-162.
Panaccione, V. F. and Wahler, R. G. (1986). Child
behavior, maternal depression, and social coercion as
factors in the quality of child care. Journal of Abnormal
Child Psychology, 14, 263-278.
Pearl, L. F. (1993). Developmental follow-up of at-risk
infants. In W. Brown, S. Kenneth Thurman and L. F.
Pearl (Eds), Family-Centered Early Intervention with
Znfants and Toddlers. Baltimore: Paul H. Brookes,
pp. 211-243.
Pederson, D. R., Bento, S., Chance, G. W., Evans, B. and
Fox, M. (1987). Maternal Emotional Responses to
Preterm Birth. American Journal of Orthopsychiatry
57(1), 15-21.
Radke-Yarrow, M. and Brown, E. (1993). Resilience and
vulnerability in children of multiple-risk families.
Development and Psychopathology, 5,581-592.
Radke-Yarrow, M., Cummings, E. M., Kuczynski, L.
and Chapman, M. (1985). Patterns of attachment in
two- and three-year-olds in normal families and
families with parental depression. Child Development,
56, 884-893.
Rauh, V. A., Achenbach, T. M., Nurcombe, B., Howell,
C. T. and Teti, D. M. (1988). Minimizing adverse
effects of low birthweight: four-year results of an early
intervention program. Child Development, 59, 544-553.
Rickard, K. M., Forehand, R., Wells, K. C., Griest, D. L.
and McMahon, R. J. (1981). Factors in the referral of
children for behavioral treatment: a comparison of
mothers of clinic-referred deviant, clinic-referred non-
deviant and non-clinic children. Behaviour Research and
Therapy, 19,201-205.
Rodrigue, J. R., Morgan, S. B. and Geffken, G. (1990).
Families of autistic children: psychological functioning
of mothers. Journal of Clinical Child Psychology, 19(4),
371-379.
Rogers, T. R. and Forehand, R. (1983). The role of parent
depression in interactions between mothers and their
clinic-referred children. Cognitive Therapy and Research,
7,315324.
Roman, L. A., Lindsay, J. K., Boger, R. P., DeWys, M.,
Beaumont, E. J., Jones, A. S. and Haas, B. (1995).
Parent-to-parent support initiated in the neonatal
intensive care unit. Research in Nursing 6 Health, 18,
385-394.
Rothbart, M. K. (1981).Measurement of temperament in
infancy. Child Development, 52, 569-578.
Rutter, M. (1987). Psychosocial resilience and protective
mechanisms. American Journal of Orthopsychiatry, 57,
316-331.
Sameroff, A. J. (1975). Early influences on development:
fact or fancy? Merrill Palmer Quarterly, 21, 3-33.
Schaughency, E. A. and Lahey, B. B. (1985). Mothers’ and
fathers’ perceptions of child deviance: roles of child
behavior, parental depression, and marital
satisfaction. journal of Consulting and Clinical
Psychology, 53,718-723.
Seideman, R. Y. and Klein, P. F. (1995). A theory of
transformed parenting: parenting a child with
Early Dev. Parent. 5 237-250 (1996)
D. M. Teti, M. A. O’Connell and C. D. Reiner
developmental delay/mental retardation. Nursing
Research, 44(1), 38-44.
Sigel, I. E. (1985) (Ed.). Parental Belief Systems. Hillsdale,
NJ: Erlbaum.
Solnit, A. J. and Stark, M. H. (1961). Mourning and the
birth of a defective child. Psychoanalytic Study of the
Child, 16, 523-537.
Spanier, G. B. (1976).Measuring dyadic adjustment: new
scales for assessing the quality of marriage and similar
dyads. Journal of Marriage and the Family, 38,15-28.
Sroufe, L. A. (1983). Infant-caregiver attachment and
patterns of adaptation in preschool: the roots of
maladaptation and competence. In M. Perlmutter
(Ed.), Minnesota Symposium in Child Psychology,
Vol. 16. Hillsdale, NJ: Erlbaum, pp. 41-81.
Sroufe, L. A. and Fleeson, J. (1986). Attachment and the
construction of relationships. In W. Hartup and Z.
Rubin (Eds), The Nature and Development of
Relationships. Hillsdale, NJ: Erlbaum, pp. 51-71.
Teasdale, J. D. and Fogarty, S. J. (1979). Differential
effects of induced mood on retrieval of pleasant and
unpleasant events from episodic memory. Journal of
Abnormal Psychology, 88,248-257.
Teti, D. M. and Gelfand, D. M. (1991). Behavioral
competence among mothers of infants in the first
year: the mediational role of maternal self-efficacy.
Child Development, 62, 918-929.
Teti, D. M., Gelfand, D. M., Messinger, D. S. and Isabella,
R. (1995).Maternal depression and the quality of early
attachment: an examination of infants, preschoolers,
and their mothers. Developmental Psychology, 31,
364-376.
Teti, D. M., Gelfand, D. M. and Pompa, J. (1990).
Depressed mothers’ behavioral competence with
their infants: demographic and psychosocial
correlates. Development and Psychopathology, 2,259-270.
Thomas, A. and Chess, S. (1977). Temperament and
Development. New York Brunner/Mazel.
Thomas, A., Chess, S. and Birch, H. (1970). The origin of
personality. Scientipc American, 223, 102-109.
Van Ijzendoorn, M. H. (1992). Intergenerational
transmission of parenting: other-child interactions:
an interbehavioral model. Psychological Bulletin, 105,
116-130.
Webster-Stratton, C. and Hammond, M. (1988).Maternal
depression and its relationship to life stress,
perceptions of child behavior problems, parenting
behaviors, and child conduct problems. Journal of
Abnormal Child Psychology, 16, 299-315.
Westen, D. (1991). Social cognition and object relations.
Psychological Bulletin, 109, 429455.
Zahn-Waxler, C., Cummings, E. M., Ianotti, R. J. and
Radke-Yarrow, M. (1984). Altruism, aggression, and
social interactions in young children with a manic-
depressive parent. Child Development, 55,
112-122.
Zoll, D. A., Lyons-Ruth, K. and Connell, D. (1984).
Infants at psychiatric risk maternal behavior,
depression, and family history. Paper presented at
the 92nd Annual Convention of the American
Psychological Association, Toronto, August.
01996 by JohnWiley & Sons, Ltd.