Master of Science, The Ohio State University, 2010, Dentistry

Purpose: The purpose of this study was to determine whether full-mouth rehabilitation of children with severe early childhood caries (S-ECC) had any impact on parental stress as measured by the Parenting Stress Index (PSI). Methods: This IRB-approved longitudinal case control study consisted of a cohort examined at the Nationwide Children's Hospital Dental Surgery Center (DSC). Children were required to have a minimum of 6 carious teeth for inclusion. Patients were treated under general anesthesia for S-ECC. The primary caregiver completed the PSI and demographic information. Patients were scheduled for a recall visit 1-3 months later with standardized study personnel. Caregivers re-accomplished the PSI. Continuous variables were analyzed using the Student's t-test. Results: Forty parent-child dyads completed the initial and 3 month recall visits for pilot data. Mean age of children was 43 months (±12.5). Mean caregiver age was 27.4 years (±8.3). Children presented with a mean of 9.6 carious teeth ((±3.4). Treatment of S-ECC did not significantly impact parental stress (p=0.426) or total family stress (p=.237). There were small but significant changes in three subscales within the Child Domain: Adaptability (p=0.034), Reinforces Parent (p=0.039), and Mood (p=0.038). Conclusions: Parental stress levels, as measured by the PSI, are not significantly altered by treatment of S-ECC under general anesthesia.

Committee: Sarat Thikkurissy DDS, MS (Advisor); Henry Fields DDS, MS (Committee Member); Dennis McTigue DDS, MS, MSD (Committee Member) Subjects: Dental Care; Families and Family Life; Health; Health Care; Psychological Tests

Ph.D., Antioch University, 2024, Antioch New England: Marriage and Family Therapy

Parentification, or parent-child role reversal, occurs when children and adolescents take on parental responsibilities within the family (Boszormenyi-Nagy & Spark, 1973). This can include caring for younger siblings, attending to their parents' emotional needs, and assisting with tasks such as translation. Parentification disrupts family dynamics as parents transfer significant responsibilities to the child (Martino & Coburn, 2022). Extensive research consistently demonstrates the negative impact of parentification on children, leading to depression, suicidal feelings, shame, guilt, worry, and social isolation (Jurkovic, 1997). It can also contribute to the development of conduct disorders. Unfortunately, these difficulties often go unnoticed. However, when it comes to language brokering, which can be viewed as a similar experience to parentification as indicated by research, it can yield some positive results, such as developing new skills, improving self-esteem, and contributing to family survival (Kam et al., 2017; Martino & Coburn, 2022). Limited research exists on factors that alleviate the impact of parentification in Latine and Hispanic households, and despite its potential harm, parentification is often rationalized by families for various reasons. Familismo, a cultural value emphasizing loyalty and community within the family (Ayon et al., 2010) may play a significant role in the experiences of Latine parentified individuals. Familismo promotes unity, support, and loyalty within the family, resulting in enhanced self-esteem, a strong sense of belonging, and deep respect for the cultural community and family members (Fuligni et al., 1999; Ayon et al., 2010, Montero & Ceballo, 2021; Walker et al., 2022). This quantitative study demonstrates that familismo acts as a moderator in the relationship between parentification and depression. Specifically, this study reveals that higher levels of familismo weaken the link between parentification and depression. This d (open full item for complete abstract)

Committee: Kevin Lyness Ph.D. (Committee Chair); Denzel Jones Ph.D. (Committee Member); Bryson Greaves Ph.D. (Committee Member) Subjects: Families and Family Life; Hispanic American Studies; Hispanic Americans; Individual and Family Studies; Latin American Studies; Mental Health; Therapy

