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Child Anxiety and Parenting in England and Italy: The Moderating Role of Maternal Warmth

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Title: Child Anxiety and Parenting in England and Italy: The Moderating Role of Maternal Warmth
Language: English
Authors: Raudino, Alessandra, Murray, Lynne, Turner, Corinne, Tsampala, Eirini, Lis, Adriana, De Pascalis, Leonardo, Cooper, Peter J.
Source: Journal of Child Psychology and Psychiatry. Dec 2013 54(12):1318-1326.
Availability: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
Peer Reviewed: Y
Page Count: 9
Publication Date: 2013
Document Type: Journal Articles
Reports - Research
Descriptors: Mothers, Parent Child Relationship, Affective Behavior, Anxiety, Correlation, Foreign Countries, Parenting Styles, Cross Cultural Studies, Role, Measures (Individuals), Daily Living Skills, Check Lists, Personal Autonomy, Questionnaires, Task Analysis, Anxiety Disorders, Children
Geographic Terms: Italy, United Kingdom (England)
DOI: 10.1111/jcpp.12105
ISSN: 0021-9630
Abstract: Background: Parenting factors have been implicated in the aetiology and maintenance of child anxiety. Most research has been correlational with little experimental or longitudinal work. Cross-cultural comparison could be illuminating. A comparison of Italian and British children and their mothers was conducted. Methods: A sample of 8- to 10-year old children, 60 Italian and 49 English, completed the Spence Child Anxiety Scale. Mothers also completed two questionnaires of parenting: the Skills of Daily Living Checklist (assessing maternal autonomy granting) and the Parent-Child Interaction Questionnaire (assessing maternal intrusiveness). Parenting was assessed in two video-recorded blindly rated mother-child interaction tasks, the "belt-buckling" tasks and the "etch-a-sketch ", providing objective indices of overcontrol, warmth, lack of autonomy granting, and overprotection. Results: There were no differences between the children in overall anxiety and specific forms of anxiety. Parenting, however, was markedly different for the two countries. Compared to English mothers, on the two questionnaires, Italian mothers were significantly less autonomy granting and more intrusive; and in terms of the observed indices, a significantly greater proportion of the Italian mothers displayed a high level of both overprotection and overcontrol, and a low level of autonomy granting. Notably, Italian mothers evidenced significantly more warmth than English mothers; and maternal warmth was found to moderate the impact of self-reported maternal intrusiveness on the level of both overall child anxiety and the level of child separation anxiety; and it also moderated the relationship between both observed maternal intrusiveness and overall child anxiety and observed maternal overprotectiveness and child separation anxiety. Conclusions: Although, compared to the British mothers, the Italian mothers were more likely to evidence high levels of parenting behaviours previously found to be anxiogenic, the high levels of warmth displayed by these mothers to their children appears to have neutralised the adverse impact of these behaviours.
Abstractor: As Provided
Entry Date: 2014
Accession Number: EJ1026097
Database: ERIC
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  Value: <anid>AN0092005236;jyy01dec.13;2024Jun04.07:33;v2.2.500</anid> <title id="AN0092005236-1">Child anxiety and parenting in England and Italy: the moderating role of maternal warmth. </title> <p>Background: Parenting factors have been implicated in the aetiology and maintenance of child anxiety. Most research has been correlational with little experimental or longitudinal work. Cross‐cultural comparison could be illuminating. A comparison of Italian and British children and their mothers was conducted. Methods: A sample of 8‐ to 10‐year old children, 60 Italian and 49 English, completed the Spence Child Anxiety Scale. Mothers also completed two questionnaires of parenting: the Skills of Daily Living Checklist (assessing maternal autonomy granting) and the Parent–Child Interaction Questionnaire (assessing maternal intrusiveness). Parenting was assessed in two video‐recorded blindly rated mother–child interaction tasks, the ‘belt‐buckling tasks and the ‘etch‐a‐sketch’, providing objective indices of overcontrol, warmth, lack of autonomy granting, and overprotection. Results: There were no differences between the children in overall anxiety and specific forms of anxiety. Parenting, however, was markedly different for the two countries. Compared to English mothers, on the two questionnaires, Italian mothers were significantly less autonomy granting and more intrusive; and in terms of the observed indices, a significantly greater proportion of the Italian mothers displayed a high level of both overprotection and overcontrol, and a low level of autonomy granting. Notably, Italian mothers evidenced significantly more warmth than English mothers; and maternal warmth was found to moderate the impact of self‐reported maternal intrusiveness on the level of both overall child anxiety and the level of child separation anxiety; and it also moderated the relationship between both observed maternal intrusiveness and overall child anxiety and observed maternal overprotectiveness and child separation anxiety. Conclusions: Although, compared to the British mothers, the Italian mothers were more likely to evidence high levels of parenting behaviours previously found to be anxiogenic, the high levels of warmth displayed by these mothers to their children appears to have neutralised the adverse impact of these behaviours.</p> <p>parenting; development; Anxiety</p> <p>Anxiety disorders are strongly familial (Hettema, Neale, & Kendler, [<reflink idref="bib16" id="ref1">16</reflink>] ). Thus, ‘top‐down’ studies have consistently demonstrated that offspring of adults with anxiety disorders are at increased risk of anxiety disorder themselves (Beidel & Turner, [<reflink idref="bib1" id="ref2">1</reflink>] ; Silverman, Cerny, & Nelles, [<reflink idref="bib37" id="ref3">37</reflink>] ; Turner, Beidel, & Costello, [<reflink idref="bib40" id="ref4">40</reflink>] ) and ‘bottom‐up’ studies have, similarly, noted the increased prevalence of anxiety disorders amongst parents of children with an anxiety disorder (Cooper, Fearn, Willetts, Seabrook, & Parkinson, [<reflink idref="bib4" id="ref5">4</reflink>] ; Last, Hersen, Kazdin, Orvaschel, & Perrin, [<reflink idref="bib24" id="ref6">24</reflink>] ). Genetic research, while identifying modest heritability (Hettema et al., [<reflink idref="bib16" id="ref7">16</reflink>] ), points to a strong environmental component in the aetiology of anxiety disorders (Gregory & Eley, [<reflink idref="bib15" id="ref8">15</reflink>] ). Considerable research attention has, therefore, focused on the possible contribution of parenting to intergenerational transmission.