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The relationship between family routines and perceived stress in mothers with children with and without a disability
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Content
THE RELATIONSHIP BETWEEN FAMILY ROUTINES AND
PERCEIVED STRESS IN MOTHERS WITH CHILDREN
WITH AND WITHOUT A DISABILITY
Copyright 2004
by
Valerie J. O’Brien
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(OCCUPATIONAL SCIENCE)
August 2004
Valerie J. O’Brien
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UMI Number: 3145255
Copyright 2004 by
O'Brien, Valerie J.
All rights reserved.
INFORMATION TO USERS
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DEDICATION
This dissertation is dedicated to my father, who would have been delighted to witness its’
completion, and to my mother, who has always been a source of unwavering support.
ii
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ACKNOWLEDGMENTS
I wish to thank Diane Parham, PhD, for her constant support and
encouragement throughout this long journey, and JoAnn Farver, PhD, who inspired
my interest in the family environment.
Sincere appreciation is extended to all of the mothers who so graciously
contributed their time and told me their stories of family life.
I send heartfelt thanks to my husband and children, who encouraged me to
continue wherever we were living.
My appreciation goes to the U.S. Army Medical Specialist Corps for
providing financial support and time.
1 1 1
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TABLE OF CONTENTS
Page
DEDICATION ....................................................................................................... ii
ACKNOWLEDGMENTS..................................................................................... iii
LIST OF TABLES ................................................................................................. vii
ABSTRACT ........................................................................................................... viii
Chapter
1. THE PROBLEM..................................................................................... 1
Background of the Problem ............................................................ 5
Statement of the Problem................................................................ 8
Purpose of the Study....................................................................... 8
Mediating Role of Age ............................................................ 9
Influence of Disabilities........................................................... 9
Presence Versus Absence of Disability........................... 9
Severity of Disability........................................................ 10
General Parenting Stress.......................................................... 10
Identification of Stressful Routines........................................ 11
Maternal Strategies to Manage Family Routines .................. 11
Importance of the Study.................................................................. 12
2. REVIEW OF THE LITERATURE........................................................ 14
The Family in the Context of Occupation and Early
Intervention............................................................................... 15
Family Routine Occupations .......................................................... 17
The Impact of Family Routines on Family M embers................... 20
The Significance of Time and Stress in the Routines of
Families With Children With Disabilities .............................. 24
Ecocultural Theory and Sociotemporal Context Related to
Routines.................................................................................... 28
Ecocultural Theory.................................................................. 28
The Sociotemporal Context..................................................... 30
Summary.......................................................................................... 36
3. METHODOLOGY.................................................................................. 38
Purpose of the Study....................................................................... 38
Participants....................................................................................... 40
Instruments....................................................................................... 43
Family Routines Inventory...................................................... 43
Parenting Stress Index, Short F orm ........................................ 45
Pediatric Evaluation of Disability Index ................................ 46
iv
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Chapter Page
Demographic Information....................................................... 47
Interview................................................................................... 48
Procedure ......................................................................................... 49
Pilot Study........................................................................................ 50
Data Analysis...................................................................................... 51
Limitations of the Study ................................................................. 53
4. RESULTS ................................................................................................ 54
Demographic Characteristics of the Participants........................... 54
Inventory Scores of Participants..................................................... 58
Research Question 1 ....................................................................... 60
Most and Least Frequent Routines ......................................... 61
Most and Least Important Routines........................................ 67
Most and Least Stressful Routines ......................................... 68
Research Questions 2 and 3 ............................................................ 70
Presence of a Disability........................................................... 70
General Parenting Stress.......................................................... 70
Research Questions 4, 5, and 6 ....................................................... 73
Age of the Youngest C hild...................................................... 73
Severity of Disability............................................................... 75
General Parenting Stress.......................................................... 79
5. INTERVIEW RESULTS ........................................................................ 84
Unfolding......................................................................................... 87
Temporal Unfolding ................................................................ 87
Unfolding by Inclusion............................................................ 88
Enfolding ......................................................................................... 91
Chunking.......................................................................................... 92
Organization and Planning.............................................................. 93
Mother’s Attitude............................................................................. 94
Mother’s Accommodations............................................................. 96
6. DISCUSSION.......................................................................................... 98
Research Question 1: Most and Least Stressful Routines ... 98
Research Question 2: Presence of a Disability........................... 100
Research Question 3: Disability and General Parenting Stress ... 102
Research Question 4: Mediating Role of Age ............................ 104
Research Question 5: Severity of the Disability and Routines .... 104
Research Question 6: General Parenting Stress and Routines 105
Research Question 7: Maternal Strategies to Manage Daily
Routines.................................................................................... 106
Implications for Occupational Science and Occupational
Therapy..................................................................................... 107
Conclusions and Recommendations................................................ 108
REFERENCES......................................................................................................... 110
v
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Chapter Page
APPENDICES........................................................................................................ 116
A. DEMOGRAPHIC INFORMATION FORM....................................... 117
B. LETTERS OF INTRODUCTION ....................................................... 120
C. FAMILY ROUTINES INVENTORY ................................................. 123
D. INTERVIEW G U ID E........................................................................... 129
E. INFORMED CONSENT FO RM ......................................................... 131
F. RANK ORDER OF ROUTINES FOR MOTHERS WITH
CHILDREN WITHOUT DISABILITIES ............................................ 134
G. RATING OF ROUTINES BY MEAN AND M O D E......................... 141
H. RESULTS OF ANALYSIS OF VARIANCE..................................... 151
I. FREQUENCIES OF STRATEGIES TO MANAGE STRESS
REPORTED BY MOTHERS ................................................................ 153
vi
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LIST OF TABLES
Table Page
1. Demographic Characteristics of Participants ........................................... 55
2. Inventory Scores of Participants................................................................ 59
3. Pediatric Evaluation of Disability Index (PEDI) Normative
Standard Scores..................................................................................... 60
4. Most and Least Frequent Routines of Mothers of Children Without
a Disability............................................................................................ 61
5. Most and Least Frequent Routines of Mothers of Children With
a Disability............................................................................................ 62
6. Most and Least Important Routines of Mothers of Children Without
a Disability............................................................................................ 63
7. Most and Least Important Routines of Mothers of Children With
a Disability............................................................................................ 64
8. Most and Least Stressful Routines of Mothers of Children Without
a Disability............................................................................................ 65
9. Most and Least Stressful Routines of Mothers of Children With
a Disability............................................................................................ 66
10. Intercorrelations Among 13 Variables ..................................................... 74
11. Predictor Variables of Maternal Stress Related to Routines:
Mothers of Children Without Disabilities............................................ 81
12. Predictor Variables of Maternal Stress Related to Routine:
Mothers of Children With Disabilities................................................ 83
vii
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ABSTRACT
This study explored the relationship between family routine occupations
and perceived maternal stress. The mediating roles of age of the children, the
presence and severity of child disability, and general parenting stress on maternal
stress related to routines were examined. Seventy-two Caucasian mothers in two-
parent families with young children from the San Antonio, Texas, area (40 with
children without disabilities and 32 with children with various types and levels of
severity of disabilities) completed a Family Routines Inventory; Parenting Stress
Index, Short Form; and demographic information. Mothers with children with
disabilities assisted with completion of the Pediatric Evaluation of Disability Index.
Sixty-eight of the mothers were interviewed to enable identification of maternal
strategies used to manage stress related to daily routines.
Mothers of children with disabilities reported significantly greater stress
related to daily routines and greater general parenting stress than did mothers of
children without disabilities. There was no correlation between the age of the
youngest child in the family and the mother’s report of stress related to routines.
Correlational analyses inconsistently supported the hypothesis that mothers with
children with more severe disabilities would have increased frequency, importance,
and stress related to daily routines than would mothers with children with less
severe disabilities. Maternal stress related to family routines was positively
correlated with general parenting stress and negatively correlated with the
frequency of routines. There was a strong positive correlation between the
frequency of routines and the importance of routines. Six major categories of
maternal strategies that seemed to decrease mothers’ perceptions of stress related to
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daily routines were identified: unfolding, enfolding, chunking, organization and
planning, mother’s attitudes, and mother’s accommodations. Some clusters of most
and least stressful routines were similar in the groups.
Stress related to daily routines was most evident when mothers had fewer
routinized days or were experiencing greater parenting stress. Mothers with more
functionally independent children or children with greater caregiving demands also
noted increased routine stress.
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CHAPTER 1
THE PROBLEM
Each weekday I get up at 6:10 a.m.; take a shower, get dressed, and do my
hair; begin breakfast preparations for myself and two children; check the wall
calendar for appointments; and then wake up my two oldest children, ages 5 and 7.
They arise, assist with final breakfast preparations; we all sit down and eat quickly;
and then they continue with their morning routines of cleaning teeth, washing
hands and face, combing hair, getting dressed, and checking on their supplies for
school. While they are getting ready, I constantly check them, make sure that all
lunches and supplies are packed and ready to go, complete my dressing and
makeup, while thinking briefly about dinner and what ingredients might be needed.
I mentally note if I have to pick up anything and check with my husband to see if
he can think of anything that we might need that day.
At about 7:20 every weekday morning, the three of us, after I ask whether
they have their knapsacks and lunches, get into the car. I drop the children off at
school at 7:50, and I arrive at work by 8:00. In order to have less to do in the
morning, I often pack lunches and choose the children’s clothes the night before.
As I rely on my children to complete their individual routines and they rely on me
to assist them in the sequence and completion of their tasks, our individual
weekday morning routines are interrelated and become a family routine. This basic
sequence of tasks occurs every weekday morning.
While this daily routine provides organization and predictability to our
morning, many mornings are very stressful and tense for me. I always feel a sense
of time urgency, as we must leave the house by 7:20 or we will all be late. On
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those particularly stressful mornings, one of the children may be unable to decide
what to eat for breakfast, may need continuous prodding to get ready, or may refuse
to wear the previously selected clothes; I may have overslept and started the family
routine later than usual. On those mornings I finish my makeup at work and the
children put on their shoes and socks and eat a breakfast snack food while I am
driving them to school. While these minor changes to our morning routine allow us
to complete the necessary daily tasks, there is evidence of increased stress, such as
scurrying around to get ready, yelling, and snapping at each other. This stressful
feeling is generally short-lived as we all gradually calm down on the drive to
school.
Families with younger children or children with disabilities have described
slightly different morning routines. In 1992 I completed a pilot study that
examined the ways in which mothers of young children organized and managed
their daily routines. Interviews with four mothers—two mothers of toddlers with
moderate disabilities and two mothers of toddlers without a disability—focused on
the daily routines and the sequence of routines that were needed to complete the
child care tasks.
All mothers expressed concern with the temporal constraints imposed by
societal schedules, such as getting the children ready on time in order to go to
school or day care. The presence of time constraints—both those imposed by
society (getting to school on time) and those imposed by the mother (getting the
children in bed by 8:00 PM)—seemed to be an element of family routines that
greatly affected the mother’s perception of stress.
In response to the tight time schedules, some mothers described practical
strategies that they used in order to cope with time constraints. One mother of a
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3-year-old described getting a drive-through breakfast on the way to day care each
morning. Instead of preparing breakfast and taking the time to eat at home on
weekday mornings, she found that the morning routine could be shortened and that
she and her child could sleep 10 minutes longer if they ate breakfast while driving
in the car. This enfolded activity (Bateson, 1996)—doing more than one activity at
a time—allowed this mother to streamline her morning routine.
The same mother also noted that, each evening, in preparation for the next
day, she made lunches, organized her own and her child’s supplies and equipment
and placed them by the door, and prepared and laid out clothes. This temporal
unfolding (Segal, 1995)—moving part of a usual routine to another time—of the
morning routine into the evening allowed this mother to focus on completing the
family morning tasks and seemed to decrease her perception of stress related to the
morning preparations.
An at-home mother of a 3-year old with cerebral palsy felt that she had no
options in organizing her family’s weekday morning routine. Her child had to be
dressed using specific handling techniques and fed with an adapted spoon while
seated in a specific chair. Feeding breakfast to her daughter always took at least 30
minutes. The mother organized and completed her child’s morning routine, as her
child was only minimally able to assist in any self-care function. If the mother
arose later than usual, she would not have enough time to feed breakfast to her
daughter. On those days of disrupted morning routine, the mother would keep her
daughter home from school or bring her to school an hour or so later, after she had
completed their morning care. The mother did not feel that anyone at school would
assist her daughter with breakfast nor assure that she was cleaned up after eating.
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The mother expressed feelings of time-related stress nearly every weekday
morning as she tried to assure that all of her daughter’s morning care needs were
met. However, once her daughter was on the bus, the mother’s perception of stress
dissipated. This mother did not describe any evening pre-preparation as an option
to help to reduce the number of morning routine tasks that she had to perform.
As a pediatric occupational therapist, I have often instructed mothers in
home treatment activities and suggested that they complete some specified task,
such as having the child pick up and eat cheerios, to enhance fine, visual, and oral
motor skills. As much as I tried to make the task specific and time-limited or
assisted in helping them to identify a place within the daily routine where the thera
peutic activity could be included, many mothers reported that they were unable to
perform the recommended activities in their daily routines. They typically
expressed that they had so much to do, and that it was so difficult to manage day-
to-day life as well as attend all of the therapy and medical appointments, that find
ing time to include home activities in their daily routines seemed too difficult.
However, some mothers successfully integrated these home activities.
Many of these mothers had children with similar diagnoses as well as similar
schedules and appointments as the mothers who noted that they were unable to find
time for the home therapy. How was it that some mothers were able to include
therapy activities in their daily schedules but other mothers were not able to do so?
Did the successful mothers have more routinized days or did they structure fewer
routines that allowed for more flexibility in the organization of their family
routines? Did the organization of specific tasks within the daily routines allow
more flexibility within the routine? Did they have specific strategies for accom
modating to changes in the family routines? Did adding activities increase their
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perception of stress because they had more to do? Did the severity of the child’s
disability impact the daily routines and make adaptations more difficult? Answer
ing some of these questions would assist professionals in deciding when, what, and
how home activities should be suggested for incorporation within the family’s daily
routines.
Background of the Problem
Occupational science is concerned with the study of humans as occupa
tional beings and their engagement in occupations, “chunks of daily activity that
can be named in the lexicon of the culture” (Clark et al., 1991, p. 301). The field
of occupational science is defining and describing human occupations as well as
attempting to understand the context, meaning, and form of occupation (Clark et
al.). The focus of occupational science is to understand how humans achieve a
sense of meaning through engagement in purposeful activity (Clark & Larson,
1993).
The study of occupations addresses not only individual physical perform
ance but also the psychological state and social environment in which the person
engages in meaningful occupations. Occupations can be routinized or habitual,
such as cleaning teeth, or nonroutine and individually unique, such as painting a
picture. A key concept is that engaging in the occupation has meaning for the
individual (Clark & Larson, 1993).
The study of routine occupations helps in understanding how people in a
particular culture orchestrate their daily life. Individual daily routines can be com
prised of singular tasks, such as combing hair, or a series of tasks performed with
regularity, such as getting ready for work. Routines performed on a regular basis
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that are enacted by two or more family members together are defined as family
routines; these activities are the focus of this study.
A family routine can be a singular co-occupation, an occupation that is done
together with another family member such as going for a walk. It can also be a
series of co-occupations with another family member. The bedtime routine may
involve a mother and child completing a series of co-occupations, with mother
helping the child put on pajamas, assisting with brushing teeth, and then snuggling
in bed with the child while they look at a picture book together. These family
routines, or co-occupations, have meaning both for the individuals and for the
family as a whole.
Parents, especially mothers, orchestrate the daily routines of family life.
Parents select and guide their young children through a sequence of daily occupa
tions. Parents, typically mothers, decide whether young children will have break
fast before or after getting dressed in the morning, whether their children will
attend preschool or play group, and when they will eat dinner and go to bed.
Parents not only make decisions about children’s engagement in occupations but
also orchestrate their own work and leisure occupations (Primeau, Clark, & Pierce,
1989).