Doctor of Philosophy, The Ohio State University, 2022, Psychology

In recent decades, the field of autism has embraced family-centered care (FCC) as one tool for decreasing parental stress, with several studies demonstrating the positive impact of FCC on families (Dunst et al., 2007). However, parents of children with autism spectrum disorder (ASD) are less likely to report receiving FCC than parents of children with other health care needs (Brachlow et al., 2007; Gabovitch & Curtin, 2009). Applied Behavior Analysis (ABA) is a highly utilized category of treatment for ASD (Hyman et al., 2020), allowing providers of ABA the opportunity to have a particularly significant impact on families. No known studies have examined the state of FCC in ABA in the United States, and FCC is not a required component of training for Board Certified Behavior Analysts (BCBAs) (Behavior Analyst Certification Board, 2020). The aims of this study were: 1) Explore the current implementation of FCC in ABA and 2) Develop, implement, and evaluate a series of trainings for BCBAs focused on family-centered topics. In Phase One of this study, 16 parents of children aged 2-18 receiving ABA intervention for ASD and 10 BCBAs providing ABA intervention to children with ASD participated in focus groups. Transcripts were analyzed using grounded theory to identify the extent to which parents receive and BCBAs practice the four core components of FCC (respect and dignity, information sharing, participation, and collaboration). Several identified themes were common to both groups, with some themes unique to either the parent or BCBA groups. Overall, areas of strength and weakness related to the provision of FCC were shared by parents and BCBAs. Parents and BCBAs identified several barriers that prevent the provision of high-quality FCC, and BCBAs identified areas in which they would like to receive additional training. In Phase Two of this study, a series of 8 training sessions utilizing the Extension of Community Healthcare Outcomes (ECHO™) model were provided (open full item for complete abstract)

Committee: Andrea Witwer (Advisor); Vanessa Rodriguez (Committee Member); Susan Havercamp (Committee Member); Katherine Walton (Committee Chair) Subjects: Psychology

Doctor of Philosophy, Case Western Reserve University, 2021, Nursing

Background: Nearly 50-86% of children with autism spectrum disorder (ASD) have sleep disturbances, 64-93% experience disruptive behaviors, and 63% do not meet the recommended moderate-to-vigorous physical activity (MVPA) levels. MVPA improves sleep in children with ASD, which can mitigate challenging behaviors. With poor sleep and challenging behaviors, parental stress significantly increases thereby influencing the child with ASD and caregiver's quality of life. Purpose: The aim of this study was to elucidate the link of how physical activity, challenging behaviors, and parental stress are influenced by sleep in children with ASD. Methods: This prospective correlational study took place over one year and included a sample of 32 children with ASD aged 2 to 8 years (mean age=5.50±1.68; 75.0% male; 78.1% White), and their caregivers (mean age=37.44±6.30; 96.9% female; 90.6% White), in the Midwest region of the United States. The caregiver's completed measures of sleep behaviors (Children's Sleep Habits Questionnaire), challenging behaviors (Aberrant Behavior Checklist-Irritability), and caregiver stress (Parenting Stress Index). Sleep efficiency (SE%) and MVPA were measured objectively on the child's non-dominant wrist with the ActigraphTM wGT3X-BT for 5 consecutive days and nights. Findings: Linear regressions revealed MVPA was not a significant predictor of SE%, but was a meaningful, though non-significant predictor of sleep behaviors (Standardized β=.257, p=.196). SE% was not a significant predictor of challenging behaviors. On the other hand, sleep behaviors were a meaningful, though non-significant, predictor of the number of challenging behaviors (Standardized β=.316, p=.079). In the two multivariate regression models, challenging behaviors was the highest significant predictor of parental stress (Standardized β=.679, p<.001; Standardized β=.634, p<.001), while SE% and sleep behaviors were not significant predictors of parental stress. The Pearson corre (open full item for complete abstract)

Committee: Jaclene Zauszniewski PhD, RN-BC, CCS, CPC, FAAN (Committee Chair); Christopher Burant PhD, MACTM (Committee Member); Marguerite DiMarco PhD, RN, CPNP, FAAN (Committee Member); Cynthia Johnson PhD, BCBA-D (Committee Member); Beth Malow MD, MS (Committee Member) Subjects: Nursing