</p> <p>Several aspects of parental influences have been investigated. Thus, experimental work has demonstrated vicarious learning as a process by which anxiety can be transmitted from parent to child (Gerull & Rapee, [<reflink idref="bib13" id="ref9">13</reflink>] ; de Rosnay, Cooper, Tsigaras, & Murray, [<reflink idref="bib35" id="ref10">35</reflink>] ); and longitudinal research has similarly demonstrated an impact of parental anxiety on the development of anxious avoidance in infants (Murray et al., [<reflink idref="bib29" id="ref11">29</reflink>] ). The transfer of verbal information has also been experimentally demonstrated to have an impact on children's anxious beliefs and behaviours (Field, Hamilton, Knowles, & Plews, [<reflink idref="bib11" id="ref12">11</reflink>] ; Field, Lawson, & Banerjee, [<reflink idref="bib12" id="ref13">12</reflink>] ) and is another means by which parents could influence the development of child anxiety. Finally, considerable attention has been paid to the impact of the emotional quality of parenting on child anxiety, and particularly overcontrol/protectiveness (e.g. Hudson & Dodd, [<reflink idref="bib19" id="ref14">19</reflink>] ).</p> <p>Parental overcontrol and the associated discouragement of child independence, it has been argued, convey to the child the idea that the world is a dangerous and uncontrollable place (Hudson & Rapee, [<reflink idref="bib21" id="ref15">21</reflink>] ) which, by reinforcing the avoidance of challenge, militates against the child developing a sense of competence and mastery (Chorpita & Barlow, [<reflink idref="bib3" id="ref16">3</reflink>] ). Studies have differed in precisely how parental control is defined and assessed. Some have focused on parental overinvolvement (or overprotection), where nurturance and support is given to the child when it is not needed (Edwards, Rapee, & Kennedy, [<reflink idref="bib8" id="ref17">8</reflink>] ; Hudson & Rapee, [<reflink idref="bib20" id="ref18">20</reflink>] ). Others have focused on intrusive control, where the parent takes over or strongly directs the child (Wood, [<reflink idref="bib41" id="ref19">41</reflink>] ). Finally, some have focused on lack of autonomy‐granting, where a parent fails to encourage the child to face challenges (Moore, Whaley, & Sigman, [<reflink idref="bib28" id="ref20">28</reflink>] ). In a meta‐analytic review, McLeod, Wood and Weisz ([<reflink idref="bib26" id="ref21">26</reflink>] ) reported overall effect sizes for parenting variables. Although the effect sizes for overcontrol and overinvolvement were modest (r = .25 and.23, respectively), for lack of autonomy‐granting it was.42. Notably, parenting effects were strongest in studies where direct observations of parenting had been made.</p> <p>Parental negativity, or lack of warmth, has also been suggested as important in the development of anxiety, insofar as it may lead the child to believe that the environment is fundamentally hostile and threatening (Bögels & Tarrier, [<reflink idref="bib2" id="ref22">2</reflink>] ). The evidence for parental lack of warmth being associated with child anxiety is, however, weak and inconsistent (DiBartolo & Helt, [<reflink idref="bib6" id="ref23">6</reflink>] ). McLeod et al. ([<reflink idref="bib26" id="ref24">26</reflink>] ) reported an effect size of r = .06 for warmth. However, there is evidence to suggest that parental warmth may moderate the impact of other adverse parenting factors, such as maternal intrusiveness and harsh discipline, on child externalising problems and hostility (Ispa et al., [<reflink idref="bib22" id="ref25">22</reflink>] ; McLoyd & Smith, [<reflink idref="bib27" id="ref26">27</reflink>] ; Skopp, McDonald, Jouriles, & Rosenfield, [<reflink idref="bib38" id="ref27">38</reflink>] ). The possibility that such a moderating effect might obtain in relation to child anxiety disorders has not been examined.</p> <p>Differences in parenting have been invoked to account for variations in the prevalence of child anxiety in different countries. Thus, Essau, Sakano, Ishikawa and Sasagawa ([<reflink idref="bib9" id="ref28">9</reflink>] ) found that, compared to 8‐ to 12‐year old Japanese children, similar aged German children had more symptoms of social phobia, obsessions and compulsions, and generalised anxiety and fewer symptoms of physical injury fears. They ascribed these differences to variations in the ‘cultural contexts and environmental experiences’ of the children. Cultural variation was also invoked to explain differences in the prevalence of fears between children in China, Nigeria, America and Australia (Ollendick, [<reflink idref="bib30" id="ref29">30</reflink>] ): the former two countries, which had higher rates of fears than the latter two, were said to be characterised by compliant and restrictive family environments (Ollendick, Yang, King, Dong, & Akande, [<reflink idref="bib31" id="ref30">31</reflink>] ). Similar cultural arguments were advanced to account for the high rate of social‐evaluative fears amongst Chinese children and adolescents compared to children in America, England and Australia: here, the generally restrictive and overprotective Chinese family environment was highlighted as a significant factor (Dong, Yang, & Ollendick, [<reflink idref="bib7" id="ref31">7</reflink>] ). Intriguing as these speculations may be on the causal role of culturally driven parenting factors in accounting for country differences in rates of child anxiety, for these cultural arguments to have any empirical force, direct assessment of parenting needs to be made. Indeed, if the prevalence of child anxiety is different between two countries, and parenting factors mediate the relationship between country and child anxiety, this would provide a novel strand of evidence in support of the aetiological role of parenting in the development of child anxiety.