Engagement in particular occupations presents both demands and benefits,
and these have an impact on the selection and orchestration of family routines
(Primeau et al., 1989). Studies have suggested that family routines appear to buffer
the effects of life event stress and promote health within the family by providing a
sense of security, organization, and predictability on a daily basis (Boyce, Jensen,
James, & Peacock, 1983; Keltner, Keltner, & Farren, 1990; Kliewer & Kung, 1998;
McCubbin & McCubbin, 1988; Sprunger, Boyce, & Gaines, 1985). For example,
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Keltner et al. found that family routines were inversely correlated with conduct
disorders in adolescent girls: Girls from families who placed greater importance
on family routines and adhered to those routines had fewer conduct disorders.
Although researchers have examined family routines in general, there may be some
families that, of necessity, have more routines than others. Furthermore, some
elements of the family routines may have greater impact on the family than others,
and some family routines themselves may be a source of stress.
Families with a child with a disability may indeed have more routine daily
care demands placed on them than other families. Research has shown that famil
ies with children with disabilities have increased time constraints related to the
special needs and care of their children (Dyson, 1993; Hinojosa, 1990). For
example, Johnson and Dietz (1985) noted that mothers of young children with a
physical disability spent more time in feeding, dressing, grooming, bathing, and
transporting their child than did mothers of normally developing children.
Parents of children with disabilities more frequently report feelings of
fatigue, the burden of care, and increased child care responsibilities than do parents
of children without disabilities (Dyson, 1991; Hinojosa, 1990; Kazak, 1987).
Cherry (1989) revealed that the demands of daily management of a child with a
disability may be a significant stressor “for what most people do quickly and easily
becomes for such parents a daily trial of patience” (p. 26). These reports of
increased routine care demands related to the presence of a child with a disability
seem to imply that more time is needed to complete daily routines or that there are
more routines to be completed. The literature seems to support both assumptions.
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Statement of the Problem
Family routinization seems to be an important yet not widely studied family
variable. In general, adherence to family routine occupations appears to buffer the
effects of stress within the family. However, families differ, and some families
may have more routines (or more time-consuming routines) that increase the per
ception of stress within the family. The literature clearly indicates that parents of
children with disabilities report increased stress, specifically related to the daily
care demands of their child, relative to parents of children without disabilities.
Parents of children with disabilities reported that they needed a “25-hour day”
(Hinojosa, 1990). However, it is unclear whether this stress is related to more care
routines, less flexibility within the routines, or extended amount of time spent in
routines, compared to other parents. Furthermore, it is unclear whether the severity
of the child’s disability impacts the number of routines and amount of time
involved in each routine.
Purpose of the Study
The purpose of this study is to explore the relationship between family
routines and maternal perceived stress related to those routines in families with
children with and without disabilities. Specifically, the mediating roles of age of
the child, severity of the child’s disability, and general maternal parenting stress on
the perceived stress related to routines are examined. In addition, routines that
seem to increase or decrease stress and maternal strategies used to manage routines
are identified.
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Mediating Role o f Age
I expected that there would be a negative correlation between the age of the
youngest child and the number of routines, as well as between the age of the
youngest child and perceived stress. Mothers of children who are younger, and
therefore more dependent, were expected to have more routines, value those
routines more, and report increased perception of stress related to those routines
than mothers of more independent, and generally older, children. Lawson and
Ingleby (1974) found that, as children grew older, parents spent less time in daily
caregiving tasks. Other evidence suggests that, even with the presence of a child
with a disability, parental child care time decreases as children grow older (Smith,
1986).
Influence o f Disabilities
Presence Versus Absence of
Disability
It was expected that there would be significant differences between mothers
of children with and without disabilities, although the literature is not consistent on
this issue. Smith (1986) and Crowe (1993) reported that the presence of a child
with a physical disability was associated with increased parental time spent on
child caregiving tasks when compared to families with a child without a disability.
Others have described increased caregiving demands and time constraints within
families with children with physical disabilities (Cherry, 1989; Hinojosa, 1990).
However, Lucca and Settles (1981) found no significant differences in the amount
of physical care provided by mothers of children with or without disabilities.
Children with behavioral disorders, learning disabilities, and physical disabilities
were included in the study, dividing them into mild, moderate, and severe
9
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disabilities based upon the child’s functional performance. No between-group
differences were discerned, although the researchers suggested that caregiver tasks
increased when the functional ability of the child decreased.
Severity of Disability
Although some evidence indicates that children with disabilities demand
more daily care and management than children without disabilities (Cherry, 1989;
Hinojosa, 1990; Smith, 1986), it is unclear whether the severity of the disability is
related to an increase in the frequency of family routines and the perception of
stress related to those routines. It seems plausible that a child with a more severe
physical disability would require more time related to routine care, such as feeding
or bathing routines, than a child with a less severe disability. I expected that the
severity of the child’s disability would be significantly and positively related to the
frequency and importance of routines and the perception of stress. In other words,
mothers whose children have fewer functional abilities than their peers (more
dependent on their mother for routine care) would have more routines, value those
routines more, and report more stress related to performing those routines than
would mothers of children with less severe disabilities.
General Parenting Stress
I expected that mothers of children with disabilities would report more
general parenting stress than mothers of children without disabilities. Many
researchers noted that mothers with a child with a disability reported more feelings
of parental stress and psychological distress (Breslau, Starbuch, & Mortimer, 1982;
Frey, Fewell, & Vadasy, 1989). I also expected that there would be a significant,
positive relationship between the level of general parenting stress and the frequency
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and importance of family routines and the maternal perceived stress related to
family routines. My pilot study examining the routines of mothers of toddlers with
and without disability revealed that some routines were reported to be quite stress
ful for most parents. I expected that the completion of stressful routines on a daily
basis would increase the report of general parenting stress.
Identification o f Stressful Routines
This study identified which routines tended to be most and least stressful for
mothers. In 1995 a second pilot study of 22 mothers was completed using the
Family Routines Inventory (Jensen, James, Boyce, & Hartnett, 1983) with supple
mentary questions on stress related to each routine. A convenience sample of 13
mothers of young children without disabilities and 9 mothers of young children
with disabilities were recruited from Los Angeles, California, and San Antonio,
Texas. The mothers completed a demographic information sheet and the Family
Routines Inventory. Examination of response distributions revealed a cluster of
family routines that were related to increased perceptions of stress. The categories
of weekend and leisure, bedtime, meals, disciplinary, and chore routines seemed to
be associated with the mother’s perception of increased stress. The least stressful
routines were linked to children’s, parent’s, and extended family routines. This
study identified the most and least stressful routines as well as those deemed most
and least frequent and most and least important.
Maternal Strategies to Manage Family Routines
The study revealed some of the strategies that mothers used to adapt family
routines and reduce the mothers’ perception of stress related to particular routines.
Segal (1995) noted that unfolding (moving a task to another time of day or
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delegating it to another) and the use of schedules were adaptive strategies fre
quently employed by families with children with Attention Deficit Hyperactivity
Disorder (ADHD). Bateson (1996) described the extensive enfolding of activi
ties—doing more than one activity at a time—that women typically do during daily
life. Zerubavel (1981) delineated the temporal division of tasks in response to
societal and social contexts. Many of the seemingly “simple” strategies used by
mothers included aspects of temporal coordination (scheduling), unfolding, and
enfolding. Understanding the impact of these strategies within daily family life
may be helpful to therapists treating families with young children, as they will be
better able to assist parents in the successful management of daily routines.
Importance of the Study
The engagement in routine occupations is fundamental in human life.
Although routine occupations are done regularly, one can choose when and how to
engage in these routines, thus allowing an ability to respond flexibly to changing
life situations. This study expands the knowledge about the form and context of
routine occupations in families and links these to psychological health via their
association with the mother’s perceived stress.
It is well known that stress influences health. Prolonged stress has been
associated with both psychological changes within the immune system and the
manifestations of symptoms of physical and psychological illness (Blake, 1988;
Dorian & Garfinkel, 1987). Also, the negative impact of daily hassles (such as
having too many things to do at once) on well-being has been found to exceed that
of major life events (Holahan & Holahan, 1987; Weinberger, Hiner, & Tierney,
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1987). By targeting daily occupations that create stressful hassles in the lives of
parents, this study expands the understanding of how occupations influence health.
This study advances the understanding of family routines in ways that
support the practice of occupational therapy with families who have children with
disabilities. Anderson and Hinojosa (1984) noted that occupational therapists
treating young children with cerebral palsy believed that parental involvement was
essential to a child’s treatment success. Approximately 75% of the therapists’
treatment time was spent in teaching treatment activities and proper handling and
positioning techniques to parents. Gross, Eudy, and Drabman (1982) showed that
important gains were achieved by young children with physical disabilities when
their parents continued home treatment activities at home.
Occupational therapists expect that parents will either integrate the treat
ment activities into their daily routines or plan specific therapy-related routines.
Extensive therapeutic involvement, increased time demands of daily life, and
increased stress have been suggested by parents and therapists as possibly influ
encing the lack of follow-through with therapist-directed home programs
(Hinojosa, 1990; Lucca & Settles, 1981).
This study provides critical information for occupational therapists about
the relationship of daily routines to maternal stress and will allow therapists to
make better informed decisions about when and how parents might best incorporate
therapeutic activities into daily family life. By understanding the mothers’ per
spectives and identifying modifications to routines that have been successful for
parents, therapists will have a greater appreciation and understanding of the
demands and complexities of daily life within the family with a child with a
disability.
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CHAPTER 2
REVIEW OF THE LITERATURE
Occupations are “chunks of culturally and personally meaningful activity
described in the lexicon of the culture” (Clark et al., 1991, p. 301). Routine
occupations are occupations that occur frequently and regularly within daily life.
Routine occupations can occur singularly, such as combing hair, or can be com
pleted as a series of occupations, such as the occupations included within the
morning self-care routine. When routine occupations involve two or more family
members, they can be described as family routine occupations, or family routines.
Family routine occupations also occur singularly or in a series. A singular family
routine occupation may be eating dinner together, while a series of family routine
occupations may constitute the bedtime routine.
Routines provide organization and structure within daily life. Beyond
providing organization and structure, family routines may offer a sense of security
for family members (Jensen et al., 1983). Family members can know that certain
occupations and ways of doing things will occur with regularity and predictability
and provide a sense of rhythm to daily life. Family health may be positively
affected by engaging in family routine occupations. The predictable home environ
ment appears to buffer the effects of daily life stressors on the family as a whole as
well as the individual family members (Keltner, 1992).
Some families appear to have the need for more routines than do others.
Families with a child with a disability often interact with numerous agencies and
various professionals. They often are asked to incorporate therapeutic activities
within their daily routine occupations. Families may be involved with ongoing
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medical care or with occupational, physical, and speech therapy, social workers,
special education professionals, or other health care workers, depending upon the
nature and severity of the child’s disability. These demands are likely to impact on
the orchestration of their daily lives and their perception of stress related to daily
routine occupations (Johnson & Dietz, 1985). Family routines may be the primary
vehicle through which the family responds to the demands of caring for and nurtur
ing a child with a disability.
This review of the literature begins with a brief discussion of the definition
of family, its role in providing the context in which routine occupations are learned,
and the emphasis on the family in current philosophies of early intervention. Next,
the definition of daily routine occupations and the impact of family routines on
family members are explored. Family routines in families with children with dis
abilities are discussed in relation to time constraints and increased parental stress
pertaining to daily care of young children with special needs. The meaning of
family routines within the family is explored through a brief discussion of eco
cultural theory and sociotemporal constraints. In conclusion, the linking of this
literature to occupational therapy is described.
The Family in the Context of Occupation
and Early Intervention
The U.S. Bureau of the Census (1985) defined the family as a group of two
or more persons living together who are related by blood, marriage, or adoption.
Societies continually reinforce the family as the unit that controls procreation,
controls sexual access, cooperates economically, and educates the children
(Maccoby, 1992). The family provides the context in which the child becomes
socialized, that is, begins to learn the rules, habits, and skills that will later allow
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the child to become a productive, effective adult (Yerxa et al., 1989). Parents,
through engagement in routine occupations and family occupations, enculturate
their children. Parents direct children within co-occupations, such as bathing, as
well as organizing their series of routine occupations, such as the selection of
occupations that occur within the bedtime routine. Parents organize and teach their
children a series of occupations at bedtime: the bath, putting on pajamas, brushing
teeth, reading a book, giving hugs and kisses, and the obligatory glass of water
signifying the end of the bedtime family routine. It is within these daily family
routine occupations that children begin to leam self-care skills, language, motor
skills, and the types of social expectations and interactions that enable children to
negotiate with others, both within the family and outside of the home.
Families orchestrate their selection of and engagement in daily routine
occupations based upon their family “theme” (Gallimore, Weisner, Kaufman, &
Bemheimer, 1989). The family theme becomes the overriding reason to organize
and maintain family routine occupations. For example, one family may religiously
eat dinner together every evening as the parents orchestrate their daily lives (and
their children’s lives) to revolve around the theme of maintaining a close, nurturing
family. Other parents may routinely eat dinner at a fast food restaurant as they
ferry their children from baseball to scouts. Their family theme might be enriching
their children’s lives through physical and social activity.
It is clear that the family is central in the development and enculturation of
the young child, yet medical professionals involved with families with a young
child with a disability traditionally tend to focus primarily on the child and his or
her physical or cognitive growth. Professionals often neglect to include the family
context in which the child lives. Success of intervention typically is measured by
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the attainment of developmental goals or adaptive skills, such as independent
walking or dressing. The family of the child may be considered mainly as an asset
or hindrance to the therapeutic process. As the understanding of the significance
of the family’s importance in assisting the child to gain developmental skills has
increased in recent years, the family has begun to be recognized as crucial to
reinforcing intervention strategies. The focus of early intervention has shifted from
the child to the child within the family.
The current emphasis in early intervention programs on family assessment
and treatment is a direct result of the implementation of PL 99-457, essentially an
extension of PL 94-142. Whereas PL 94-142 focused intervention services
primarily on the school-age child through provision of child-oriented services,
PL 99-457 extended the age of service provision to include preschoolers and, in
some instances, toddlers and infants. PL 99-457 also guided the focus of interven
tion from child-oriented to family-oriented services. This law mandated the
development of the Individualized Family Service Plan (IFSP), which finally
acknowledged that the child is part of a family system that provides an interactive
environment for development (Bailey, 1988). The family is now the focus of early
intervention programs and is recognized as the system that can enable the young
child to learn and grow into a competent adult.
Family Routine Occupations
The daily care and nurturing of the child within the family system involves
repetitive daily occupations. Families in every culture develop family routines that
assist in organizing daily life. While each family member has specific individual
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daily routine occupations, families develop family routine occupations which
become the “organizational units of ordinary life” (Boyce et al., 1983, p. 194).
A routine can be described as the “procedure usually followed; habitual;
ordinary” (Soukhanov, 1988, p. 1022). A family routine is defined as “those
observable, repetitive behaviors which involve two or more family members and
which occur with predictable regularity in the ongoing life of the family” (Jensen et
al., 1983, p. 201). Boyce et al. (1983) and McCubbin, McCubbin, and Thompson
(1987) noted 10 categories of family routines: work day, weekend and leisure,
children’s, parent(s)’, bedtime, mealtime, extended family, leaving and homecom
ing, disciplinary, and chore routines. Although there may be others, these 10
categories of routines appear to occur repeatedly in nearly all types of families.
Individual and family routine occupations are developed over time. Routine
and predictability begin to shape an infant’s day from birth, with daily patterns
forming in response to both internal and external cues (Christiansen, 1995).
Internal physiological rhythms of the newborn help to organize sleeping and eating
patterns, while parental responses to the infant’s biological signals begin to impose
cultural expectations. For example, some parents feed newborns every 3 hours—
even waking the infant for feeding. Other parents feed newborns “on demand,”
that is, when the infant cries or indicates hunger. While these parents are complet
ing the daily family routine of feeding the baby, their orchestration of the routine
within family life looks quite different to the observer. The mother who provides
“on demand” feedings may respond to the crying infant even in the middle of
cooking dinner, displaying flexibility within the orchestration of the family
routines. The mother who plans her infant’s feeding every 3 hours may schedule
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her daily routines accordingly, perhaps preparing dinner between feeding times and
perhaps allowing greater control over the sequence of the daily routine occupations.