Master of Arts, The Ohio State University, 2019, Psychology

Parents of children with autism spectrum disorder (ASD) experience more stress than parents of children with other developmental disabilities (Blacher & McIntyre, 2006). Although there is a growing body of research identifying the predictors of stress in families of children with ASD, little is known about the role that treatment plays in these transactions. Applied Behavior Analysis (ABA) is a common intervention that can be intrusive and increase the responsibilities of parents (Strauss et al., 2012). Despite the intensive nature of ABA, it is unknown how participation in this type of treatment impacts parental stress. The primary aim of this study was to examine the predictors of parental stress in families of children receiving ABA intervention for ASD. 58 parents of children aged 2-12 completed a standard set of data including demographics, intervention information, and four assessments: Caregiver Strain Questionnaire, Aberrant Behavior Checklist, Family Support Survey, and Family Needs Survey. A primary regression model was conducted with parental stress as the outcome variable and demographic and assessment variables as the predictor variables. Additionally, a moderation analysis was conducted to examine the possible interaction between family support and unmet family needs. In order to examine the relationship between child comorbid psychiatric diagnoses and parental stress, a secondary regression analysis was conducted with parental stress as the outcome variable and the presence of various comorbid psychiatric diagnoses as the predictor variables. The primary regression model indicates parental stress is predicted by child utilization of psychotropic medication (p=0.027), the Hyperactivity/Noncompliance subscale score of the ABC (p=0.023), and the total score of the Family Needs Survey. No variables related to ABA intervention predict parental stress, and there is no evidence of moderation of unmet family needs on the relationship between family socia (open full item for complete abstract)

Committee: Andrea Witwer (Advisor); Luc Lecavalier (Committee Member); Susan Havercamp (Committee Member) Subjects: Psychology

Psy. D., Antioch University, 2017, Antioch New England: Clinical Psychology

The allocation of educational resources has been a widely debated topic. While scholars and government officials have focused their attention on how resources are divided, significantly less attention has been paid to how parents are advocating for their children to obtain necessary resources themselves. Existing data agree that fighting for educational resources can cause stress to parents (Levine, 2006). This is especially true for parents of children with learning disabilities. These children often require more individualized academic and educational attention. Currently, little research exists which focuses on the relationship between parental stress and parental self efficacy (the belief that one has an ability to accomplish a task) and none of the existing research focuses on parents of learning disabled children specifically. Self-efficacy is particularly important for those seeking resources for their children because parents who believe they can gain resources for their children are more likely to attempt to do so. The purpose of this study was to understand the relationship between parental stress and parental self-efficacy as well as understand the impact socioeconomic status has on parental perception of efficacy. Using a series of regression models, I determined that there is a negative correlation between stress and self-efficacy but that socioeconomic status seems to have no impact on the strength of this relationship. Such results suggest that regardless of socioeconomic status, the more stress Generation X parents feel, the less self-efficacious they feel. While no significant moderation was found, understanding the relationship between self-efficacy and parental stress of Generation X parents is still important. This information can help inform mental health practitioner's conceptualization and treatment of parents of learning-disabled children.

Committee: Martha Straus Phd (Committee Chair); Barbara Belcher-Timme PsyD (Committee Member); Gina Pasquale PsyD (Committee Member) Subjects: Clinical Psychology