</p> <p>A cross‐cultural study of child anxiety and parenting was therefore conducted, comparing English and Italian families, which included self‐report parenting questionnaires, as well as direct observations of parent–child interactions specifically designed to elucidate the specific aspects of control, as well as parental warmth. These two cultures were chosen because previous reports had highlighted facets of these cultures that both differed and were potentially relevant to child anxiety. For example, Hsu and Lavelli ([<reflink idref="bib18" id="ref32">18</reflink>] ) report that Italian mothers of infants display significantly more affect and physical contact during feeding than American mothers. Higher rates of cosleeping have been found in Italian samples compared to American samples (Cortesi, Giannotti, Sebastiani, & Vagnoni, [<reflink idref="bib5" id="ref33">5</reflink>] ; Lozoff, Askew, & Wolf, [<reflink idref="bib25" id="ref34">25</reflink>] ; Owens, [<reflink idref="bib32" id="ref35">32</reflink>] ). And Italian children have consistently been found to separate from the parental home much later than do American or English offspring (Hollinger & Haller, [<reflink idref="bib17" id="ref36">17</reflink>] ; Scabini, [<reflink idref="bib36" id="ref37">36</reflink>] ).</p> <p>Findings such as these suggest that Italian and British samples may well be differentiated in terms of overcontrol, and the extent to which independence and autonomy are promoted. If this were, indeed, the case, one could hypothesise that there would be a higher rate of anxiety in Italian than English children. As these parenting variables have been found to be particularly associated with separation anxiety disorder (Wood, [<reflink idref="bib41" id="ref38">41</reflink>] ), one could hypothesise, moreover, a particular elevation of this form of anxiety in Italian children.</p> <hd id="AN0092005236-2">Methods</hd> <hd id="AN0092005236-3">Participants</hd> <p>This project received ethical approval from the Research Ethics Committees of the University of Reading (United Kingdom) and the University of Padua (Italy). Participants were all volunteers recruited from four schools in middle class areas, two in England and two in Italy. In an effort to maximise sample ethnic homogeneity, families who had not lived in England or in Italy for at least two generations were excluded from the study. The English sample came from schools in Reading and South East London. Across both schools, of the 125 eligible families approached, 49 agreed to being visited at home for assessment. The Italian sample came from two districts in the region of Venice, Mestre and Maerne. Of the 147 eligible families approached, 60 agreed to the home assessments. The final sample therefore comprised 109 8‐ to 10‐year old children and their mothers (49 English and 60 Italian dyads).</p> <hd id="AN0092005236-4">Procedure</hd> <p>In the first assessment phase, children completed a self‐report questionnaire in the classroom, the Spence Child‐Anxiety Assessment Scale (SCAS) (Spence, [<reflink idref="bib39" id="ref39">39</reflink>] ), a well validated measure of child anxiety. The second assessment phase involved a visit by the researcher to the family home. Initially the mother and child were filmed during two interaction tasks selected to provide contexts for key parental behaviours, including differentiation of the various components of the concept of control. The first was the Etch‐A‐Sketch task, a cooperative task requiring parent and child to work together, which has previously been used in the context of child anxiety research (Ginsburg, Grover, Cord, & Ialongo, [<reflink idref="bib14" id="ref40">14</reflink>] ). The parent and child were instructed to use an Etch‐A‐Sketch board to copy a picture of a house. They had to work together, with one controlling the knob which draws horizontal lines, the other controlling the vertical line knob. They were allowed 10 minutes to complete the drawing. This structured challenge has the potential to elicit parental behaviours of putative importance to child anxiety (in particular, overcontrol). The mother and child were videotaped carrying out this task, and the tapes were coded using an adaptation of the scheme developed by Ginsburg et al. ([<reflink idref="bib14" id="ref41">14</reflink>] ). Maternal behaviours were rated at 1‐min intervals on 5‐point Likert scales incorporating both frequency and severity of the behaviour, ranging from 0 (no presence of the behaviour) to 4 (presence of the behaviour for most of the minute or several instances of extreme examples of the behaviour). Three dimensions of maternal behaviour were rated.</p> <p>Overcontrol: where the mother takes a strong lead in completing the task, issuing commands and clearly directing the proceedings, and providing unsolicited help to the child (such as manipulating the child's knob),</p> <p>Lack of autonomy granting: where the mother does not allow the child to participate as an active partner in the task, and does not acknowledge the child's active role in solving the problem and she fails to encourage or accept the child's contributions.</p> <p>Warmth: where the mother expresses positive affect towards the child, both verbal and physical (through eye contact, facial expression and orientation).</p> <p>The second observational task was an adaptation of the belt‐buckling task described by Wood and colleagues (Wood, [<reflink idref="bib41" id="ref42">41</reflink>] ; Wood, McLeod, Piacentini & Sigman, [<reflink idref="bib42" id="ref43">42</reflink>] ). This involves the child attempting to put on a complicated belt over his/her clothes to attach a microphone (‘to boost the sound of the camera’), and the mother was asked to intervene only if she felt the child needed help. The task was videotaped. Maternal behaviour was rated in terms of how many seconds the mother spent touching or checking the belt, wrapping her arms around the child, placing the child on her lap, picking up and putting the child in an optimal position and expressions of physical affection while the child was attempting to complete the task. An aggregate of these variables was obtained (i.e. the sum of number of seconds touching, wrapping, and so on), which was divided for the number of seconds of the entire episode. The resulting proportion, ranging from 0 to 1, provided an index of maternal overprotectiveness.</p> <p>Table [NaN] shows the correlations between the four interaction variables. It can be seen that, although there were some positive correlations between these variables, warmth was significantly associated only with overprotection.