Both infants and caregivers respond and adjust as the infant’s cyclic func
tions—eating, sleeping, alert time—are integrated into daily family life. Many
researchers refer to the importance of the child’s environment as crucial to the
child’s developmental outcome (Gallimore et al., 1989; Harkness & Super, 1994;
Maccoby, 1992). Environmental features include the routines or regular patterns of
daily life, which the parents orchestrate. Lubeck and Chandler (1990) stressed the
importance of consistency and predictability in the care of infants and young
children. For example, they suggested that lack of regularity in daily care can
create feeding and sleep problems in children and increased stress for caregivers.
Sprunger et al. (1985) examined infant rhythmicity—the predictable
biological patterns such as eating, sleeping, or elimination—and its relationship to
family rhythmicity, described as the frequency of family routines. Two hundred
eighty-five families, each with an infant between the ages of 2 and 13 months and
an older sibling, were given a variety of questionnaires related to family routine
occupations, infant rhythmicity (based on the questions about daily patterns and
temperament), maternal, and parenting satisfaction. Correlational analysis revealed
that more rhythmic infants were found in families that had more routines. Further
more, the mothers’ sense of competence was higher in families with more consist
ent routines. Perhaps a competent mother is better able to maintain family routine
occupations or perhaps, by keeping consistent family routines, a mother’s percep
tion of competence is increased and an infant’s rhythmicity is enhanced. Both
viewpoints suggest that family routine occupations are important in maintaining a
sense of control and organization in daily family life.
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Douglas, Lawson, Cooper, and Cooper (1968) used a time log interview
method to gather data that described the types of activities and interactions in
which infants and young children were involved on “normal” days. The methodo
logy proved useful in describing fairly consistent patterns of daily activities over
days and months. Weekday routines and interactions were similar and remained
constant during the 19-month longitudinal study. This consistency in patterns of
routine occupations supports the function of routines as providing predictability
and organization to daily life.
The Impact of Family Routines
on Family Members
For some families, routines may be flexible and flowing, while other
families may be more focused on completing routine occupations in a particular
order. Gallimore, Weisner, Bemheimer, Guthrie, and Nihira(1993) noted that
families develop a theme in the “construction and maintenance of a daily routine in
which families organize and shape their child’s activity and development” (p. 186).
This family theme appears to provide the meaning that underlies the selection and
engagement in family routine occupations. Research by Douglas et al. (1968)
demonstrated that families constructed daily routine occupations that were fairly
consistent over an extended period of time and that families attempted to sustain
those daily repetitive patterns.
Although routines are an accepted part of daily life, little has been
researched on the variety, maintenance, and meaning of family routine occupations.
Many researchers have alluded to the importance of daily routines within the
family (Carlson, Ricci, & Shade-Zelow, 1990; Cherry, 1989; Dunst, Trivette, &
Deal, 1990; Lubeck & Chandler, 1990), but only a few have attempted to reveal the
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significance of family routines in daily life and the impact that they have on family
members (Boyce, Jensen, Cassel, Collier, Smith, & Ramey, 1977; Boyce et al.,
1983; Gallimore et al., 1993; Jensen et al., 1983; Keltner, 1992; Kliewer & Kung,
1998; McCubbin et al., 1987).
Boyce et al. (1977) were the first to focus research on family routine
occupations as a family characteristic and to relate that characteristic to family
members’ health. They hypothesized that routines are part of daily life and that
routinization provides family organization and stability that help families to cope
with life stressors. Their study noted the influence of life event stressors and
family routines on minor illnesses in preschool-age children.
Over a 1-year period, 58 children attending a day care were observed on a
daily basis for evidence of respiratory illness. Biweekly nasopharyngeal cultures to
determine the existence of bacteria, mycoplasms, and viruses were obtained from
each child. Each illness was evaluated and categorized by a nurse practitioner or
pediatrician. At the end of the year, families completed a life change inventory that
provided a total life event change score. Each family also completed a family
routines inventory that provided a total number of common routines in which the
family engaged.
Initial results revealed that the life event change score was positively
correlated with both the average duration and severity of children’s respiratory
illnesses, indicating that children in families with greater life changes had longer
and more severe colds and respiratory illnesses. Family routine scores were
inversely related to the number of illnesses, the duration, and the total sickness
score; that is, children in more routinized families had fewer illnesses of less
severity and of a shorter duration. Further analyses revealed an unexpected finding,
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however. Children’s illnesses tended to be longer and more severe as the life event
change score and the family routines scores increased; that is, children with more
major event changes within the family who had more routinized family life had
longer and more severe illnesses. It had been expected that greater family routiniz-
ation would help protect the child from illness; therefore, it was surprising that
those children from more routinized families had longer and more severe illnesses
when they experienced greater degrees of life event changes. This might suggest
that adherence to an excessive number of family routines may actually increase the
susceptibility to stress and illness, rather than helping to mediate it.
Keltner et al. (1990) and Keltner (1992) also reported that the frequency of
family routines was related to child health. Keltner et al. studied 37 adolescent
girls, 15 with a nonaggressive conduct disorder, 7 with an aggressive conduct dis
order, and 15 with no conduct disorder. Using the Family Routines Inventory and
demographic information, these researchers found that several family characteris
tics, including family routines, were predictive of conduct disorders in families
with adolescent girls. More routinized families had a greater tendency to not have
a teenager with a conduct disorder. Kliewer and Kung (1998) also noted a similar
tendency for adolescents growing up in inner-city neighborhoods. This would lend
support to the premise that routines provide a family with stability and security and
could impact the emotional health of adolescent girls within the family and
adolescents in general.
Keltner (1992) investigated family routines and the link to family health.
Families of 110 preschool-aged children enrolled in a Head Start program com
pleted the Family Routines Inventory and the Home Screening Questionnaire. The
children’s health records were screened for five health-related factors: a physical
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examination, hematocrit/hemoglobin values, height and weight, dental inspection,
and vision screening. Family routines were found to be positively correlated with
the child’s health status; that is, families who had more routines had children who
were more healthy. This study, like that by Boyce et al. (1977), suggests that
family routines have an impact on the physical health of the children within a
family.
McCubbin and McCubbin (1988) found that families whose members
adhered to and acknowledged the importance of routine occupations seemed to
have greater cohesiveness; that is, they were more cooperative and supportive of
each other. These researchers also reported that families were likely to have more
routines and consider those routines more important during different life stages.
Couples and families with older children placed less emphasis on routines and had
fewer family routines than did families with younger children. Family routines
were most important to families raising young children. This supports the belief
that routine occupations organize family life as well as enculturate the children.
Research has begun to reveal that the organization of and engagement in
daily routines impacts the physical and emotional health of individual family
members and affects the ability of the members to work together as a family. The
belief that engaging in occupations can promote health is a foundational concept in
occupational therapy (Meyer, 1922; Yerxa et al., 1989). Therefore, an exploration
of the relationship between routine occupations and maternal stress would make an
important contribution to the science of occupation that supports the practice of
occupational therapy.
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The Significance of Time and Stress in the Routines
of Families With Children With Disabilities
Time studies are frequently used to describe the routine occupations of
individuals and families. Families with a child with a disability are found to spend
more time in child care routines than families with children without a disability.
This increased time spent in physically caring for the child with a disability sug
gests that family members, particularly primary caregivers, have decreased time
available for other family activities.
Lucca and Settles (1981) noted a prominent link between time use and the
child’s disability. They compared time use in 41 families with children with
disabilities to 18 control families with children without disabilities. The disabled
child’s functional skill, as measured by the Vineland Scales of Social Maturity, was
inversely related to the mother’s self-care time; that is, the mother had less time for
personal care when there was a child with limited functional abilities in the family.
Fewer family leisure occupations were experienced in families with a child with a
disability than with control families. Of interest, however, is that the researchers
found no relationship between the total amount of time spent in physical child care
provided by the mother and the presence or severity of disability. Unfortunately,
the authors’ description of the measure of actual time spent in physical child care
occupations was unclear. The researchers suggested that differences in the amount
of time spent on daily child care activities would vary with the functional skills of
the child, although this contention was not supported by the data.
However, Smith (1986) noted increased time spent in routine childcare
occupations of the school-age child with a physical disability. His study compared
the time use of 46 parents of children with disabilities with parental data from a
nationwide time use study of 109 control families. The children with physical
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disabilities required greater time spent on daily care than children without disabili
ties. Mothers of children with disabilities averaged 33 minutes per day in routine
child care occupations, compared to 11.5 minutes for mothers of children without
disabilities. The child’s age and functional abilities, based on physical disabilities
rating profile composed of self-care items, were related to the time demands. As
the child grew older or functional skills increased, daily care demands decreased.
Fathers of children with a disability were also shown to have more child care
occupations than controls. These results imply that parents of children with
disabilities spend more time in family routine occupations and may have more
occupations in which they routinely engage.
Johnson and Dietz (1985) described the time use of mothers with pre
schoolers with and without physical disabilities. Their study compared 37 mothers
of preschoolers with physical disabilities to 21 control mothers of young children
without disabilities. Results indicated that mothers of young children with physical
disabilities spent significantly more time in providing daily physical care and
transporting children to medical appointments than did control mothers. The
results also indicated that the increased demands of daily routine child care for
mothers with children with physical disabilities were related to mothers’ reports of
an overall feeling of burden and stress.
Hinojosa (1990), in a qualitative study using interview and participant
observation methods, described a link between daily routine occupations involved
in the care of children with disabilities and mothers’ stress. Mothers characterized
their feelings of caring for young children with cerebral palsy as “If only I had a 25
hour day.” Findings from this study of 8 mothers showed that the mothers often
felt burdened with the daily care and therapy demands of their young children.
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Their time demands were met by completing only the necessary and most meaning
ful daily activities. This suggests that there might be fewer rather than more daily
routines in some families with a child with a physical disability, but that the
routines may hold greater importance within the family.
Segal (1995) described the unfolding of daily routines that seemed to help
parents of children with ADHD to manage the demands of family life. The process
of unfolding routines allowed mothers to reorganize their daily routines so that they
were more able to focus on assisting their children’s engagement in a particular
task. Routines were unfolded by time (temporal unfolding), such as packing
lunches or organizing bags in the evening in preparation for the next day, or by
inclusion. Unfolding by inclusion allowed the daily routine to continue as usual
but the mother delegated the task to other family members or paid help, such as
when the father participated in mealtime preparations at breakfast or dinner while
the mother assisted the child with dressing or homework. Segal also noted that
enfolding (Bateson, 1996)—doing more than one occupation at a time—was
common among these mothers as they managed daily routine activities.
Much research has focused on the increased stress found in families with
children with disabilities. Compared to families with children without disabilities,
families with children with disabilities have been shown to have more parental
stress related to the care of young children with special needs and specific handi
caps (Breslau et al., 1982; Dyson, 1991; Frey et al., 1989). Families with a child
with a disability not only experience the normal day-to-day stressors of modem life
but also experience increased stress (compared to other families) related to the
presence of a child with a disability within the family (Gallagher, Beckman, &
Cross, 1983).
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Breslau et al. (1982) compared 369 mothers of children with cystic fibrosis,
cerebral palsy, spina bifida, and multiple handicaps with 456 control mothers.
Mothers of the children with disabilities, whatever the disability, scored signifi
cantly higher on a psychological stress scale. As the child’s functional level
decreased (as measured by the level of independence in dressing, eating, toileting,
and ambulating) and the mother was required to assist the child with more daily
routine occupations, the mother’s stress level increased.
Frey, Greenberg, and Fewell (1989) noted that parental stress was affected
by the severity of disability of the child. Forty-eight parents of children with
varying disabilities were assessed on a variety of parental scales of coping abilities,
parenting hassles, resources, and psychological symptoms of stress. Children’s
functional abilities were ascertained by using the Vineland Adaptive Behavior
Scales. The researchers reported that greater parental stress was significantly
related to children with more severe disabilities, especially those with more limited
communication skills.
Sloper and Turner (1993) reported that the severity of the child’s disability
was significantly related to the parent’s report of psychological distress. In this
study, 107 families completed questionnaires as well as an interview. Parental
inventories were used to measure psychological distress as well as life satisfaction
and coping styles. The extent of children’s functional abilities was assessed
through interview. Parents reported increased distress when children had limited
feeding and communication abilities. The routine occupation of feeding the child
with a severe disability was described via interview as extremely time consuming
and restrictive of parents’ opportunities for engagement in activities outside of the
home.
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In their extensive literature review of families with children with disabili
ties, Gallagher et al. (1983) noted that, in addition to parental stress related to the
presence of a child with a disability, the degree of stress reported by parents of
children with disabilities tended to increase as the child aged. As the children grew
older and physically bigger, they became more difficult to bathe, dress, and feed.
Also, the differences between the child with a disability and his or her peers
became more obvious and influenced the parents’ perception of the child as socially
acceptable. These differences were noted especially in children of elementary
school age or older.
The time demands based on the child care routine occupations and the
emotional burden of childcare required of parents of children with disabilities seem
fairly well documented. Many studies reveal that these parents experience
increased daily care demands that impacted the use of time (Cherry, 1989;
Hinojosa, 1990; Johnson & Dietz, 1985; Smith, 1986). It seems likely that these
care demands produce feelings of pressure and increased stress, as described by
Sloper and Turner (1993). The present study links the enactment of family routine
occupations to perceived stress in families with children with and without dis
ability. It also elaborates on the relationship of the severity of the child’s disability
to the number of routines and maternal stress related to routine occupations.
Ecocultural Theory and Sociotemporal
Context Related to Routines
Ecocultural Theory
Ecocultural theory (Gallimore et al., 1989,1993) describes family life as
reflecting ecological (environmental) and cultural factors that are mediated through
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a family’s ecocultural niche. The niche is derived from both material ecology (e.g.
family income, housing) and the particular cultural characteristics that the family
embraces (e.g., beliefs, values, and goals). These ecological features are reflected
in “activity settings”: those activities of everyday life in which the family partici
pates. The activity settings include the who, what, why, and when of daily life.
The description of activity settings addresses “who is present, their values and
goals, what tasks are being performed, why they are being performed, and what
scripts govern interactions” (Gallimore et al., 1989, p. 217).
Families make decisions about the ways in which they orchestrate their
daily activities based on many ecocultural factors. “Family accommodation”
(Gallimore et al., 1993) describes the ways in which families choose to respond to
myriad circumstances and factors that can impinge on their situation. In the
American ecocultural environment, families may choose to construct their daily
routines based on various personal explanations. Some may be based on personal
values such as religious beliefs. Other families may choose to provide a stimulat
ing home environment or succumb to the most demanding need of the present.
Gallimore et al. (1989, 1993) studied 102 families with young children with
developmental delays of unknown cause, using both questionnaires and interview.
The families were found to be “driven by the task of constructing and sustaining a
daily routine for themselves and their children and making the routine coherent in
terms of their view of family and child life” (p. 219). The families exposed the
interconnectedness of many facets of the ecocultural niche, their interpretation of
the features as positive or negative depending on the context, and the reflection of
occupational choice in daily life as having a “theme.” These themes, such as con
tinuously providing therapeutically stimulating activities for the child, appeared to
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provide meaning for the family routines and the accommodations in which the
families engaged.
The importance and meaning of family routines is central to ecocultural
theory and the representation of the ecocultural niche. Within day-to-day life,
family members must make choices that are bound by many ecocultural con
straints. Sociotemporal forces, or time constraints, may impose great strain on the
completion of daily routine occupations of families with children with disabilities.
In the present study, ecocultural theory provides a framework for the interpretation
of the frequency and importance of family routine occupations based on a family
theme as well as guiding the identification of maternal strategies used in the
management of daily family routines.
The Sociotemporal Context
Ecocultural theory broadly describes the constellation of ecological and
cultural factors that impact daily family life. In contrast, Zerubavel’s (1979)
sociotemporal order describes in depth one cultural feature that influences the
selection and performance of family routines. Family members are forced to
consider other people’s life plans that may impact on the completion of their own
routines. All of these choices and tempos for living are directly and indirectly
related to the culture in which these family members live.
The selection and performance of one’s daily routines can be construed as
“inseparable parts of a larger whole, that they are essentially organized within some
social context” (Zerubavel, 1979, p. 106). Zerubavel’s sociotemporal order can be
viewed as a systems approach to the study of a person’s organization of time in
daily life, which includes involvement in family routine occupations.
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Zerubavel (1979) presented the conception of time within the social context.