PhD, University of Cincinnati, 2006, Arts and Sciences : Psychology

Research suggests divorce can have significant effects on the emotional well-being of children and adolescents. However, there are few studies of depression comparing young college women of divorce with young college women from intact families. Depressive symptoms during college could affect academic achievement and impact eventual socioeconomic success of these women. Young women with multiple adverse family experiences, including parental divorce, appear to respond to recent negative life stress with depression. Some studies of the effects of parental divorce on offspring have examined whether related family issues moderate negative outcomes. However, these studies have focused on relatively mild types of family dysfunction, such as inter-parental conflict and parent-child discord. No known studies examine serious parental psychopathology, such as substance abuse, mental illness and violence, in college women with divorced parents. The current study addressed a gap in the parental divorce literature by examining negative family factors, along with the effect of parental divorce, on perceived stress and levels of depression among college women. Recent life stress was found to be significantly higher in the divorced group. Although the difference in levels of depression between the two groups was not statistically significant, a modest difference in the predicted direction was observed. Although negative family factors were much more common for women of divorced families, negative family factors did not relate more strongly to depression in this group. In summary, increased life stress and negative family factors did not lead to more depression in this sample. These results differed significantly from those of other studies. An incidental finding was an unexpectedly high rate of substance abuse and violence among the fathers in the divorced families. The possible effects of significant psychopathology in the non-residential parent on adjustment to divorce were discu (open full item for complete abstract)

Committee: Dr. Christine Hovanitz (Advisor) Subjects: Psychology, Clinical

MS, University of Cincinnati, 2004, Allied Health Sciences : Genetic Counseling

Qualitative interviews were completed with parents of children under the age of one who were born with cleft lip and/or palate. This study characterizes parental concerns and stresses during the first year of their children's lives and clarifies what parental expectations of healthcare professionals. Concerns included stress of surgeries before and after the procedure(s), difficulty with feeding, and the social and cosmetic implications for their child. All participants were satisfied with their children's care. Interventions identified as effective included repetition of information, showing pictures of other children (before and after surgery), and anticipatory guidance about surgeries and their children's development. Parents want healthcare professionals to use more written and visual information, to have more contact with other parents of children born with clefts, and would like healthcare professionals outside the Craniofacial Center to be more knowledgeable about cleft lip and/or palate.

Committee: Howard Saal (Advisor) Subjects:

Master of Science, The Ohio State University, 2009, Dentistry

Severe early childhood (S-ECC) caries has classically been studied as a disease, whose initiation and progression is determined by biological risk factors. In recent years S-ECC has begun to be associated to numerous social and psychosocial environmental conditions, one of which is parental stress. Our study set out to investigate the association of parental/caregiver stress as a co-factors to S-ECC prevalence. Using the Parental Stress Index-Short Form we determined the stress of primary caregivers of young children who were classified under clinical exam as either having no caries or S-ECC. Other social economic status determinants and classic biological and social co-factors were accounted for. Our results indicate a weak but positive association (p=.05) between parental stress and the presence and extent of S-ECC. Parents with high stress often share risk factors common to parents of children with S-ECC. Practitioners should be aware of this possible relationship and be prepared to provide appropriate intervention.

Committee: Sarat Thikkurissy DDS,MS (Committee Chair); Homa Amini DDS,MS (Committee Member); Paul Casamassimo DDS,MS (Committee Member); Kristen Gsanger MD,PhD (Other) Subjects: Social Psychology

Doctor of Philosophy, The Ohio State University, 2005, Nursing

Cancer is the second leading cause of death in the United States. Approximately 128,089 children in 1998 had a parent diagnosed with cancer. Parental cancer may be a pervasive stressful event for children, but the impact on children is largely unrecognized. How children cope with parental cancer and the effectiveness of their coping strategies is unknown. Based on an integration of Lazarus's cognitive appraisal theory of stress and coping, cognitive developmental theory, social/emotional developmental theory, and physiologic stress response theory, this study aims to characterize the stress-coping process of children ages 7-12 who have a parent with cancer. A descriptive, cross-sectional design was used with a convenience sample of 51 school-age children from a University support group, oncology outpatient clinics and inpatient units. Data were collected through questions related to children's appraisal of their parents' cancer, 3 saliva samples, a human figure drawing, four self-report instruments for children (concurrent stressors, coping, responses to parental cancer, relationships with parents) and two instruments for parents (relationship with the child and child behavior checklist). Children's appraisal of having a parent with cancer was positively significantly correlated with the severity of their symptoms. Children identified “having your parents argue in front of you,” “not having homework done on time,” and “not spending enough time with parents” as stressors that occurred most frequently and were perceived as most severe. “Pray” was the most frequently used and effective coping strategy. The average cortisol level of the children was within the normal range. Stress symptoms were predominantly cognitive/emotional symptoms such as worried, cry or feel sad, afraid, nervous, bad, mad, and confused. More than half of the children had 2 or more than 2 emotional indicators in their drawings. The better the child-mother relationship, the more the children believ (open full item for complete abstract)