</p> <p>Correlations between dimensions of maternal behaviour</p> <p> <ephtml> <table><tr><th align="left" /><th align="char">Warmth</th><th align="char">Autonomy granting</th><th align="char">Overcontrol</th></tr><tr><td align="left">Warmth</td><td align="left" /><td align="char" char="." /><td align="char" char="." /></tr><tr><td align="left">Autonomy granting</td><td align="char" char=".">−.14</td><td align="left" /><td align="char" char="." /></tr><tr><td align="left">Overcontrol</td><td align="char" char=".">−.07</td><td align="char" char=".">.54</td><td align="left" /></tr><tr><td align="left">Overprotection</td><td align="char" char=".">.27</td><td align="char" char=".">.27</td><td align="char" char=".">.31</td></tr></table> </ephtml> </p> <p>1 p value < .01.</p> <p>Following these interaction tasks, mothers were asked to complete two self‐report questionnaires previously shown to differentiate anxious and nonanxious samples (Wood, [<reflink idref="bib41" id="ref44">41</reflink>] ). The first was the Skills of Daily Living Checklist (SDLC) (Wood, [<reflink idref="bib41" id="ref45">41</reflink>] ), a 22‐item parent report of caregiver assistance during everyday self‐care procedures (such as threading a belt or doing up a zipper). The SDLC total score provides an index of maternal autonomy granting over the previous 6 months (alpha = .94). The second questionnaire, was the Parent–Child Interaction Questionnaire (PCIQ) (Wood, [<reflink idref="bib41" id="ref46">41</reflink>] ), an eight‐item parent questionnaire, assessing the frequency of particular parent–child interactions during the past week, including providing excessive help with ordinary routines (e.g., dressing and bathing) or infantilising behaviour (e.g., using baby words). The measure provides an index of maternal intrusiveness (alpha = .60). Finally, the mother completed a sociodemographics questionnaire.</p> <p>Three independent bilingual judges coded videos, blind to both child and maternal questionnaire scores, to establish reliability. Initially they practised on a set of 12 videos (half English and half Italian), discussing together their preliminary coding and resolving discrepancies. Reliability was then assessed on a further set of 12 videos (half English and half Italian). Intra‐class correlation coefficients showed acceptable agreement: overprotectiveness = .93; overcontrol = .84; warmth = .75 and lack of autonomy granting = .68. When the analyses were repeated for each country separately, very similar levels of agreement were obtained.</p> <hd id="AN0092005236-5">Data analysis</hd> <p>Statistical analyses were performed using R for Windows (R Core Team, [<reflink idref="bib33" id="ref47">33</reflink>] ). Pearson's chi‐squared tests were used to investigate differences in the demographic categorical variables and linear models for continuous variables. Linear models were also used to investigate the effect of country of origin on both parenting and child anxiety.</p> <p>To test for the moderating effect of maternal warmth on the relation between child anxiety and parenting variables, generalised linear models were fitted using a top‐down approach. In the initial models, the dependent variables were the SCAS scores (either overall anxiety, or separation anxiety) and the independent variables were the main effects and interactions of country of origin, the maternal warmth score and one of the ‘anxiogenic’ behaviour scores (SDLC, PCIQ, Overcontrol, Overprotectiveness and Autonomy Granting), controlling for the main effects of potentially confounding demographical variables. Adopting the bootstrapping procedure suggested by Faraway ([<reflink idref="bib10" id="ref48">10</reflink>] ), two Likelihood Ratio Tests (LRT) were then conducted, the first to verify whether the effect of the demographic covariates could be dropped without a significant impact on the model and the second to test whether dropping the main effect and interactions of nationality significantly affected the model fit.</p> <p>In all models bias corrected and accelerated (BCa) bootstrap 95% confidence intervals were calculated (<reflink idref="bib5" id="ref49">5</reflink>,000 replications) for the coefficients of the investigated effects because of concerns regarding the normality of several variables included in the analyses and the limited sample size.</p> <hd id="AN0092005236-6">Results</hd> <hd id="AN0092005236-7">Demographic characteristics</hd> <p>Table [NaN] shows basic demographic characteristics of the two samples. Although the samples were similar in terms of social class, marital status and maternal age, they differed in terms of certain features: number of years of maternal education (b = −2.49, BCa bootstrap 95% CI [−3.55, −1.37], t = −4.50, p < .001), number of children per family (b = −0.52, BCa bootstrap 95% CI [−0.83, −0.20] t = −3.31, p = .001) and child age (b = −5.07, BCa bootstrap 95% CI [−8.33, −1.53], t = −2.78, p = .006). Thus, compared to the Italian sample, the English mothers had spent, on average, two and a half years longer in education; the English mothers on average had had more children than the Italian mothers; and the English children were, on average, 5 months older than the Italian children. The effects of these three variables were controlled for in all analyses.</p> <p>Demographic variables for the Italian and the English samples</p> <p> <ephtml> <table><tr><th align="left" /><th align="char">Italy (N = 60)</th><th align="char">England (N = 49)</th></tr><tr><th align="char">N</th><th align="char">%</th><th align="char">N</th><th align="char">%</th></tr><tr><td align="left">Child gender (% female)</td><td align="char" char=".">30</td><td align="char" char=".">50.00</td><td align="char" char=".">23</td><td align="char" char=".">46.94</td></tr><tr><td align="left">Child firstborn</td><td align="char" char=".">31</td><td align="char" char=".">51.67</td><td align="char" char=".">17</td><td align="char" char=".">34.69</td></tr><tr><td align="left">Marital status (married/cohabiting)</td><td align="char" char=".">56</td><td align="char" char=".">93.33</td><td align="char" char=".">47</td><td align="char" char=".">95.92</td></tr><tr><td align="left" /><td align="char">M (min‐max)</td><td align="char">SD</td><td align="char">M (min‐max)</td><td align="char">SD</td></tr><tr><td align="left">Number of children per family</td><td align="char" char=".">1.97 (1–5)</td><td align="char" char=".">0.74</td><td align="char" char=".">2.49 (1–4)</td><td align="char" char=".">0.92</td></tr><tr><td align="left">Mother's age (years)</td><td align="char" char=".">40.22 (26–50)</td><td align="char" char=".">7.12</td><td align="char" char=".">41.58 (32–53)</td><td align="char" char=".">4.71</td></tr><tr><td align="left">Children age (months)</td><td align="char" char=".">112.50 (96–131)</td><td align="char" char=".">11.16</td><td align="char" char=".">117.57 (98–130)</td><td align="char" char=".">6.81</td></tr><tr><td align="left">Mother education (number of years)</td><td align="char" char=".">12.83 (8–18)</td><td align="char" char=".">2.60</td><td align="char" char=".">15.33 (11–18)</td><td align="char" char=".">3.18</td></tr><tr><td align="left">SES</td><td align="char" char=".">43.65 (18.5–64)</td><td align="char" char=".">10.50</td><td align="char" char=".">42.79 (14–66)</td><td align="char" char=".">13.31</td></tr></table> </ephtml> </p> <p>2 Hollingshead ‘Four Index Factors’ (1975). SES, Socioeconomic status.