Drawing upon research completed within a hospital, he examined the patterns of
social life that were directed by time use within the hospital culture. The cyclical
nature of the social structure of the hospital (e.g., year, rotation, week, day, shift)
highlights the development of regular predictable routines that are necessary to
organize a group of people within a particular social system.
As people grow older, social order often precludes satisfaction of biological
needs. Some must be at work by 7:30, so they must arise at 6:00 instead of sleep
ing to a more desirable time of 8:00. Lunch is at noon, even though they may be
hungry at 11:30. These individual rhythms and preferences become subservient to
the sociotemporal order.
Sociotemporal order is described as a key feature of social organization.
Zerubavel (1979) noted that the sociotemporal order subsumes individual personal
time patterns and that personal time patterns become inseparable from the social
patterns of the culture. The person becomes part of the collective social order of
the organization and culture and responds to the time demands imposed by that
order. The organization provides an impersonal structure to organize daily life:
start at 7:30, lunch at noon, meetings at 3:00, go home at 4:30. Each individual is
subject to the sociotemporal structure of the organization.
The temporal order within any business, school, or hospital is central to the
order of society and the societies that interact with it. Temporal symmetry is one
of the “fundamental principles of social organization” (Zerubavel, 1981, p. 65).
Individuals become part of a larger system that makes them feel like part of a group
and helps them to develop a group identity. For example, a work cohort entitles the
worker to become part of the commuting cohort that allows the worker to shop in
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the evenings or on weekends with many others who are part of the sociotemporal
cohort in the largest sense. The fact that many of us do many of the same things at
the same time permits us to presume the regular order of everyday life.
Although this symmetry enhances the sense of belonging to and being part
of a group, individual needs are relegated to a minor position. The specific needs
of couples with small children or the family with a child with a disability are
generally discounted within the sociotemporal symmetry required of working
people. Temporal symmetry imposes order and denies individualism.
How, then, can a society that seems to applaud individualism be dominated
by temporal symmetry? Zerubavel (1981) proposed that modem cultures also
include an element of temporal complementarity, or individual differentiation.
Temporal complementarity is necessary to allow people to interact with a variety of
social organizations. Individual schedules are coordinated to allow for the “variety
of relationships and daily affairs of modem individuals and the differentiation of
their interests” (Zerubavel, 1981, p. 68). This concept of temporal coordination
seems well suited to the ways in which individuals within a family may plan and
organize their daily lives, both with each other and with societal organizations.
In temporal complementarity, each family member has an individual
schedule that is coordinated with those of other family members. In a two-parent
family, with both parents in full-time employment, temporal complementarity is
clearly in evidence. On his way to work, father may drop off the oldest child at
elementary school. Mother, during her commute, may take the youngest child to
day care. After-school care for the oldest child is provided by the same day care
program attended by the youngest child. Shopping and errands are coordinated
between parents as they make their way home at the end of the work day.
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Coordination of daily family routines involves great temporal demands placed upon
responsible family members.
In a family with a child with a disability, twice-weekly therapy sessions and
intermittent medical appointments must be coordinated between parents as well as
with the employers. Single parents or parents with less flexibility in work demands
may be increasingly strained by the temporal inflexibility of larger organizations
and may need to unfold more daily tasks. Medical, therapy, and school appoint
ments are rarely available on Saturdays, when family routines are generally more
flexible.
Zerubavel (1981) noted the importance of the temporal division of labor as
enhancing a group’s “interdependence and, thus, functions as a most powerful basis
for strong organic solidarity within the group” (p. 69). This concept could be con
sidered within the family unit as each family member has a particular function that
is based on responsibilities and, somewhat, on interest. If an important family
theme is to enhance the potential for development of the young child with a dis
ability, then sharing the tasks that would enhance that child’s development would
enhance family cohesiveness. Both parents and siblings would assist in taking the
child to therapy appointments, providing opportunities within daily routines to
enrich development, and focusing most family routines on child development
goals. Family jobs and responsibilities would be divided temporally into comple
mentary and supportive functions to enrich development of the child with a
disability.
Unfolding and enfolding may be methods that can be used frequently within
families to enable parents to complete all required daily tasks. Segal (1995) noted
that parents of children with ADHD frequently unfold daily activities, completing
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parts of some routines at different times of the day or allowing another person to
complete a routine. Bateson (1996) described the enfolding of activities as doing
more than one task simultaneously. For example, mothers frequently perform two
or more tasks at once, such as watching over the children while cooking dinner.
Gallimore et al. (1993) described the family theme as a guiding set of
values influencing the organization of daily activities, such as eating together as a
family to nurture togetherness. Family themes allow the family to overlay a sense
of meaning within their selection of daily routines. The family’s theme has a
temporal component. In a family with numerous appointments and involvement
with many agencies, a family schedule would be developed based on the family
theme of optimizing care for the child with a disability.
The schedule, based on family temporal patterns and the family theme,
allows us to predict, with some degree of certainty, whom we will meet and when.
Schedules provide the world with structure and provide a solution as to how we
should order our lives (Zerubavel, 1981). Families often must rely on schedules in
order for family needs to be met. General family care requires order so that those
family members can be in synchrony for certain family functions, such as the
family meal or getting ready for work or school. Schedules imply organization and
routinization.
Most families function in a temporally complementary fashion. They
engage in daily family routines and plan activities in advance to promote the effect
ive functioning of the family. Family schedules and routines depend upon the
number of family members and the flexibility of each family member’s time as he
or she responds to individual temporal order. Work and school systems often pose
many temporal conflicts for family members. For example, if the parents must
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begin work at 8:00 A.M. and the children must be at school by 8:00 A.M., the
family must organize morning routine occupations that facilitate both children and
parents to meet the culturally imposed expectation of arriving at school and work
“on time.” Families with children with disabilities may have more complex
scheduling challenges than most families because they are also involved with other
social and medical programs in addition to the typical work and school organiza
tions. Segal (1995) used the term “anchored schedule” to describe family
schedules that are organized by job and school hours and allow limited flexibility
for the family.
In addition to responding to larger social organizations when organizing
family daily routines and schedules, families must respond to individual family
members’ priorities. Some daily activities are carried out by all family members,
such as getting ready for work or school. The selection of other family routines
often depends on the individual’s attitude toward that activity as well other family
members’ perceived status of that activity. Dinner in a family with two working
parents may include more take-away meals, as the priority for meal preparation
becomes subservient to other family routines. On the other hand, meal preparation
may be more elaborate in some families, as the family meal reflects a greater
family value. Segal (1995) noted that these selected occupations are part of the
responsive schedule; they may reflect the family theme (Gallimore et al., 1993).
Families in modem American society vary greatly. Daily activities and
routine occupations performed by individuals within a family are a combination of
personal and socially significant variables. Ecocultural factors, including the
sociotemporal demands within the culture, affect the selection and organization of
daily routine occupations. An individual’s routines must be considered within the
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family context and must be considered to be interdependent with other family
members. In the present study, the organization of routine occupations within the
sociotemporal context of the family are explored through interviews with mothers
and described as the routines related to maternal stress that help mothers to manage
daily family life.
Summary
Family routine occupations provide a sense of predictability and regularity
in daily life. Jensen et al. (1983) described family routine occupations as providing
organization to family life while encouraging stability within daily family life.
Routines serve to define the family and establish their focus of functioning.
Engagement in family routine occupations has significant positive implications for
family members’ physical and emotional health (Boyce et al., 1977; Keltner, 1992;
Keltner et al., 1990; McCubbin & McCubbin, 1988).
Gallimore et al. (1989) stressed the ecocultural features that allow a family
to develop and sustain daily routines based on a family theme: the meaning that the
family ascribes to their daily lives. “Family themes can transform what may seem
to be a stimulating, enriched home environment into a stressful and frenzied set of
activities of uncertain benefit or turn a seemingly impoverished family circum
stance into a satisfying and meaningful one” (p. 224).
Zerubavel (1981) described the importance of time within daily routines.
Temporal symmetry or complementarity within the ecocultural context is an
important consideration in the organization and execution of family routines—what
needs to be done versus what is important to be done. Gallimore et al. (1989, 1993)
might presume that the family would choose daily tasks that support the family
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theme, yet acknowledge that these choices are often influenced by the greater
environmental context, such as time or finances.
Although all families with young children have demands on time and daily
tasks, families with young children with disabilities seem to have more time and
activity constraints than other families (Cherry, 1989; Hinojosa, 1990; Johnson &
Dietz, 1985; Smith, 1986). Increased time demands and the perception of increased
stress may be related to the increased demands in daily routine care of the young
child with a disability. As suggested by Hinojosa, the desire to create and sustain
family routines may be severely impacted by time and the number of tasks that
must be done.
It appears that the perceived importance, or meaning, of the family routine
affects the selection of daily tasks and the interpretation of those activities by
family members (Gallimore et al., 1989,1993). While both Jensen et al. (1983)
and Gallimore et al. (1989,1993) emphasized the relevance of the selection and
orchestration of family routines to quality of family life, little has been explored
about the details of the daily routines in families with young children. This study
expands the understanding of family routine occupations and the impact that
organization and engagement in those routines have on mothers.
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CHAPTER 3
METHODOLOGY
Purpose o f the Study
This study explores the relationship between family routine occupations and
perceived maternal stress in families with children with and without disabilities.
Of particular interest are the mediating roles of child age and severity of child dis
ability on perceived stress as it relates to routines. Also, stress-reducing routines,
the relationship between maternal perceived stress related to routines and general
parenting stress, and maternal strategies used to manage routines are identified.
Mothers of young children less than 8 years old, with varying degrees of disability
(from no disability to severe disability), completed a family routines and stress
questionnaire and a parenting stress index. Each mother of a child with a disability
described the child’s level of functional performance via a questionnaire that
measures degree of disability in order to determine the severity of the child’s
disability. Mothers were interviewed in order to identify the occupations involved
within the family routines and the strategies that the mothers used in the orchestra
tion of daily family routine occupations.
The following research questions were addressed:
1. What routines are most or least stressful for mothers, and what daily
occupations are associated with most or least stressful family routines? (I
expected that mothers in the study, regardless of the presence or absence of a child
with a disability, would have clusters of routines that were especially stressful or
non-stress producing and that particular occupations would seem to provoke greater
perceived stress.)
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2. Do mothers o f children with disabilities have more routines, value those
routines more, and have increased stress related to routines than mothers o f
children without disabilities? (I expected that mothers of children with disabilities
would have more routines, would deem those routines more important, and would
report more stress related to performing those routines than would mothers of
children without disabilities.)
3. Do mothers o f children with disabilities report more general parenting
stress than mothers o f children without disabilities? (I expected that mothers of
children with disabilities would report more general parenting stress than would
mothers of children without disabilities.)
4. Is there a relationship between the age o f the youngest child in each
family and the mother’ s reports o f routine frequency and importance and stress
related to those routines? (I expected that there would be a significant negative
correlation between the age of the child and the number of family routines, the
importance of those routines, and stress related to those routines, regardless of the
presence or absence of disability).
5. Is there a positive relationship between the severity o f disability and the
mother’ s reports offrequency and importance o f routines as well as stress related
to those routines? (I expected that the severity of the child’s disability would be
significantly related to the frequency of routines, importance of routines, and stress
related to those routines, such that mothers of children with severe disabilities
would tend to report more routines, deem those routines more important, and note
more stress related to those routines than would mothers of children with less
severe disabilities.)
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6. Are there relationships among the level o f general parenting stress, the
frequency and importance o f family routines, and maternal perceived stress related
to family routines? (I expected that mothers who report more routines, deem those
routines more important, and report more stress related to family routines would
have more general parenting stress.)
7. What strategies do mothers employ to manage family routines, and how
do these strategies change the mothers ’perceptions o f stress? (I expected that
interviews with mothers would reveal a variety of successful strategies used to
modify family routine occupations.)
Participants
A convenience sample of mothers of children between the ages of 1 and 8
years was recruited from the greater San Antonio, Texas, area. Seventy-two
mothers with young children (40 with children without disabilities and 32 with
children with varying degrees of disability) were included in the study. Mothers
were selected as informants because they were more likely than other caregivers to
bring children to therapy or preschool and to be actively involved in their children’s
daily care (Hinojosa, 1990; Johnson & Dietz, 1985) and because they were likely to
be able to provide accurate information on daily routines within the family.
Mothers were included in the study if they were Caucasian, married, and living
with their husband and children in a household with an income under $100,000,
and if they had at least a high school diploma.
Even though the orchestration and maintenance of family routines is not
unique to a particular ethnic group or marital group, routine occupations may vary
depending upon family ethnicity and marital status. Although the Family Routines
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Inventory measures routine occupations in which any family can engage, without
regard to marital status or race, and has been used with subjects of varied ethnic
backgrounds (Keltner et al., 1990; Sprunger et al., 1985), there may be differences
in adherence to and importance placed upon specific routines in families of
different ethnic backgrounds or marital status. Using only married Caucasian
mothers living with their husbands allowed a degree of control of group variance
related to ethnicity or marital status.
Socioeconomic status was determined using Entwistle and Astone’s (1994)
guidelines. Drawing from research in child development and considering the
diversity in the American population as well as current social trends, Entwistle and
Astone recommended that a series of questions be used in questionnaires or inter
views to provide comprehensive information for ascertaining both ethnic and socio
economic status. Questions found in the Demographic Information form (appendix
A) related to family income, educational level, and the presence of parents, step
parents, and grandparents in the home were developed using Entwistle and Astone
guidelines. All mothers in the study had at least a high school diploma and a
annual family income between $20,000 and $100,000. There were no stepchildren
or grandparents living with any of the families.
Mothers who were eligible to participate in the study had to have children at
home who were all between 12 months and 8 years old. Each family had at least
one child under 5 years, as children under the age of 5 have been shown to require
more child care time than families with older children (Johnson & Dietz, 1985) and
less ability to perform many self-care tasks independently (Haley, Coster, Ludlow,
Haltiwinger, & Andrellos, 1992). The target child in each family was the youngest
child or the child with a disability. Thirty-five months was the mean age of the
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target, or youngest, child in the families of mothers of children without a disability,
and 40 months was the mean age of the target child of mothers of a child with a
disability.
The children with disabilities were diagnosed with a variety of medical
conditions. Ten children were deemed to have a general developmental delay not
delineated by another medical diagnosis; 7 were diagnosed with cerebral palsy, 4
with autism, 4 with multiple handicaps (involving vision, hearing, or seizures in
addition to a developmental delay), 3 with speech impairment, 3 with sensory
integration disorder, and one with Down syndrome.
Forty mothers of children without disabilities were recruited primarily
through activity groups such as gymnastics, soccer, and dance programs. Activity
groups were targeted because mothers were making the effort to enrich their
children’s development, just as mothers of children with disabilities attempt to
enhance their children’s development through therapy or other intervention
programs. Initial contact was made with the activity directors, and approval was
given to attend sessions and recruit mothers while they were waiting for their
children. Letters of introduction (appendix B) were placed at four activity centers
with instructions to contact the researcher if the mother were interested in partici
pating in the study. Eighty-eight information packets were distributed, yielding 40
respondents who met the participant requirements.
The 32 mothers of children with disabilities were much more difficult to
recruit. Four mothers were initially recruited through their attendance at the same
activity groups used to recruit mothers of children without disabilities. These
mothers had children with impairments who were attending the activity groups,
or the mothers noted that they had another child in the family with a disability.
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Twenty-two mothers were recruited through contact with nine early intervention
and therapy service providers, including a school for the learning disabled, a clinic
for behavioral disorders, and a therapeutic riding program. Three agencies denied
access or permission to distribute letters of introduction to potential participants.
Contacts were also initiated with 12 physician offices provided services in
specialties such as pediatric orthopedics, pediatric neurology, and pediatric ophthal
mology. These specialists treat a wide variety of children with disabilities. Some
of these offices placed letters of introduction to allow potential participants to
contact the researcher. Over 200 letters of introduction were made available for
distribution, but only one mother was recruited into the study through this method.