Committee: Nancy Ryan-Wenger (Advisor) Subjects:

Master of Science (MS), Ohio University, 2004, Psychology (Arts and Sciences)

The goal of this study was to examine key factors that may predict success in school-based mental health interventions. This study occurred in the context of a larger study in which a behavioral, school-based mental health intervention was implemented and evaluated. The children who participated in the intervention (n=30) had been identified as demonstrating significant inattentive and disruptive behavior problems. Treatment outcome was defined as the change in the severity of the child's behavior across three points in time (baseline, 1-month assessment, post-treatment) as rated by parents and teachers. Predictor variables that were examined included child variables (the child's intelligence and pre-intervention behavior), family variables (parents' discipline style, stress associated with their child's behavior, and involvement in their child's intervention), and a school variable (the teacher's degree of optimism regarding the child's intervention). Data collected were analyzed using mixed model linear regression. A common theme emerged from the analyses—pre-treatment severity of Oppositional Defiant Disorder (ODD) symptoms predicted treatment outcome relatively consistently, i.e., regardless of the rater or the symptom dimension that was used to define outcome. Therefore, the children in our sample who displayed severe symptoms of ODD prior to treatment tended to benefit less from treatment than those who had less severe initial symptoms of ODD. In addition to pre-treatment ODD symptom severity, other variables emerged as significant predictors of outcome (e.g., parenting stress). It is hoped that the knowledge derived from this study can be used to improve school-based intervention programs by better matching them to the characteristics of the children and families that they serve.

Committee: Julie Owens (Advisor) Subjects: Psychology, Clinical

Doctor of Philosophy, University of Akron, 2006, Counseling Psychology

Ninety postpartum women participated in a study examining protective factors against eating disorder symptomology during the postpartum period. Using Taylor et al's “tend and befriend” theory of stress responses for women (2000) and considering disordered eating as on a continuum, it was hypothesized that if women engage in more “tending and befriending” responses at this stressful point in their lives (e.g., nurturing one's infant, breastfeeding, mobilizing social support), they have less eating symptomology than if they engage in fewer of these behaviors. Specific hypotheses examined corrleations between parental stress and eating disorder symptoms and how use of tending and befriending behaviors statistically predicted eating disorder symptoms and percieved parental stress separately, in an additive manner, and as moderators for the relation between stress and eating disorder symptoms. A relationship was found between parental stress and Eating Disorder Inventory –2 (EDI) total scores, however no significant relationships were found between stress and the specific eating disorder behaviors of interest (e.g. Drive for Thinness, Bulimia, and Body Dissatisfaction subscale scores). Tending behavior was a significant predictor of parental stress and EDI total scores as expected, but again not of any of the specific eating disorder behavioral variables of interest. Similarly, befriending variables statistically predicted eating disorder symptoms (EDI total scores and Drive for Thinness), and stress, but did not predict Bulimia or Body Dissatisfaction. These results showed that greater amounts of befriending were associated with lower EDI total scores and lower parental stress scores. In addition, an additive effect was found for tending and befriending behaviors for EDI total scores. No interaction effects were found; therefore "Tending and Befriending" do not moderate the relation between stress and eating disorder symptoms. Overall, the results of this study provide (open full item for complete abstract)

Committee: Linda Subich (Advisor) Subjects: Psychology, Clinical