</p> <hd id="AN0092005236-8">The relation between country of origin and parenting</hd> <p>The two samples differed significantly on the two self‐report measures of parenting (see Table [NaN] ). Thus, controlling for the three demographic factors, compared to English mothers, Italian mothers were significantly less autonomy granting (i.e. they had higher SDLC scores), and significantly more intrusive (i.e. they had higher PCIQ scores).</p> <p>Differences in self‐reported and observed parenting between the Italian and the English samples</p> <p> <ephtml> <table><tr><th align="left">Parenting variables</th><th align="char">Italy</th><th align="char">England</th><th align="char">b</th><th align="char">t</th><th align="char">p</th></tr><tr><th align="char">M (SD)</th><th align="char">M (SD)</th><th align="char">(BCa Bootstrap 95% CI)</th></tr><tr><td align="left">SDLC</td><td align="char" char=" ">53.35 (6.54)</td><td align="char" char=" ">30.93 (5.37)</td><td align="char" char=" ">23.59 (20.92, 25.95)</td><td align="char" char=".">17.22</td><td align="char" char="."><.001</td></tr><tr><td align="left">PCIQ</td><td align="char" char=" ">13.01 (2.91)</td><td align="char" char=" ">11.55 (2.06)</td><td align="char" char=" ">1.17 (0.15, 2.32)</td><td align="char" char=".">2.05</td><td align="char" char=".">.043</td></tr><tr><td align="left">Overprotectiveness</td><td align="char" char=" ">0.56 (0.32)</td><td align="char" char=" ">0.15 (0.26)</td><td align="char" char=" ">0.40 (0.26, 0.52)</td><td align="char" char=".">5.86</td><td align="char" char="."><.001</td></tr><tr><td align="left">Overcontrol</td><td align="char" char=" ">0.55 (0.67)</td><td align="char" char=" ">0.13 (0.25)</td><td align="char" char=" ">0.28 (0.09, 0.51)</td><td align="char" char=".">2.42</td><td align="char" char=".">.017</td></tr><tr><td align="left">Lack of autonomy Granting</td><td align="char" char=" ">1.40 (1.00)</td><td align="char" char=" ">0.54 (0.87)</td><td align="char" char=" ">0.82 (0.33, 1.21)</td><td align="char" char=".">3.81</td><td align="char" char="."><.001</td></tr><tr><td align="left">Warmth</td><td align="char" char=" ">3.08 (0.88)</td><td align="char" char=" ">2.45 (0.89)</td><td align="char" char=" ">0.78 (0.37, 1.15)</td><td align="char" char=".">3.95</td><td align="char" char="."><.001</td></tr></table> </ephtml> </p> <p>3 SDLC, skills of daily living checklist; PCIQ, parent–child interaction questionnaire.</p> <p>The differences between the two samples on the observational measures of parenting are also shown in Table [NaN] . It can be seen that, controlling for the effect of the three demographic variables, compared to the English mothers, the Italian mothers were rated as showing higher levels of overprotectiveness and overcontrol, and a lower level of autonomy granting. The Italian mothers, however, were rated as displaying a significantly higher level of warmth to their child than were the English mothers.</p> <hd id="AN0092005236-9">The relation between country of origin and child anxiety</hd> <p>As can be seen from Table [NaN] , there were no differences between the English and the Italian children with respect to either overall anxiety (i.e. SCAS total) or separation anxiety (or, indeed, any other dimension of anxiety assessed by the SCAS). This lack of difference between the two samples of children remained after controlling for the three demographic factors.</p> <p>Anxiety (SCAS scores) in the Italian and the English children</p> <p> <ephtml> <table><tr><th align="left">Child's Self‐Report</th><th align="char">Italy</th><th align="char">England</th><th align="char">b</th><th align="char">t</th><th align="char">p</th></tr><tr><th align="char">M (SD)</th><th align="char">M (SD)</th><th align="char">(BCa Bootstrap 95% CI)</th></tr><tr><td align="left">SCAS total score</td><td align="char" char=" ">34.23 (17.00)</td><td align="char" char=" ">33.02 (14.62)</td><td align="char" char=" ">−1.61 (−9.44, 5.28)</td><td align="char" char=".">−0.44</td><td align="char" char=".">.659</td></tr><tr><td align="left">Separation</td><td align="char" char=" ">5.67 (3.02)</td><td align="char" char=" ">5.02 (2.96)</td><td align="char" char=" ">0.18 (−1.22, 1.50)</td><td align="char" char=".">0.27</td><td align="char" char=".">.789</td></tr><tr><td align="left">Panic</td><td align="char" char=" ">5.12 (4.50)</td><td align="char" char=" ">4.76 (4.15)</td><td align="char" char=" ">−0.42 (−2.62, 1.42)</td><td align="char" char=".">−0.42</td><td align="char" char=".">.674</td></tr><tr><td align="left">Obsessive</td><td align="char" char=" ">6.05 (3.84)</td><td align="char" char=" ">6.22 (3.36)</td><td align="char" char=" ">−0.81 (−2.68, 0.92)</td><td align="char" char=".">−0.95</td><td align="char" char=".">.343</td></tr><tr><td align="left">Social phobia</td><td align="char" char=" ">5.85 (3.79)</td><td align="char" char=" ">6.51 (3.54)</td><td align="char" char=" ">−0.79 (−2.45, 0.75)</td><td align="char" char=".">−0.94</td><td align="char" char=".">.349</td></tr><tr><td align="left">Physical injury</td><td align="char" char=" ">3.77 (2.72)</td><td align="char" char=" ">4.08 (2.66)</td><td align="char" char=" ">−0.61 (−1.82, 0.54)</td><td align="char" char=".">−1.00</td><td align="char" char=".">.321</td></tr><tr><td align="left">Gen. Anxiety</td><td align="char" char=" ">6.62 (3.66)</td><td align="char" char=" ">6.67 (2.42)</td><td align="char" char=" ">−0.66 (−1.96, 0.60)</td><td align="char" char=".">−0.92</td><td align="char" char=".">.358</td></tr></table> </ephtml> </p> <hd id="AN0092005236-10">An examination of the potential moderating impact of maternal warmth</hd> <p>Given that on both self‐report and observational measures of parenting, compared to English mothers, the Italian mothers evidenced significantly more behaviours previously identified as anxiogenic, it was unexpected that the two samples of children reported equivalent levels of anxiety. However, the Italian mothers were rated as expressing more warmth to their children than the English mothers, and the possibility was therefore explored that warmth exerted a moderating impact on the relationship between maternal overprotectiveness/overcontrol/overintrusiveness/lack of autonomy granting and child anxiety. To ensure that this moderating effect, if present, was not peculiar to the Italian mothers, we also tested whether any moderating relationship differed between the two countries.