A Down syndrome support group hosted a presentation of the study
concept, which yielded 1 participant. Since 12 more participants were required to
meet the target of 40 mothers in the group with disabilities, two notices were placed
in a San Antonio children’s bulletin and a children’s activity magazine, describing
the study and inviting interested parents to contact the researcher for more informa
tion. The researcher also recontacted two mothers who had mentioned that they
might be able to help in acquiring more participants, and remailed 15 information
packets to mothers who had initially expressed an interest in the study but had
failed to return the questionnaires. Responses were received from 4 more mothers,
bringing the total number of mothers of children with disabilities to 32.
Instruments
Family Routines Inventory
The Family Routines Inventory (Jensen et al., 1983) is a 28-item scale that
was used to measure frequency and importance of a variety of daily family routine
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occupations, such as work day routines or parent(s) routines (see appendix C).
Scores were obtained by summing the responses circled on each scale, resulting in
a frequency score and an importance score. Both frequency and importance scores
were used in the statistical analyses.
The Family Routines Inventory was initially developed from extensive
interview data of 52 families, 26 Black and 26 White (Jensen et al., 1983). Partici
pant observation of family routines occurred in 15 families as daily family routines
were selected for use in the inventory (Boyce et al., 1983). Three hundred seven
mothers with at least one child under the age of 16 participated in the reliability
studies (Jensen et al.). The reliability coefficients for 30-day test-retest were
between .74 and .79 for both frequency and importance scores.
Validity was measured using correlation statistics with the cohesion,
organization, control, and conflict scales of the Moos Family Environment Scale,
which rates families on characteristics such as cohesion, control, and conflict
(Moos & Moos, 1981). The inventory was found to be significantly correlated with
family cohesion (r = .35), organization (r = .36), control (r = .29), and conflict (r =
.18) scales of the Moos Family Environment Scale, although the correlations were
not exceptionally strong. As the instrument was used in the present study to
measure frequency and importance of family routines related to maternal stress and
not to relate the scale to dynamic family constructs, these low correlational magni
tudes were not cause for concern regarding its use in the present study.
For the purposes of this study, two items were added to the inventory in
order to include possible therapy- or educationally related routines in the analysis:
(a) Parent(s) do regular activities with the child as suggested by teachers, thera
pists, or other professionals, and (b) Family members have a regular schedule o f
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child-oriented or educational activities, or therapy appointments. A column was
added to all items to indicate the frequency with which stress was related to that
routine. The frequency of stress related to the particular routine was noted on a
scale from 4 = Almost Always to 1 = Almost Never/Never and 0 = Not Applicable.
This rating was used to obtain a stress score in relation to routines. The stress score
as it pertains to routines was obtained by summing the responses in the stress
column; this appeared to have face validity. The stress score was used in statistical
analyses to indicate the degree of perceived maternal stress pertaining to routine
occupations.
Parenting Stress Index, Short Form
The Parenting Stress Index, Short Form (PSI-SF; Abidin, 1995) is a 36-item
scale that is used to measure general parenting stress. Subscale scores are obtained
by summing the scores on items in the domains of Parental Distress, Parent-Child
Dysfunctional Interaction, and Difficult Child. The total parenting stress score is
obtained by summing the three subscale scores. The total parenting stress score is
of primary interest in statistical analysis; however, the subscales were included in
the statistical analyses in an attempt to identify the sources of parental stress.
The short form of the Parenting Stress Index (PSI; Abidin, 1995) was
developed directly from the PSI full-length test, and all items are contained in the
long version. Although the full-length version examines the parent-child inter
action in greater depth than does the short form, the present study was concerned
primarily with the relationship between maternal perceived stress and engagement
in specific family routine occupations and not with the general feelings of being a
parent. The short form of the PSI provides a total parenting stress score that was
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used in this study to determine the relationship of general parenting to maternal
stress that is related to family routines.
The PSI-SF was developed through a series of factor analyses involving an
original sample of 530 mothers and a second sample of 270 mothers. The reliabil
ity coefficient for test-retest, assessed using the first sample over a 6-month inter
val, was .84 for the Total Stress score. The internal consistency, or coefficient
alpha, was computed using the entire normative sample of 800 participants. The
alpha reliability coefficients were .91 for the Total Stress score, .87 for Parental
Distress, .80 for Parent-Child Dysfunction, and .85 for Difficult Child.
Validity was established using the full-length version of the PSI on a
sample of 530 subjects from the original normative sample. The short form corre
lated highly with the full-length version, r = .95. Presently, there is no other inde
pendent research that supports the validity of the short form; however, the author
suggests that the short form possesses the validity of the full-length version.
Pediatric Evaluation o f D isability Inventory
The Pediatric Evaluation of Disability Inventory (PEDI; Haley et al., 1992)
was used to measure severity of disability in the target child. This instrument was
designed to evaluate the functional abilities of young children ages 6 months to 7.5
years. The PEDI measures capability and performance of functional abilities in
three content areas: self-care, mobility, and social function. Capability is
measured through ratings of functional skills for which the child has demonstrated
mastery and competence. Performance is measured through ratings of the level of
caregiver assistance needed to accomplish major functional activities, such as
eating or dressing.
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The scale was normed on a representative sample of 412 children between
the ages of 6 months and 7.5 years. Internal consistency was calculated using the
Cronbach’s coefficient alpha, with coefficients ranging between .95 and .99. Inter
interviewer reliability of both normative and clinical samples on all scales was
between .79 and 1.00, using the intraclass correlation coefficient. Reliability
between two types of respondents (professionals and parents) was between .74 and
.96 (intraclass correlation coefficient) on all scales. Construct validity was evalu
ated by correlating raw scores with chronological age. Correlation coefficients
ranged from .77 to .91, indicating that functional status was measured by the PEDI
is age-dependent, as expected. Concurrent validity was established with the
Battelle Developmental Inventory Screening Test. The overall correlations
between the scales in a sample of children with disabilities was between .62 and .73
for all scales. In a more severely disabled sample, correlations increased to .80 to
.97 on all scales.
In this study, each target child with a disability had three normative
standard Functional Skills scores for the domains of Self-Care, Mobility, and Social
Function, and three normative standard Caregiver Assistance scores in Self-Care,
Mobility, and Social Function domains, for a total of six scores. These six norma
tive standard scores reflect the overall functional performance of a child in relation
to his or her peers; they were used in the present study to measure severity of each
target child’s disability.
Dem ographic Information
A demographic information data collection form (appendix A) was
completed by all mothers. Mothers provided information on age, marital status,
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educational level, financial status, ethnic origin, and family size. These areas were
described by Entwistle and Astone (1994) as necessary to determine socioeconomic
status and ethnicity. This information was used in this study to describe partici
pants and to allow statistical control for demographic characteristics in the primary
data analyses.
Interview
Interviews guided by an interview schedule (appendix D) and lasting
between 20 and 75 minutes were completed by all but 4 mothers who had children
without disabilities. Three of these four mothers were contacted on three separate
occasions, and interviews were scheduled each time. Two mothers failed to be
available for telephone or personal interviews at three scheduled times. One
mother canceled phone interviews twice and could not be contacted to schedule
another interview. The fourth mother provided an inaccurate telephone number and
could not be contacted.
Interviews were completed with 68 mothers, 36 of whom had children
without disabilities and 32 of whom had children with disabilities. The interviews
focused on typical daily and weekend routines, with specific probing of routines
that seemed especially stressful or nonstressful according to the Family Routines
Inventory. Questions concerning the “activity settings” (Gallimore et al., 1989) of
problematic or easy routines (i.e., the what, why, when, where, and who of those
routines) and strategies used to manage daily routines were the focus of the
interview.
Interviews were conducted at the mothers’ convenience. Depending upon
the mothers’ preference and availability, interviews were completed by telephone
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or in person. Extensive notes were taken during all interviews. Thirty-one inter
views were audiotaped with the mothers’ consent and were used as back-up for
notes taken during the interview.
Procedure
There were two ways that mothers were invited to participate in the study.
Mothers were either asked personally to participate after being briefed on the study
details or they contacted the researcher by telephone after reading the letter that
introduced the study or after reading the study description in the children’s bulletin.
Once they expressed an interest in participating, they received a research packet
that contained a description of the study and the part that they were expected to
play, the Informed Consent form, Demographic Information sheet, Family Routines
Questionnaire, and PSI, as well as an addressed stamped envelope to return the
questionnaires and consent form, if appropriate.
Some mothers preferred to complete the packet and return it in person.
Others took the packet home, completing and returning the Informed Consent and
questionnaires by mail. Packets were either mailed or handed to 159 mothers who
had stated an interest in participating in the study. Eighty-five packets were
returned; however, 13 did not meet criteria for inclusion in the study based on
demographic criteria or missing information. Each participating mother read and
signed the consent form (appendix E), and a copy of the form was provided to each
mother. Mothers of children with disabilities assisted with completion of the PEDI
with either verbal descriptions of function or allowed the researcher access to
developmental evaluations and reports.
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The total time for completion of the Consent Form, Demographic Informa
tion, Family Routines Inventory, and the PSI was 15 to 35 minutes, as noted by
participants. Completion of the PEDI ranged from 15 to 30 minutes. Interviews
lasted from 20 to 75 minutes.
Pilot Study
In 1995 a pilot study was conducted to assess the usefulness of the Demo
graphic Information form and the Family Routines Inventory with related questions
on stress. Twenty-one mothers (13 with children without disabilities and 8 children
with disabilities) completed the Family Routines Inventory and the Demographic
Information form. Two mothers of children with disabilities assisted with com-
pletionof the PEDI.
The Family Routines Inventory was assessed to ensure that respondents
understood the descriptions of routines and the scoring. Upon questioning,
respondents reported no difficulty comprehending routine descriptions. However,
respondents noted that some routines were not applicable to younger children, such
as homework routines or chores.
The Demographic Information form was modified based upon the recom
mendations of Entwistle and Astone (1994). Specifically, two item—presence of
stepchildren and presence of grandparents in the home—were added to reflect
current cultural considerations. The PEDI was easily completed with mothers’
assistance and scored. Preliminary between-group analyses of variance (ANOVA)
and correlational analyses were completed; they indicated appropriateness of
selected statistical analyses. No significant findings were discerned on this limited
sample; all analyses were completed without complication.
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Data Analysis
The means and modes of responses to each item on the Family Routines
Inventory were computed for each group. Mean responses across all items were
compared to determine the most and least stressful routines (in response to
Research Question 1) as well as the most and least frequent and the most and least
important routines. The five routines with the highest mean stress scores and the
five routines with the lowest mean stress scores were deemed the most and least
stressful routines. These were used in order to determine the clusters of routines
that were stressful for each group.
In order to determine the between-group differences in routine frequency,
routine importance, and stress related to those routines (Research Question 2) and
between group differences in general parenting stress (Research Question 3), four
one-way ANOVAs were conducted. Mothers of children with disabilities were
expected to have significantly more routines, value those routines more, have
increased stress related to those routines, and have greater general parenting stress
than mothers of children without disabilities.
Ten scores plus three demographic variables were used to produce a corre
lational matrix. The scores were frequency of routines total score, importance of
routines total score, routine stress total score, total parenting stress score, and the
six PEDI normative standard scores. The age of the target child, age of the young
est child in the family, and the number of children in the family were included in
the correlation analysis to reveal the primary associations among the primary
variables of interest in this study.
The correlational analysis determined whether there was a negative
relationship between the ages of the youngest children in the families and mothers’
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ratings of frequency, importance, and stress of routines (Research Question 4);
whether there was a relationship between the severity of the child’s disability and
mothers’ ratings of frequency, importance, and stress of routines (Research
Question 5); and whether there was a relationship between frequency and import
ance of family routines, maternal perceived stress related to routines, and general
parenting stress (Research Question 6).
To further explore maternal stress related to routines, a multiple regression
analysis was conducted in order to estimate the effects of each independent
(predictor) variable on routine-related stress while controlling for effects of the
other predictor variables. Number of children in the family, age of the youngest
child, presence of a child with a disability, severity of disability, frequency of
routines, importance of routines, and general parenting stress were included as
predictor variables relating to the dependent variable of stress related to routines in
the multiple regression analysis.
In order to identify successful strategies that mothers used to modify routine
occupations (Research Question 7) and the contexts for these strategies, interview
data were categorized using concepts from the ecocultural niche literature
(Gallimore et al., 1989). Results were initially organized to reveal (a) what family
routines were reported to decrease or increase stress; (b) reasons that they were
perceived to be most or least stressful; (c) when, during the routines, the greatest or
least degree of stress occurred; (d) who was involved in the routines; (e) where the
most or least stressful routines occurred; and (f) what strategies were employed in
order to manage family routines.
The strategies used to manage daily routines were organized under three
broad categories that had emerged from the pilot study and information obtained
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from the literature (Bateson, 1996; Gallimore et al., 1989; Segal, 1995; Zerubavel,
1979). The initial categories were unfolding, enfolding, and organization and
planning.
As the categories of data were examined further, the strategies listed under
organization and planning included items that reflected the mothers’ attitudes
toward family life, routines that were chunked together at a particular time, and
major family accommodations that families accomplished in order to manage daily
family routines. Thus, the organization and planning category became further
delineated into three types of strategies (chunking, mother’s attitudes, and family
accommodations), for a total of six separate strategy categories.
Limitations of the Study
This study targeted only married, Caucasian mothers living with their hus
bands who tended to enroll their children in early intervention services or specific
child enrichment programs, such as gymnastics. The mothers who chose to be
involved in this study comprised a self-selected group and may not reflect those in
the general population. Indeed, these mothers may reflect a group that is managing
daily life very effectively, as they successfully organized their time to participate in
this study. Also, the inventories and interviews were conducted by self-report;
thus, responses may have been biased by social desirability.
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CHAPTER 4
RESULTS
Demographic Characteristics
of the Participants
Table 1 provides a summary of the demographic characteristics of the
mothers who participated in the study, including their family and child attributes.
Mothers’ mean ages in both groups were approximately 34 years. The mean ages
of the target children differed by only 4 months for the two groups, but the mean
ages of the youngest children in each of the families differed by nearly 8 months:
35 months for families with a child without a disability and 28 months for families
with a child with a disability. These age differences could affect maternal stress
differentially in the two groups because the presence of younger children may
require more parental guidance during daily routines.
Families with a child with a disability averaged over 2.2 children per
family, while families with a child without a disability averaged 1.8 children.
Closer inspection of the data revealed that 46% (15) of families with children with
disabilities had 3 children, while only 12.5% (5) of families with children without
disabilities had 3 children within the family. One family with a child with a
disability had 4 children, while no families with children without disabilities had 4
children. This may also affect results in that the degree of parental involvement
and supervision necessary to guide more children (and generally younger children)
through the family routines may influence maternal perception of stress related to
daily routines.
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Table 1
Demographic Characteristics o f Participants
Characteristic
All
mothers
(A =72)
Mothers with
child without
disability
(n = 40)
Mothers with
child with
disability
(n = 32)
Mean age of mothers (years) 34.33 34.38 34.28
Range 22-50 26-44 22-50
SD 5.43 4.87 6.13
Mean number of children
in family 1.99 1.80 2.22
Range 1-4 1-3 1-4
SD 0.81 0.65 0.94
Mean age of target
child (months) 37.06 35.12 39.47
Range 12-96 12-96 12-90
SD 21.22 19.13 23.66
Mean age of youngest
child (months) 31.78 35.12 27.59
Range 12-96 12-96 12-82
SD 18.08 19.13 15.98
Working mother 35 (48.6%) 15 (37.5%) 20 (62.5%)
Educational level
High school 6 ( 8.3%) 2 ( 5.0%) 4 (12.5%)
College/Bachelor 40 (55.5%) 27 (67.5%) 13 (40.6%)
Master/PhD 22 (30.5%) 9 (22.5%) 13 (40.6%)
Other (certificate) 4 ( 5.0%) 2 ( 5.0%) 2 ( 6.2%)
Income levels
$20,000-30,000 7 ( 9.7%) 3 ( 5.0%) 4 (12.5%)
$30,000-60,000 36 (50.0%) 20 (50.0%) 16 (50.0%)
$60,000-80,000 20 (27.7%) 11 (27.5%) 9 (28.1%)
$80,000-100,000 9 (12.5%) 6(15.0%) 3 ( 9.4%)
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Mothers of children with disabilities tended to have more advanced degrees:
40.6% of those with a child with a disability had a graduate degree versus 22.5% of
those with children without disabilities. Advanced education may influence a
mother’s understanding of child development and increase the likelihood that she
would seek assistance and involvement in activities or services. Advanced educa
tion can also be related to economic advantages that may relieve stress related to
routines, such as being able hire a housekeeper or regular babysitter.
Conversely, 12.5% of mothers with a child with a disability had only a high
school diploma, while only 5% of mothers with children without disabilities had
completed only high school. A lower level of education is often linked to more
limited family income, implying fewer options that could relieve stress related to
routines, such as hiring a babysitter or having family outings. In general, however,
the mothers of all children were well educated, with over 85% having attended or
completed college at some level.
Three quarters of all mothers had family incomes between $30,000 and
$80,000: 77.5% of mothers without a child with a disability and 78.1% of mothers
of children with disabilities. Fifty percent of mothers in both groups had incomes
between $30,000 and $60,000. The lowest and highest income levels of each group
were only slightly different. More mothers of children without disabilities had
higher incomes. Fifteen percent of mothers of children without disabilities had
family incomes between $80,000 and $100,000 versus 9.4% of mothers of children
with disabilities. Only 7.5% of mothers of children without disabilities had family
incomes between $20,000 and $30,000, while 12.5% of mothers of children with
disabilities had total family income within that range. Having a lower income with
less money available for discretionary spending within the family may affect the
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perception of maternal stress related to parenting and family routines. Families
with more limited financial means are less able to access with ease the resources
that may help to relieve stress associated with daily routines, such as using baby
sitters or fast food options.
More mothers of children with disabilities than mothers of children without
disabilities were employed outside the home. Sixty-two and a half percent of
mothers of children with disabilities were in paid employment, either full- or part-
time, while only 37.5% of mothers with children without disabilities worked out
side the home. The percentage of working mothers with children with disabilities
is consistent with the national average of more than 60% of women working out
side of the home (Robinson & Godbey, 1997). Engaging in employment outside of
the home may increase the maternal report of stress related to routines, as mothers
must respond to external schedules of their own as well as to those of their families.
As more mothers of children with disabilities are employed outside of the home,
these mothers may perceive increased stress related to daily routines. Time
pressures from external demands, such as getting family to school and work on
time, may affect mothers’ perception of stress within the daily routine.
Overall, mothers of children with disabilities tended to have more children
and younger children, a higher level of education, and a somewhat lower family
income than those mothers of children with no disabilities. These mothers also
tended to work outside the home more than the mothers of children without dis
abilities. The combination of these factors may increase the mothers’ perceptions
of stress related to daily routines, suggesting that their demographic characteristics
alone may account for a stronger perception of stress related to family routines
among these mothers than that held by the mothers of children without disabilities.
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Inventory Scores of Participants
Table 2 provides a summary of the Family Routines Inventory and PSI
scores for the mothers who participated in the study. The means, ranges, and
standard deviations of scores on the Family Routines Inventory and the PSI are
included for each group of mothers as well as for all mothers combined.
The mean scores on all stress indices were higher for mothers of children
with disabilities than for mothers of children without disabilities. The mean scores
on both the frequency of routines and the importance of routine were slightly lower
for mothers with children with disabilities than for mothers with children without
disabilities. This was somewhat unexpected, as it was anticipated that mothers
with children with disabilities would report completing routines more often and
would ascribe more importance to their routines than would mothers with children
without disabilities.
Table 3 presents the mean, range, and standard deviation of the normative
standard scores on the PEDI. The normative standard scores of the PEDI reflect
the variation from the normal score obtained by a child of the same age whose
development is considered to be within normal limits. A score of 50 is considered
normal, a score of 30 is 1 standard deviation below normal, and a score of 10 is 2
deviations below normal. In this study, the mean scores for all domain areas for the
children with disabilities were nearly 1 standard deviation below the norm, which
would indicate a delay in development. However, the range indicates that at least
some children scored within the normal developmental range in some aspects of the
developmental domains. For example, an autistic child may score normally for
functional and caregiver assistance mobility while scoring 1 to 2 standard devia
tions below normal in both functional and caregiver assistance social functions.
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Table 2
Inventory Scores o f Participants
Instrument and subscale
All
mothers
(N = 72)
Mothers with
child without
disability
(n = 40)
Mothers with
child with
disability
(n - 32)
Family Routine Inventory
Frequency of routines 88.9 89.8 87.9
SD 9.1 9.4 8.7
Range 69-111 72-111 69-107
Importance of routines 72.0 72.4 71.5
SD 8.1 8.2 8.1
Range 54-93 55-93 54-85
Stress related to routines 45.9 42.5 50.3
SD 11.3 10.2 11.4
Range 24-79 24-73 30-79
Parenting Stress Index
Total Parenting Stress 71.1 64.5 79.3
SD 19.2 17.8 17.9
Range 37-124 37-111 51-124
Parental Distress 25.7 23.2 28.9
SD 7.5 6.6 7.4
Range 12-45 12-35 17-45
Parent-Child Dysfunctional
Interaction 18.9 17.1 21.1
SD 5.7 5.2 5.7
Range 12-35 12-29 12-35
Difficult Child 26.4 23.9 29.7
SD 9.8 9.2 9.8
Range 13-53 13-52 13-53
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Table 3
Pediatric Evaluation o f Disability Index (PEDI) Normative Standard Scores (n
32)
Domain and scale Mean SD Range
Functional Skills
Self-Care 25.3 10.8 10-46.4
Mobility 27.2 13.7 10-55.1
Social Function 27.5 13.5 10-49.2
Caregiver Assistance
Self-Care 28.4 11.4 10-50.5
Mobility 31.0 14.9 10-70.5
Social Function 33.1 13.2 10-57.6
Research Question 1
In response to Research Question 1 (What routines are most or least
stressful for mothers and what daily occupations are associated with most or least
stressful family routines?), Tables 4 through 9 present a summary of the means of
the most and least frequent routines, the most and least important routines, and the
most and least stressful routine by, as reflected by mean scores on the Family
Routines Inventory. More detailed information on ranking routines using the mean
frequency and importance helps to frame the most and least stressful routines in
daily family life. Appendix F includes the complete rank order of mean responses
for each routine with respect to frequency, importance, and stress for each group of
mothers. Appendix G contains the tables of mean and mode of responses for each
item on the Family Routines Inventory for each group and for total participants.
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Table 4
Most and Least Frequent Routines o f Mothers o f Children Without a Disability
(n = 40)
Routine Rank M
Most ffeauent
24. Family checks in/out with each other when someone
leaves or comes home. 1 3.97
2. Parents have certain things they do every morning while
getting ready to start the day. 2 3.90
17. Children have special things they do or ask for each night
at bedtime. 3 3.87
1. Parents have some time each day for just talking with
the children. 4 3.82
11. Parents read of tell stories to the children every day. 5 3.75
Least freauent
16. Parents have a certain hobby or sport that they regularly
do together. 1 1.82
28. Children do regular household chores. 2 2.41
30. Family members have a regular schedule of
child-oriented activities, or therapy appointments. 3 2.58
13. Children take part in regular activities after school. 4 2.62
10. Family has a certain “family time” each week when
they do things together at home. 5 2.67
M ost and Least Frequent Routines
Tables 4 and 5 reveal how similar the two groups were in the mean rankings
of most and least frequent routines. Perhaps the most noteworthy difference is in
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the mean ratings of routine 30 {Family members have a regular schedule o f child-
oriented or educational activities, or therapy appointments).
Table 5
Most and Least Frequent Routines o f Mothers o f Children With a Disability (n -
32)
Routine Rank M
Most freauent
2. Parents have certain things they do every morning while
getting ready to start the day. 1 3.82
17. Children have special things they do or ask for each night
at bedtime. 2 3.78
1. Parents have some time each day for just talking with
the children. 3 3.75
24. Family checks in/out with each other when someone
leaves or comes home. 4 3.66
6. Parents and children play together some time each day. 5 3.63
Least frequent
16. Parents have a certain hobby or sport that they regularly
do together. 1 1.56
23. Family regularly visits with the relatives. 2 1.90
8. Family has a “quiet time” each evening when everyone
talks or plays quietly. 3 2.28
10. Family has a certain “family time” each week when
they do things together at home. 4 2.28
13. Children take part in regular activities after school. 5 2.35
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Table 6
Most and Least Important Routines o f Mothers o f Children Without a Disability
(n = 40)
Routine Rank M
Most imnortant
2. Parents have certain things they do every morning while
getting ready to start the day. 1 2.97
17. Children have special things they do or ask for each night
at bedtime. 2 2.90
1. Parents have some time each day for just talking with
the children. 3 2.87
6. Parents and children play together some time each day. 4 2.85
12. Each child has some time each day for playing alone. 4 2.85
27. Parents have certain things they always do each time
the children get out of line. 4 2.85
Least imnortant
16. Parents have a certain hobby or sport that they regularly
do together. 1 1.87
20. At least some of the family has breakfast together
every morning. 2 2.02
13. Children take part in regular activities after school. 3 2.15
26. Family has certain things they always do to greet
the working parent(s) at the end of the day. 4 2.20
25. Working parent comes home from work at the same time
each day. 4 2.20
5. Children do the same things every morning as soon
as they wake up. 4 2.20
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Table 7
Most and Least Important Routines o f Mothers o f Children With a Disability
(n = 32)
Routine Rank M
Most important
1. Parents have some time each day for just talking with
the children. 1 3.00
6. Parents and children play together some time each day. 2 2.97
25. Working parent comes home from work at the same time
each day. 3 2.84
17. Children have special things they do or ask for each night
at bedtime. 4 2.78
22. At least one parent talks to his/her relatives regularly. 4 2.78
24. Family checks in/out with each other when someone
leaves or comes home. 4 2.78
29. Parents do regular activities with child such as those
suggested by teachers, therapists, or others. 4 2.78
Least imnortant
13. Children take part in regular activities after school. 1 1.95
20. At least some of the family eats breakfast together
every morning. 2 2.00
16. Parents have a certain hobby or sport that they regularly
do together. 3 2.16
26. Family has certain things they always do to greet the
working parent(s) at the end of the day. 4 2.25
8. Family has a “quiet time” each evening when everyone
talks or plays quietly. 5 2.29
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Table 8
Most and Least Stressful Routines o f Mothers o f Children Without a Disability
(n = 40)
Routine Rank M
Most stressful
27. Parents have certain things they always do each time the
children get out of line. 1 2.02
28. Children do regular household chores. 2 1.85
2. Parents have certain things they do every morning while
getting ready to start the day. 3 1.82
18. Children go to bed at the same time every night. 3 1.82
19.Family eats at the same time each night. 5 1.72
Least stressful
26. Family has certain things they always do to greet the
working parent(s) at the end of the day. 1 1.08
11. Parents read or tell stories to the children every day. 2 1.17
24. Family checks in/out with each other when someone
leaves or comes home. 3 1.20
8. Family has a “quiet time” each evening when everyone
talks or play quietly. 3 1.20
22. At least one parent talks to his/her relatives regularly. 5 1.22
The mean score for this item for mothers of children without disabilities
was 2.58, resulting in a rank order of 28, while the mean score on this item for
mothers of children with disabilities was 3.5, resulting in a rank order of 9.
Mothers of children with disabilities engaged their children in regularly scheduled
activities often, usually more than 3-5 times per week, while mothers of children
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Table 9
Most and Least Stressful Routines o f Mothers o f Children With a Disability (n =
32)
Routine Rank M
Most stressful
27. Parents have certain things they always do each time the
children get out of line. 1 2.44
28. Children do regular household chores. 2 2.36
2. Parents have certain things they do every morning
while getting ready to start the day. 3 2.19
29. Parents do regular activities with child such as those
suggested by teachers, therapists, or others. 3 2.19
4. Working parent takes care of the children some time
every day. 5 2.13
18. Children go to bed at the same time every night. 5 2.13
Least stressful
26. Family has certain things they always do to greet the
working parent(s) at the end of the day. 1 1.23
10. Family has certain “family time” each week when they
do things together at home. 2 1.28
11. Parents read or tell stories to the children every day. 3 1.37
22. At least one parent talks to his/her relatives regularly. 4 1.41
8. Family has a “quiet time” each evening when everyone
talks or play quietly. 4 1.41
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without disabilities involved their children in activities sometimes, generally 1-2
times per week. The increased frequency of engaging children with disabilities in
regularly scheduled activities could impact on routine stress and general parenting
stress, as these mothers schedule and attend more activities than do mothers of
children without disabilities.
M ost and Least Important Routines
Tables 6 and 7 show that mothers of both groups were similar in placing
value on the importance of certain routines. Three of the five most important
routines were the same for both groups, while four of the five least important
routines were the same.
The most noteworthy difference in the rank order for importance of routine
was for item 25 {Workingparent comes home at the same time each day). Mothers
of children without disabilities gave a ranking of 25 out of 30 to this item, making
it one of the least important routines (mean score = 2.2). Mothers of children with
disabilities had a mean score of 2.84 on this routine, with a rank order of 3, which
was one of the most important routines for this group of mothers. Mothers of
children with disabilities may find that routinely having their husbands, and even
themselves, arriving home at a set time is especially important and helps with the
completion of mealtime and evening routines within their families. They may rely
more on their husbands to assist with the daily management of their children, often
involving assistance with feeding a child with a disability or engaging other child
ren as they complete the meal or evening preparations. Interview data reported in
chapter 5 support the importance of fathers participating in daily family routines
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within the family, providing assistance with many of the specialized tasks often
required for the care o f children with disabilities.
M ost and Least Stressful Routines
Tables 8 and 9 indicate great similarity between the two groups in routines
rated as most or least stressful. The only conspicuous discrepancy appeared in
item 29 (Parents do regular activities with the child such as those suggested by
teachers, therapists, or others). With a mean of 2.19, this routine ranked as the 4th
most stressful for mothers of children with disabilities but 15th (mean score 1.53)
for mothers of children without disabilities (see appendix F). This seems to support
Hinojosa’s (1990) contention that mothers feel burdened by therapy demands
required by their young children with disabilities.
Two routines were ranked as most frequent and most stressful for both
groups of mothers: routine 2 (Parents have certain things they do every morning
while getting ready to start the day) and routine 18 (Children go to bed at the same
time every night). During interviews, these two routines were frequently described
as stressful routines in the family day, most notably during the weekday. Only
routine 18 (Children go to bed at the same time every night) was noted to be quite
important within the family as well.
Routine 27 (Parents have certain things they always do each time the
children get out o f line) was also identified as being both frequent and stressful for
both groups of mothers. Both groups of mothers considered this quite a frequent
routine within the family, regularly occurring more than 3-5 times weekly. The
mean was 3.62 (rank order 7) for mothers of children without disabilities and 3.47
(rank order 10) for mothers of children with disabilities. For both groups of
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mothers it was the most stressful routine within their families, with a mean of 2.02
for mothers of children without disabilities and 2.44 for mothers of children with
disabilities. Mothers of children without disabilities indicated that this was a very
important routine in their families (mean 2.85, rank order 4), while mothers of
children with disabilities did not deem this to be as important (mean 2.47, rank
order 20).
Mothers of children with disabilities indicated that routine 29 {Parents do
regular activities with the child such as those suggested by teachers, therapists, or
others) was most frequent (mean 3.59, rank order 6) and most important (mean
2.78, rank order 4), in addition to being quite stressful (mean 2.19, rank order 3).
The identification of this routine as a source of maternal stress within the family
indicates that all practitioners and teachers should examine the types of activities
and tasks that are encouraged within the home, paying particular attention to co
occupations that are time intensive or emotionally difficult for either mother or
child.
Both groups of mothers identified three routines as least stressful. These
routines are also important routines within the family as well as being frequent
routines. Routine 11 {Parents read or tell stories to the children every day),
routine 22 {At least one parent talks to his/her relatives regularly), and routine 24
{Family checks in and out with each other when someone leaves or comes home)
were often described during interviews as warm, calming, or quiet times. It may be
important, in addition to identifying stressful times, to note co-occupations that
tend to help calm and relax family members and encourage the use of those
routines when family demands may be more intense.
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Research Questions 2 and 3
ANOVA data (appendix H) were used to answer Research Question 2 (Do
mothers o f children with disabilities have more frequent routines, value those
routines more, and have increased stress related to those routines than mothers o f
children without disabilities?) and Research Question 3 (Do mothers o f children
with disabilities report more general parenting stress than mothers o f children
without disabilities?), in addition to noting significant data obtained from the PSI
(Abidin, 1995) involving parenting issues.