</p> <p>All LRTs performed to test whether the main effects of the three demographic covariates (years of maternal education, number of children per family and child's age) needed to be included in the final models returned nonsignificant p values; therefore, only the more parsimonious models (i.e. without covariates) will be presented. Furthermore, all LRTs performed to test whether the main effect and interactions of nationality needed to be included in the final models returned nonsignificant p values, indicating that any moderating relationship between maternal warmth and ‘anxiogenic’ behaviour was independent of national origin; and the main effect and interactions of nationality were, therefore, also dropped from the model.</p> <p>Only the models that were found to fit the data significantly better than the samples' mean score for the dependent variable will be presented below.</p> <p>For overall child anxiety (i.e. SCAS total score), two models emerged as significant (Table [NaN] ).</p> <p>Generalised regression models on the moderating effect of maternal warmth on the relationship between maternal ‘anxiogenic’ behaviour and both overall child anxiety (SCAS total score) and separation anxiety</p> <p> <ephtml> <table><tr><th align="left">Overall Child Anxiety</th><th align="left">Child Separation Anxiety</th></tr><tr><td align="left">Self‐reported maternal intrusiveness (PCIQ) [F(3, 105) = 2.944, p = .036]</td><td align="left">Self‐reported maternal intrusiveness (PCIQ) [F(3, 105) = 5.058, p = .003]</td></tr><tr><td align="left" /><td align="center">b</td><td align="center">BCa Bootstrap 95% CI</td><td align="center">t</td><td align="center">p</td><td align="left" /><td align="center">b</td><td align="center">BCa Bootstrap 95% CI</td><td align="center">t</td><td align="center">p</td></tr><tr><td align="left">PCIQ</td><td align="char" char=".">0.39</td><td align="char" char=".">−0.66, 1.74</td><td align="char" char=".">0.69</td><td align="char" char=".">.494</td><td align="left">PCIQ</td><td align="char" char=".">0.34</td><td align="char" char=".">0.14, 0.55</td><td align="char" char=".">3.24</td><td align="char" char=".">.002</td></tr><tr><td align="left">Maternal Warmth</td><td align="char" char=".">−3.61</td><td align="char" char=".">−7.76, −0.08</td><td align="char" char=".">−2.21</td><td align="char" char=".">.030</td><td align="left">Maternal Warmth</td><td align="char" char=".">−0.40</td><td align="char" char=".">−1.08, 0.23</td><td align="char" char=".">−1.34</td><td align="char" char=".">.182</td></tr><tr><td align="left">PCIQ x Maternal Warmth</td><td align="char" char=".">−1.67</td><td align="char" char=".">−2.81, −0.54</td><td align="char" char=".">−2.35</td><td align="char" char=".">.020</td><td align="left">PCIQ x Maternal Warmth</td><td align="char" char=".">−0.34</td><td align="char" char=".">−0.58, −0.11</td><td align="char" char=".">−2.59</td><td align="char" char=".">.011</td></tr><tr><td align="left">Maternal OC [F(3, 105) = 3.688, p = .014]</td><td align="left">Maternal OP [F(3, 105) = 3,277; p = .024]</td></tr><tr><td align="left">Maternal OC</td><td align="char" char=".">3.79</td><td align="char" char=".">−1.33, 8.67</td><td align="char" char=".">1.43</td><td align="char" char=".">.154</td><td align="left">Maternal OP</td><td align="char" char=".">1.24</td><td align="char" char=".">−0.32, 2.83</td><td align="char" char=".">1.53</td><td align="char" char=".">.128</td></tr><tr><td align="left">Maternal Warmth</td><td align="char" char=".">−1.78</td><td align="char" char=".">−5.81, 1.70</td><td align="char" char=".">−1.09</td><td align="char" char=".">.278</td><td align="left">Maternal Warmth</td><td align="char" char=".">−0.33</td><td align="char" char=".">−0.98, 0.25</td><td align="char" char=".">−1.06</td><td align="char" char=".">.290</td></tr><tr><td align="left">Maternal OC x Maternal Warmth</td><td align="char" char=".">−5.29</td><td align="char" char=".">−10.95, −0.13</td><td align="char" char=".">−2.31</td><td align="char" char=".">.023</td><td align="left">Maternal OP x Maternal Warmth</td><td align="char" char=".">−2.40</td><td align="char" char=".">−4.03, −0.92</td><td align="char" char=".">−2.85</td><td align="char" char=".">.005</td></tr></table> </ephtml> </p> <p>4 OC, overcontrol; OP, overprotectiveness.</p> <p>The first model included self‐reported maternal intrusiveness (i.e. the PCIQ score) and maternal warmth, and revealed a significant interaction between these two variables. That is, while at low levels of maternal warmth an increase in PCIQ score was associated with an increase in the SCAS total score, at higher level of maternal warmth variation in the PCIQ score was unrelated to child SCAS total score (Figure [NaN] a).</p> <p>The second model included observed maternal overcontrol and maternal warmth, and a significant interaction again obtained between these two variables. That is, as with maternal intrusiveness, while at low levels of maternal warmth an increase in maternal overcontrol was associated with an increase in child SCAS total score, at higher level of maternal warmth variation in the level of maternal overcontrol was unrelated to child SCAS total score (Figure [NaN] b). When child separation anxiety was similarly considered, two significant models emerged (Table [NaN] ).</p> <p>The first model included self‐reported maternal intrusiveness (i.e. the PCIQ score) and maternal warmth, and revealed a significant interaction between these two variables. As before, while at low levels of maternal warmth an increase in PCIQ scores was associated with an increase in SCAS separation anxiety score, at higher levels of maternal warmth variation in maternal PCIQ score was unrelated to child SCAS separation anxiety score.</p> <p>The final model included observed maternal overprotectiveness and maternal warmth, and a significant interaction again emerged between these two variables. While at low levels of maternal warmth an increase in observed maternal overprotectiveness was associated with an increase in SCAS separation anxiety score, at higher levels of maternal warmth variation in the level of observed maternal overprotectiveness was unrelated to child SCAS separation anxiety score.</p> <hd id="AN0092005236-11">Discussion</hd> <p>This study set out to compare both the level of child anxiety and particular parenting variables in a British and an Italian sample to determine the extent to which child differences in level of anxiety could be accounted for by cultural differences in parenting. The hypothesis was that putative anxiogenic features of parenting would characterise the Italian sample more than the British sample, and that these would account for a higher rate of anxiety in the Italian than the British children. Major differences in parenting were, indeed, found. Thus, on the self‐report indices of parenting, compared to English mothers, the Italian mothers were significantly less autonomy granting and more intrusive; and on the observed indices of parenting they were more overprotective and overcontrolling, and less autonomy granting.</p> <p>The finding of a lack of difference in terms of child anxiety in the context of major differences in terms of putatively anxiogenic parenting factors could be interpreted as casting doubt on the causal force of the parenting factors investigated. However, the two samples also differed in terms of maternal warmth; compared to the British mothers, the Italian mothers were rated as displaying higher levels of warmth towards their children. As noted earlier, there is no good evidence of an independent impact of parental warmth on levels of child anxiety (DiBartolo & Helt, [<reflink idref="bib6" id="ref50">6</reflink>] ; McLeod et al., [<reflink idref="bib26" id="ref51">26</reflink>] ); however, the fact that parental warmth has been found to moderate the impact of other parental factors on child externalising problems (Skopp et al., [<reflink idref="bib38" id="ref52">38</reflink>] ), and of temperament on internalising problems (Kochanska, [<reflink idref="bib23" id="ref53">23</reflink>] ), suggested to us that a similar moderation process might operate in relation to child anxiety. This possibility has not, to our knowledge, been previously examined. We found that, for several of the parenting dimensions which discriminated the Italian and British samples, warmth did moderate the impact of parenting on child anxiety. Thus, the presence of high maternal warmth nullified any anxiogenic impact of self‐reported maternal intrusiveness, and observed maternal overcontrol, on the overall level of child anxiety. The presence of high maternal warmth also nullified any anxiogenic impact of both self‐reported maternal intrusiveness and observed maternal overprotectiveness on the level of separation anxiety.</p> <p>Should the finding of a moderation effect of maternal warmth on the impact of potentially anxiogenic parenting behaviours on child anxiety stand up to further empirical scrutiny, this would have implications both for our study of the environmental pathways to child anxiety, as well as to recent ideas about appropriate therapeutic interventions (Rapee, Kennedy, Ingram, Edwards, & Sweeney, [<reflink idref="bib34" id="ref54">34</reflink>] ). In terms of research into parenting factors, the interaction between maternal warmth and other parenting dimensions suggests that it is critical when examining the influence of parenting factors to do so within the context of an appreciation of the affective quality of the parent–child relationship. It would seem from our findings that the meaning to a child of intrusive or controlling or protective parental behaviour is dependent on more fundamental emotional features of the child's relationship with the parent. One implication for the treatment of child anxiety is that it may be imprudent to target parental overcontrol or overprotectiveness or intrusiveness, in the absence of more comprehensive consideration of the quality of the parent–child relationship; that is, improving parental warmth may be a critical factor in a family intervention.</p> <p>In both Italy and Britain some difficulty was experienced in recruiting families. Thus, the 109 families who eventually participated represented less than half the potential sample identified. As no demographic data were available on nonparticipants one cannot be certain that the samples studied are representative of their background populations. Although we have no reason to believe that the self‐exclusion process was systematically related to the critical parenting variables which differentiated the two samples, the low‐participation rate means that the conclusions we have drawn must remain tentative, until our findings are replicated.</p> <hd id="AN0092005236-12">Acknowledgements</hd> <p>We are grateful to the children and their mothers for their participation in this study. We thank Jeff Wood for both his assistance in our implementing his belt‐buckling task and for helpful comments on our manuscript.</p> <p>Key points</p> <p>It has been suggested that parenting factors – such as overcontrolling and overprotective parenting – are implicated in the aetiology of child anxiety.</p> <p>Marked differences were found in parenting between Italian and English mothers, with the former being less autonomy granting, and more intrusive, overprotective and overcontrolling; however, there was no difference between the children in terms of anxiety.</p> <p>Compared to English mothers, the Italian mothers evidenced more warmth; and warmth moderated the impact of the potentially pathogenic parenting factors on child anxiety.</p> <p>Thus, when examining the influence of particular parenting factors on child anxiety, in both the research and the clinical context, it is necessary to do so within the context of an appreciation of the affective quality of the parent–child relationship.</p> <ref id="AN0092005236-13"> <title>Footnotes</title> <blist> <bibl id="bib1" idref="ref2" type="bt">1</bibl> <bibtext>Conflicts of interest statement: The authors have declared that they have no competing or potential conflicts of interest. </bibtext> </blist> </ref> <ref id="AN0092005236-14"> <title>References</title> <blist> <bibtext>Beidel, D.C., & Turner, S.M. 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Child Psychiatry and Human Development, 40, 301 – 316. </bibtext> </blist> </ref> <p>Graph: The moderating effect of maternal warmth on the relationship between the maternal ‘anxiogenic’ behaviour and overall child anxiety</p> <aug> <p>By Alessandra Raudino; Lynne Murray; Corinne Turner; Eirini Tsampala; Adriana Lis; Leonardo Pascalis and Peter J. Cooper</p> </aug>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Child Anxiety and Parenting in England and Italy: The Moderating Role of Maternal Warmth