Presence o f a D isability
Contrary to expectations, the mothers of children with disabilities did not
have significantly more routines, F = .79,p < .38, or consider their routines more
important than mothers of children without disabilities, F = .13, p < .71. This
appears to be consistent with Hinojosa’s (1990) suggestion that mothers of children
with disabilities select the most important or meaningful routines rather than trying
to squeeze more tasks into an already busy day. A review of the most and least
frequent and most and least important routines indicates that mothers of young
children in both groups endorsed and completed many of the same family routines
every day. This is not surprising, considering that the two groups had such similar
family ethnicity, marital, and socioeconomic status and lived in the same region of
the country.
General Parenting Stress
Supporting the original supposition, mothers of children with disabilities
had significantly more stress related to daily routines, F - 9.26, p < .003, and more
general parenting stress, F = \1 2 1 ,p < .001, than mothers of children without
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disabilities. This is consistent with the literature (Breslau et al., 1982; Dyson,
1991, 1993; Sloper & Turner, 1993) describing increased maternal stress in
mothers with children with many types of disabilities. The subscales of the PSI-SF
(Abidin, 1995) assisted in revealing some of the possible sources of parental stress
in mothers with children with disabilities. Mothers of children with disabilities had
significantly more stress related to parental distress, F = 11.36, p < .001; more
parent-child dysfunctional interactions, F = 9.63,p < .003; and children who were
significantly more difficult to manage behaviorally, F = 6.62, p < .012, based on
their PSI-SF subscale scores.
The Parental Distress subscale of the PSI-SF measures the extent to which
the parent is experiencing stress in her role as a parent. Stresses that are typically
associated with this subscale are feelings of inability to parent effectively, life role
restrictions that are perceived by the parent, lack of social support, parental conflict
with the child’s other parent, and the presence of depression (Abidin, 1995). In the
present study, mothers of children with disabilities reported more parental distress
than did the other mothers, but the identification of specific sources of their distress
is beyond the scope of this investigation.
The Parent-Child Dysfunctional Interaction subscale of the PSI-SF focuses
on a parent’s perception that the target child does not meet parental expectations
and that interactions with the child do not strengthen the mother’s perception of
competence as a parent. Mothers of children with disabilities reported significantly
more dysfunctional interactions with their children with disabilities than did the
other mothers. Frey, Greenberg, et al. (1989) and Sloper and Turner (1993) sug
gested that the severity of the disability affects the report of parental stress, and it is
quite plausible to assume that mothers of children with disabilities would express a
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sense of disappointment and a reduction in successful interactions with their child
ren, especially if the children had more severe disabilities.
Mothers of children with disabilities had higher scores on the Difficult
Child subscale of the PSI-SF, indicating that they had more difficult children to
manage than did the mothers of children without disabilities. The Difficult Child
subscale focuses on child temperament characteristics that make a child easy or
difficult to manage, especially in relation to noncompliant and demanding
behaviors. It seems reasonable to expect that a child with a disability such as
autism might display more noncompliant behaviors or that a child with multiple
disabilities might be perceived to be more demanding than children without
disabilities.
In this study, 10 children were deemed to have a general developmental
delay, with delays in one or more developmental areas such as gross or fine motor
skills. Also, there were 7 children with a diagnosis of cerebral palsy, 4 children
with autism, 4 children with multiple handicapping conditions involved in their
diagnosis of developmental delay, 3 children with sensory integration disorders, 3
children with speech impairments, and 1 child with a diagnosis of Down syndrome.
A review of the PEDI scores indicates that 16 of the children could be characterized
as moderate to severe in the extent of their disabilities, indicating significant delays
or inability to complete functional skills as well as requiring extensive caregiver
assistance when compared to peers. Even with a more mild disability, such as a
speech impairment or mild developmental delay, mothers may find their children
more demanding or less compliant and consequently more difficult to manage than
children without disabilities.
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Research Questions 4, 5, and 6
A correlation matrix (Table 10) was generated to provide an analysis of the
associations among the 13 variables of interest: routine frequency, routine import
ance, routine stress, parenting stress, three PEDI functional scales, three PEDI
caregiver scales, age of target child, age of the youngest child, and number of
children in the family. This analysis provides information to answer Research
Question 4 (Is there a negative relationship between the age o f the youngest child
in the family and the mothers ’ routine and stress scores?), Research Question 5 (Is
there a positive relationship between the severity o f disability and mothers ’
frequency, importance, and stress related to routines?), and Research Question 6
(Is there a relationship between the level ofgeneral parenting stress and frequency,
importance, and stress related to family routines?).
Age o f the Youngest Child
In answer to Research Question 4 (Is there a negative relationship between
the age o f the youngest child in the family and the mothers ’ routine and stress
scores?), there was no correlation between the age of the youngest child in the
family and routine frequency, r = .00, p < .98; importance, r = .01, p < .94; or
general parenting stress, r = -.04, p < .71. However, there was a negative relation
ship (albeit quite low) between age of the youngest child and mother’s stress
related to routine, r = -A5,p < .21. This may suggest (and it seems plausible) that
mothers reported slightly more stress in daily routines when caring for younger
children.
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Table 10
Intercorrelations Among IS Variables (N = 72)
Variable 1 2 3 4 5 6 7 8 9 10 11 12 13
1 Routine Frequency —
SO
i *
*
o
so
-.24 .21 -.17 -.24 .31 -.29 -.31 .11 .00 .15
2 Routine Importance .19 -.08 .07 -.22 -.23 .02 -.22 -.14 .03 .01 .32
3 Routine Stress - .54* .22 .13 .13 -.03 -.05 .14 -.03 -.15 .29
4 Parenting Stress - .22 -.24 -.28 .14 -.31 -.22 .15 -.04 .03
5 Functional Mobility - .23 .23 .78 .22 .15 .31 .05 .00
6 Functional Self-Care - .81 .36 .76 .77 .31 -.09 .08
7 Functional Social - .25 .69 .84 -.52 -.19 .25
8 Caregiver Mobility - .31 .22 .22 .36 -.07
9 Caregiver Self-Care - .69 -.42 -.17 .03
10 Caregiver Social - -.49 -.12 .22
1 1 Target Child Age - .78 -.12
12 Youngest Child Age - -.28
13 Number Children —
*p < .001.
Severity o f Disability
In answer to Research Question 5 (Is there a positive relationship between
the severity o f disability and mothers ’frequency, importance, and stress related to
routines?), the relationship between the severity of the child’s disability and
mother’s report of stress related to routines varied. The correlations were not very
strong in general and the direction of the correlations was variable.
The PEDI Functional and Caregiver Mobility scores were more strongly
positively correlated with routine frequency, Functional r = .21, p < .25 and
Caregiver r= .31, p < .08, than with importance, Functional r = .07, p < .71 and
Caregiver r - .02, p < .91; however, their interpretation indicates a negative
relationship and does not support the original hypothesis. It had been expected that
mothers with more severely disabled children would have more routinized days and
more stress related to those routines than mothers with children who were more
independent. With regard to mobility, this was not the case. The mothers who had
children who were more able to move about by themselves (meaning a less severe
motor disability) seemed to have more routinized days (and considered their
routines more important) than did mothers with children who had greater limita
tions in their mobility skills.
Mothers with children who were more independent in their gross motor
skills, such as being able to go up and down stairs by themselves or climb in and
out of a car seat without assistance, had more stress related to routines, r = .22,
p < .22, than did mothers of children who were less able to move about independ
ently. It may be that children who can move about more freely themselves require
mother’s continued guidance and supervision throughout a task and could also
include more resistance from a child who may choose to move somewhere else
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during one of mother’s important routines. This type of potential conflict may
slightly increase the mother’s perception o f stress during a routine task.
Conversely, a very small negative correlation existed between Caregiver
Mobility (how much the caregiver must assist the child) and the stress related to
daily routines, r = -.03,p < .85. This correlation indicates a positive relationship,
however, in that a mother with a child who is more independent and requires less
assistance with mobility (less severe disability) perceives slightly less stress in
daily routines than a child who is more dependent on the mother. In this instance,
a mother whose child can assist with a task, such as getting in and out of a car, may
perceive less stress during a routine than a mother who must physically move her
child through each task. However, the original supposition that mothers with child
ren with more severe disabilities would perceive increased stress related to daily
routines was not supported by this small correlation.
The child’s Functional Self-Care score was negatively correlated with
routine frequency, r = -.\l,p< .36, and importance, r = -.22, p < .22) but indicates
a positive relationship. A mother who notes a child to be more functional (higher
score) in self-care activities reports lower frequency of routines and considers the
routines slightly less important than does a mother with a child who is less able to
complete self-care tasks (is more severely disabled). This correlation tends to
support the original hypothesis, indicating that mothers with children who are less
able to complete routine tasks themselves (more severely disabled) generally have
more frequent routines and consider them more important than mothers whose
children are more independent (less severely disabled), although the correlation
was not very strong.
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Increased Functional abilities (Mobility, r = .22, p < .22, Self-Care, r = .13,
p < .49, and Social Skills, r =13,/? < .47) were noted to be positively correlated
with the mother’s increased stress related to routines. These results do not support
the original hypothesis. Mothers noted greater stress related to routines when the
child had higher Functional scores (meaning that the child was more independent
and age appropriate in tasks within the self-care, mobility, and social arena).
Perhaps the child who is more independent requires continued encouragement to
complete routines or there may be conflicts over standards of performance when
children must complete self-care activities to the mother’s satisfaction. The con
tinuous enfolding of a task by mother or persistent struggles may increase the
mother’s perception of stress within various family routines.
The Functional Social, Caregiver Self-Care, and Caregiver Social scores
were all negatively correlated with routine frequency (Functional Social r = -.24,
p < .19; Caregiver Self-Care r = -.29,p < .10; Caregiver Social r = -.3l,p< .08)
and importance (Functional Social r = -.23,p < .25; Caregiver Self-Care r = -.22,
p < .23; Caregiver Social r = -.14,/? < .43). However, these correlations suggest a
positive relationship between the severity of disability and routine frequency and
importance. A lower Functional Social score indicates a child who is less able to
interact effectively and has less awareness of the environment, suggesting a child
with a more severe disability. A lower Caregiver Self-Care score and a lower
Caregiver Social score imply that the mothers must provide more direct assistance
in providing self-care and directing interactions for their child, again suggesting a
child with a more severe disability. Thus, the correlations suggest that mothers
whose children were more severely disabled (lower score) had more frequent
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routines and considered those routines more important (higher scores), supporting
the original hypothesis related to severity of child disability.
The Caregiver Self-Care score was negatively correlated (albeit very
slightly) with routine stress, r = -.05, p < .79. This suggests a positive relationship
between the severity of disability and stress related to daily routines. A child with
a lower score (more severely disabled) requires more assistance from the mother.
Mothers tended to perceive more stress when their children required more self-care
assistance (were more severely disabled). The original premise, that mothers with
children with more severe disabilities would perceive more stress with daily
routines than would mothers with children with less severe disabilities, could not be
supported because of the extremely small correlation.
The Caregiver Social score was positively correlated with routine stress,
r = .14,/? < .45. This does not support the original supposition. Again, a lower
score indicates a child who requires much assistance from the mother when inter
acting with others and the environment. It had been expected that mothers with
children who were less independent (were more severely disabled) and required
their assistance in many routines would have more stress related to the routines
than would mothers with children who were more independent (less severe dis
ability). This did not appear to be the case in this instance. Mothers with children
who were more independent in their environmental interactions seemed to perceive
more stress related to routines. This discrepancy may be related to behavioral
management issues, as the mother must constantly be watching out for her child as
the child interacts with people and things that could cause conflict, problems, or
difficulty. Mothers with more independent (less severely disabled) children thus
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perceive more stress within daily routines as they constantly monitor and guide
their children through daily routines.
General Parenting Stress
In answer to Research Question 6 (Is there a relationship between the level
ofgeneral parenting stress and frequency, importance, and stress related to family
routines?), the stress related to family routines was positively correlated with
general parenting stress, r = .54, p < .001. However, general parenting stress was
negatively correlated with frequency of family routines, r = -.24, p < .05, suggest
ing that more parental stress occurs when there are less frequent routines and that
less stress occurs when there are more frequent routines within the family. Lubeck
and Chandler (1990) contended that lack of regularity in daily care of young child
ren can create increased stress for caregivers as well as promote feeding and sleep
problems for the children. Sprunger et al. (1985) described mothers who noted
themselves as more competent and confident when they maintained a more routine
family day, further suggesting that there may be less stress when there are more
frequent routines within the family. This suggests an element of organization and
planning within the family that may impact mothers’ perceptions of general
parenting stress.
Another rather interesting correlation with possible significance to general
parenting stress was the strong positive relationship between frequency of routines
and importance of routines, r = .60, p < .001. It would seem that mothers who
complete more routines also view these routines as important and necessary for
keeping the family strong and together. This notion is consistent with that pro
posed by Hinojosa (1990), noting that mothers of children with cerebral palsy
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tended to maintain only those most important routines in their daily family round of
activities. Gallimore et al. (1993) also described maintaining daily routines that are
consistent with a family theme, noting that engagement in family routines is
important for sustaining the family meaning.
In order to better understand the relationships among routine frequency,
routine importance, and child characteristics as they impact the experience of stress
during daily routines, a multiple regression analysis was conducted to estimate the
effects of the independent variables on the dependent variable of the mother’s
report of stress related to routines. An additional multiple regression analysis was
then completed to examine the variables that tended to predict the mother’s stress
related to daily routines for mothers of children with disabilities.
The multiple regression analysis that included items relevant to the research
questions relating to mothers’ perceived stress related to routines is shown in Table
11. The number of children in the family, age of the target child, age of the young
est child, presence of a child with a disability, frequency and importance of routine
scores, and the general parenting stress score were included in the analysis. Beta
weights were used to discern which variables related to the research questions
might best predict maternal stress related to daily family routines.
General parenting stress was a strong predictor of mothers’ reports of stress
related to routines. If mothers generally perceived stress in their role as a parent,
they also perceived more stress related to carrying out their daily family routines.
This seems entirely plausible that, if a mother had an overriding feeling of stress as
a parent, then this perception would prevail in all daily routine activities. Both the
frequency of routines and the importance of routines also impacted mothers’ per
ceptions of stress related to routines. Mothers who noted that routines were
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important also had the sense that there is more stress when completing these
routines; perhaps this sense of value transforms into a sense of urgency that the
routine must be accomplished because it is of value to the mother and the family.
Table 11
Predictor Variables o f Maternal Stress Related to Routine: Mothers o f Children
Without Disabilities (N = 72)
Dependent variable B SET? Beta
P
Number of children 2.26 1.47 .16 .13
Age of youngest child -.04 .06 -.07 .49
Presence of disability 2.20 2.39 .10 .36
Routine frequency -.37 .15 -.29 .016
Routine importance .50 .17 .35 .006
Parenting stress (PSI-SF) .26 .06 .45 .0001
Note. PSI-SF = Parenting Stress Index, Short Form.
The frequency of routines seems to have a negative impact on the prediction
of stress. Mothers who noted more frequent routines (that is, routines that were
carried out more often) seemed to report less stress related to completing those
routines. This appears to support Lubeck and Chandler’s (1990) contention that
lack of regularity in daily care of young children can create increased stress for
their caregivers as well as create feeding and sleep problems for the children.
Sprunger et al. (1985) described mothers who noted themselves as more competent
and confident when they maintained more frequent routines.
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The multiple regression analysis to discern the variables that might be the
best predictors of maternal stress related to daily routines for mothers of children
with disabilities is shown in Table 12. For mothers with children with disabilities,
the child’s Functional Mobility score (ability to move about independently) and
Functional Self-Care score (ability to care for tasks such as feeding and dressing)
were strong predictors of the mothers’ reports of stress related to routines. This is
consistent with the correlational analysis discussed previously and refutes the
original hypothesis related to severity of disability. It appears that mothers with
children with disabilities who were more independent (less severe disability) in
their functional skills had more stress related to routines than mothers with children
who were more dependent (more severe disability).