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Raudino%2C+Alessandra%22">Raudino, Alessandra</searchLink><br /><searchLink fieldCode="AR" term="%22Murray%2C+Lynne%22">Murray, Lynne</searchLink><br /><searchLink fieldCode="AR" term="%22Turner%2C+Corinne%22">Turner, Corinne</searchLink><br /><searchLink fieldCode="AR" term="%22Tsampala%2C+Eirini%22">Tsampala, Eirini</searchLink><br /><searchLink fieldCode="AR" term="%22Lis%2C+Adriana%22">Lis, Adriana</searchLink><br /><searchLink fieldCode="AR" term="%22De+Pascalis%2C+Leonardo%22">De Pascalis, Leonardo</searchLink><br /><searchLink fieldCode="AR" term="%22Cooper%2C+Peter+J%2E%22">Cooper, Peter J.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Child+Psychology+and+Psychiatry%22"><i>Journal of Child Psychology and Psychiatry</i></searchLink>. Dec 2013 54(12):1318-1326.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 9
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2013
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Mothers%22">Mothers</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Affective+Behavior%22">Affective Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Correlation%22">Correlation</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Parenting+Styles%22">Parenting Styles</searchLink><br /><searchLink fieldCode="DE" term="%22Cross+Cultural+Studies%22">Cross Cultural Studies</searchLink><br /><searchLink fieldCode="DE" term="%22Role%22">Role</searchLink><br /><searchLink fieldCode="DE" term="%22Measures+%28Individuals%29%22">Measures (Individuals)</searchLink><br /><searchLink fieldCode="DE" term="%22Daily+Living+Skills%22">Daily Living Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Check+Lists%22">Check Lists</searchLink><br /><searchLink fieldCode="DE" term="%22Personal+Autonomy%22">Personal Autonomy</searchLink><br /><searchLink fieldCode="DE" term="%22Questionnaires%22">Questionnaires</searchLink><br /><searchLink fieldCode="DE" term="%22Task+Analysis%22">Task Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety+Disorders%22">Anxiety Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Italy%22">Italy</searchLink><br /><searchLink fieldCode="DE" term="%22United+Kingdom+%28England%29%22">United Kingdom (England)</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/jcpp.12105
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0021-9630
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Parenting factors have been implicated in the aetiology and maintenance of child anxiety. Most research has been correlational with little experimental or longitudinal work. Cross-cultural comparison could be illuminating. A comparison of Italian and British children and their mothers was conducted. Methods: A sample of 8- to 10-year old children, 60 Italian and 49 English, completed the Spence Child Anxiety Scale. Mothers also completed two questionnaires of parenting: the Skills of Daily Living Checklist (assessing maternal autonomy granting) and the Parent-Child Interaction Questionnaire (assessing maternal intrusiveness). Parenting was assessed in two video-recorded blindly rated mother-child interaction tasks, the "belt-buckling" tasks and the "etch-a-sketch ", providing objective indices of overcontrol, warmth, lack of autonomy granting, and overprotection. Results: There were no differences between the children in overall anxiety and specific forms of anxiety. Parenting, however, was markedly different for the two countries. Compared to English mothers, on the two questionnaires, Italian mothers were significantly less autonomy granting and more intrusive; and in terms of the observed indices, a significantly greater proportion of the Italian mothers displayed a high level of both overprotection and overcontrol, and a low level of autonomy granting. Notably, Italian mothers evidenced significantly more warmth than English mothers; and maternal warmth was found to moderate the impact of self-reported maternal intrusiveness on the level of both overall child anxiety and the level of child separation anxiety; and it also moderated the relationship between both observed maternal intrusiveness and overall child anxiety and observed maternal overprotectiveness and child separation anxiety. Conclusions: Although, compared to the British mothers, the Italian mothers were more likely to evidence high levels of parenting behaviours previously found to be anxiogenic, the high levels of warmth displayed by these mothers to their children appears to have neutralised the adverse impact of these behaviours.
– Name: AbstractInfo
  Label: Abstractor
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2014
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1026097
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1026097
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      – Type: doi
        Value: 10.1111/jcpp.12105
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 9
        StartPage: 1318
    Subjects:
      – SubjectFull: Mothers
        Type: general
      – SubjectFull: Parent Child Relationship
        Type: general
      – SubjectFull: Affective Behavior
        Type: general
      – SubjectFull: Anxiety
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      – SubjectFull: Correlation
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      – SubjectFull: Foreign Countries
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      – SubjectFull: Parenting Styles
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      – SubjectFull: Cross Cultural Studies
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      – SubjectFull: Role
        Type: general
      – SubjectFull: Measures (Individuals)
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      – SubjectFull: Daily Living Skills
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      – SubjectFull: Check Lists
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      – SubjectFull: Personal Autonomy
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      – SubjectFull: Task Analysis
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      – SubjectFull: Children
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      – SubjectFull: Italy
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      – SubjectFull: United Kingdom (England)
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      – TitleFull: Child Anxiety and Parenting in England and Italy: The Moderating Role of Maternal Warmth
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