The Caregiver Mobility score was also a strong predictor of maternal stress
related to routines, although with a negative relationship. A lower Caregiver
Mobility score denotes a child who requires more assistance from a caregiver when
moving about in the environment. This strong predictor would support the original
assumption that the severity of the disability impacts the mothers’ perception of
stress related to daily routines; that is, mothers with a child with a more severe
disability would report more stress related to daily routines than would mothers of a
child with a less severe disability. This was not supported in the previous correla
tional analysis. It seems plausible that a mother who must physically move her
child through all daily tasks may have an increased perception of stress related to
routines.
However, it is interesting to note that Parenting Stress was not as strong a
predictor of mothers’ stress related to routines as were other variables related to
child disability. This implies that the actual degree of caregiving functions required
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of mothers with children with disabilities may affect their perception of stress
related to daily routines. Hinojosa (1990), as well as Smith (1986) and Crowe
(1993), described the increased parental time spent in caregiving tasks when caring
for a child with a disability. The temporal demands of caring for a more severely
disabled child may be a source of mother’s increased perception of stress related to
caregiving daily tasks. Also, the importance of the routine was also a moderate
predictor of mothers’ stress related to daily routines.
Table 12
Predictor Variables o f Maternal Stress Related to Routine: Mothers o f Children
With Disabilities (N = 32)
Dependent variable B SET? Beta
P
Number of children -1.76 2.39 -.14 .46
Age of youngest child -.12 .13 -.17 .36
Routine frequency -.04 .30 -.03 .89
Routine importance .65 .30 .46 .04
Parenting stress (PSI-SF) .19 .12 .29 .12
Functional Mobility (PEDI) .51 .22 .60 .03
Functional Self-care (PEDI) .68 .35 .65 .07
Functional Social (PEDI) .11 .32 .12 .75
Caregiver Mobility (PEDI) -.56 .22 -.75 .02
Caregiver Self-care (PEDI) -.26 .27 -.26 .34
Caregiver Social (PEDI) -.20 .32 -.23 .54
Note. PSI-SF = Parenting Stress Index, Short Form, PEDI = Pediatric Evaluation
of Disability Inventory.
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CHAPTER 5
INTERVIEW RESULTS
In order to answer Research Question 6 {What strategies do mothers employ
to manage family routines and how do these strategies change the mother’ s
perception o f stress?), 36 mothers of children without disabilities and 32 mothers
of children with disabilities were interviewed. Using the interview guide (appendix
D), the researcher attempted to gain rapport with interviewees by asking each
mother to describe a typical family day. Prior to each interview, the Family
Routines Inventory had been reviewed regarding what the mother had reported
about her family routines.
The interview used a combination of open-ended questions (e.g., How does
your weekend differ from the weekday?), illustrative questions (e.g., Some mothers
have told me that they try to prepare everything at night, while others mentioned
that they do all the organizing in the morning when the family is getting ready.
What do you find works for you?), and simple yes/no questions (e.g., Are there
things that you find that make your day easier?), to gather data to answer the
research questions.
Interview data were initially conceptualized using the theory of the eco-
cultural niche as described by Gallimore et al. (1989). The use of this theory
assisted in visualizing the activity settings for each family’s daily routines and
served as a conceptual guide during the interviews to gather information about
when and where the daily routines occurred, who was involved in the routines, and
the reasons that mothers engaged in particular routines and management strategies.
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It also assisted to identify family accommodations that might be described by
mothers regarding management of daily family life.
The interviews were also conceptualized using Zerubavel’s (1981) concept
of sociotemporal order, including temporal symmetry and temporal complementar
ity. By having some organizing concept regarding the use of time and scheduling
within larger society, mothers’ reports of family routines were organized as they
responded to constraints imposed by school or work, as opposed to mothers’
attitudes toward organizing routines. Segal (1995) described these organizing
schedules as anchored and responsive.
The use of the qualitative data provided exploratory information about the
responses obtained from the Family Routines Inventory and assisted in understand
ing the organization of daily routines within families of two different types.
Although this interview portion of the study was considered qualitative, it did not
constitute a qualitative research study. While some characteristics of qualitative
research were used in data gathering and analysis, such as descriptive data and
coding, the interviews were used to search for evidence and examples related to the
management of daily family routines. This search for evidence is not a characteris
tic of qualitative research (Bogden & Biklen, 1982).
In order to assure that the research question were directly address, at some
point during the interview (whether directly or through prompting during a routine
description), mothers were asked (a) What routines do you find to be the most
stressful during the day? (b) What makes them seem to be stressful? and (c) Have
you found things that you do that make daily routines easier for you? In a search
for actual strategies that mothers used to organize family routines and to manage
their stress that would clarify and expand the quantitative data, the strategies were
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coded into categories originating from the pilot study. These are described in the
literature as unfolding (Segal, 1995), enfolding (Bateson, 1996), and elements of
organization and scheduling (Segal; Zerubavel, 1981).
Segal (1995) defined unfolding as completing parts of some routines at
different times of the day (temporal unfolding) or allowing another person to
complete a routine (unfolding by inclusion). Enfolding, as defined by Bateson
(1996), involves doing more than one task at once, such as cooking dinner while
minding the children. Elements of organization and scheduling, as noted by
Zerubavel (1981), involve the use of calendars and planners as well as coordinating
activities in response to both family desires and cultural obligations. These three
strategies remained useful in the initial coding of the interview data.
Upon completion of interviews and after categorization of routine manage
ment strategies, there appeared to be three additional types of strategies that could
not easily be defined under the three original categories: (a) chunking of routines
(grouping tasks together at a particular time to decrease stress), (b) mothers’ atti
tudes toward daily routine tasks, and (c) major accommodations that mothers
described that they perceived as improving their daily family life. These had been
coded originally under organization and scheduling but were more definitive strate
gies than that broader category. Thus, the categories of management strategies now
included unfolding, enfolding, organization and scheduling, chunking, mothers’
attitudes, and family accommodations. Mothers noted that, by using a reported
strategy, they felt that they better managed daily family routines and thus were
helped to control their perceptions of stress related to the engagement in routine
family activities.
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Appendix I lists the strategies and the number of mothers who reported each
strategy. This list notes only the mothers who described a particular strategy within
their day or noted that they used a particular technique. While the list is extensive,
it is probable that some mothers used strategies that they did not mention during the
interview or did not deem important, despite prompting during the interview.
Unfolding
Many mothers noted strategies of unfolding, by both temporal unfolding
and unfolding by inclusion. Temporal unfolding consists of typically enfolded
routines that are essentially unpacked and completed at another time when it is
more convenient for the mother. Unfolding by inclusion involves allotting that
routine to another person. Segal (1995) noted that mothers of children with ADHD
used both of these unfolding strategies on a frequent basis. Also in the present
study, mothers with young children, whether those children had a disability or not,
used unfolding as a strategy that could decrease the perception of stress related to
daily routines.
Temporal Unfolding
Mothers of children with disabilities and those with children without dis
abilities frequently unfolded tasks, both temporally and by inclusion. Appendix I
lists the routines that were temporally unfolded and the number of mothers report
ing each routine. Nearly 50% of all mothers reported nighttime routines that they
completed in preparation for the next day—typically, prepacking lunches (41%),
choosing and preparing clothes (52%), and prepacking backpacks and briefcases
(50%). Some mothers described extensive evening routines that involved packing
lunches, preparing clothes, and prepacking backpacks and briefcases that were set
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in a particular spot each evening. This preplanning allowed these mothers to focus
on other activities in the morning and not be concerned about tasks that were
already completed, making the morning routine less stressful. Some mothers only
chose clothes or assured that backpacks were ready for the morning. One mother
mentioned, “I try to do as much as I can in the evenings; sometimes I do and
sometimes I don’t. It is easier if we are all ready, though.”
Also, 17% of mothers of children without disabilities showered in the
evening, but only 3% of mothers of children with disabilities included showering in
the evening as a usual routine. One mother of a child with a disability noted that
she attempted to do as much the night before as she could, which included taking
her shower, so that the morning routine would require as little time as possible.
Perhaps, more mothers with a disability perceived a time crunch in the mornings, as
they tended to have children who were more difficult to care for, and more of these
mothers worked outside the home than did mothers of children without disabilities.
Some mothers reported that they prepared meals on the weekends to be
used during the week (10%) and some described early preparation of food and table
setting the night before or 3-5 hours in advance of the meal (16%). Almost half of
all mothers (46%) made time during the day for themselves for extra self-care,
quiet or meditation time, exercise, or hobbies. One mother described the import
ance of her “me time” in the morning before the rest of the family wakes up. “It
does a lot for my sanity,” she noted.
Unfolding by Inclusion
Unfolding by inclusion was also a frequent strategy of many mothers. This
strategy seemed to be particularly important when families were completing the
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morning or bedtime routines. Appendix I lists the routines that were described as
unfolded by inclusion and the number of mothers who reported each routine.
Twenty-nine percent of the mothers reported that their husbands regularly partici
pated in some aspect of the morning family routine, typically including such tasks
as getting the children up; assisting or guiding them with dressing, eating, and self-
care; and helping with breakfast.
It is quite interesting that 44% of fathers of children with disabilities were
reported to participate in morning family routines, while only 14% of fathers of
children without disabilities were reported as regularly assisting with morning
family routines. It may be that fathers are needed to help more when there is a
child with special needs, especially when there are time constraints to get the
children on the bus and the parents to work. One working mother of a child with a
severe disability stated that her husband always helped with getting the children up
and off to school and day care, as there was just too much to do in the morning.
“He [son] needs his medicine and he has special shoes and equipment. My husband
is always ready to help, but I always have to tell him what to do. He [husband]
tries his best.”
Over one third of fathers (35%) were described as participating in the
family bedtime routines, nearly equal numbers of fathers from both groups.
Mothers described fathers as assisting with bath time, getting the children
undressed and ready for bed, and reading books or telling stories. Some mothers
depicted the bedtime routine as divided, where the mother would get one child
ready for bed while the father assisted another child. Other mothers noted that the
fathers were involved in all or parts of the bedtime routine. Some mothers also
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described taking turns with the routine, so that one night the mother would direct
the bedtime routine and the next night the father would be involved.
Mothers noted that hiring others or having extended family members or
neighbors to complete household tasks or child care was a frequent strategy used to
assist with managing daily family routines. Thirty-five percent of mothers in this
study described hiring babysitters and house cleaners, having grandparents baby sit,
or having neighbors help with transportation to school or daycare. One working
mother of a 2-year-old stated, “I couldn’t do it without my mom.”
It is interesting to note that 44% percent of mothers of children with dis
abilities related that they regularly relied on people outside of the immediate family
to assist with managing daily family routines, while only 28% of mothers of child
ren without disabilities described this strategy. One mother of a child with severe
cerebral palsy described her neighbor as “wonderful. She brings my son home
early from day care at least twice a week so that he can get a really good nap. She
really watches out for him.”
Thirty-five percent of mothers reported that their children regularly ate
breakfast, lunch, and snacks at school or day care: 47% of mothers of children with
disabilities compared to 25% of mothers of children without disabilities. By having
the children eat at school or day care, the mothers did not have to prepare food or
feed or guide the children through the meal. “Thank goodness they can eat at
school—it’s just one less thing I have to worry about,” noted one mother of a
preschooler and a second grader.
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Enfolding
Enfolding, or doing more than one occupation at a time, was also frequently
described by mothers as a useful strategy when managing daily family routines.
Appendix I lists routines that were described by mothers that appeared to be
enfolded. Clearly, many mothers watched over their children while they were
engaged in other routine activities. Seventy-eight percent of the mothers noted that
their children were watching television, napping, or playing while the mothers
completed household or self-care tasks. Mothers within each group described this
strategy: 81% of mothers of children without disabilities and 75% of mothers of
children with disabilities.
As the mothers related the family morning routines, many described a
whirlwind of activities that seemed to occur within a very short period of time,
especially if children and parents needed to get to school and work. Thirty-five
percent of the mothers described their mornings as a continuous round of enfolded
routines. They guided their children (and sometimes their husbands) through
morning tasks, such as preparing breakfast, dressing and feeding the children,
packing lunches, preparing backpacks, and putting things away after breakfast,
making beds, and maybe even getting themselves ready for work or the day. One
mother of school-age children stated, “If I don’t keep after them, they will just take
their time and forget what they’re supposed to be doing.” Fifty percent of the
mothers of children with disabilities described this heavily enfolded morning
routine, while 22% of the mothers of children without disabilities noted this
strategy.
It may be that children with disabilities are more often involved in school
programs at a younger age and mothers must respond to these external time
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constraints and thus tend to enfold more morning tasks. In this study, mothers with
children with disabilities tended to have younger children, had more children in the
family, and were more likely to work outside the home than were the mothers of
children without disabilities (Table 1). These differences may also have influenced
the number of reports of heavy enfolding during the family morning routines.
Chunking
Chunking of activities, or organizing a series of occupations within a
temporal boundary based on ease of completion, seemed to be a strategy that
helped mothers to orchestrate the family routines. These strategies are listed in
appendix I. Housework and errands appeared to be the routines that were
commonly chunked. Over half (54%) of all mothers chunked errands outside of the
home, such as grocery shopping, going to the cleaners, and appointments com
pleted in one excursion from the home. Activities such as these were described as
being completed during a particular time of day, on weekends, or often on the way
home from school or work.
Sixteen percent of mothers reported completing all errands when neither
parent was working. This arrangement allowed one mother to “never go shopping
with the children.” Chunking seemed to help mothers to orchestrate their family
routines, both daily and for the week ahead, as they visualized necessary errands
and tasks that could be chunked for completion during a specific time. Chunking
seemed to ease time constraints and often allowed easier completion of tasks
without the children, specifically “not having to worry about getting the children in
and out of car seats” during multiple errand stops.
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Organization and Planning
The organization and planning of family routines offered myriad routines
that mothers described as helping to manage family life and decrease their per
ceptions of stress. Appendix I lists both the typical and atypical organizational and
planning routines that mothers noted during the interviews. There seemed to be
many organizational strategies that a few mothers described as especially useful in
the management of daily family life, such as using sticky notes (1%), checking the
children’s backpack and completing the school things immediately upon arrival at
home (12%), taking a power nap (1%), trying not to do errands on the weekend
(7%), and bathing the children every other night (2%). While strategies such as
these were not described by great numbers of mothers, they appeared to be useful
for a few mothers as they tried to orchestrate their family routines and develop an
acceptable round of activities.
However, some organizational and planning strategies were recounted by
many of the mothers. Consistent with Segal’s (1995) description of the frequent
use of schedules and calendars by families with a child with ADHD, 60% of the
mothers in this study described using a family calendar to assist with managing
family activities. One mother of a preschooler stated, “I use a calendar religiously
and write everything on it. I review the week ahead on Sunday and see what we
have to do.”
Nearly three quarters (72%) of the mothers with a child with a disability
described using a calendar on a regular basis, while only 50% of the mothers with a
child without a disability reported consistent use of a calendar to assist with
organizing family activities. Using a calendar or a scheduler helped many mothers
to keep track of family activities and appointments. One mother of a 7-year-old
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even had two calendars, one on the refrigerator and one pocket scheduler. The use
of schedulers clearly varied, as one mother of two young children noted, “I
generally keep everything in my head.”
Sixty-six percent of the mothers with a child with a disability described a
quiet time or quiet play time at some point during their day, while 42% of the
mothers of children without disabilities recounted a similar family time. A mother
of two, a kindergartner with a mild developmental delay and a toddler, scheduled a
quiet playtime for the children from 2:00 to 3:00 P.M. each day. She noted that this
quiet time, as well as a “snuggle time” with each child, seemed to make life easier
and happier for the whole family. Another mother of a preschooler and first grader
said that her “quiet hour gave them all time to regroup.”
Another organizational strategy that seemed to be important for many
mothers was cleaning up right after dinner and not leaving things to go back to
later. Fifty-four percent of all mothers related that they were most likely to clean
up the kitchen and eating area immediately after dinner, sometimes with help from
the husband and children. However, other mothers (7%) orchestrated dinner
cleanup later in the evening, finding this easier and more suitable to them. One
mother related that she and her husband cleaned the kitchen after their children,
ages 13 months and 25 months, were asleep. She found it easier to get the cleaning
done without interruptions and it allowed time to spend with her husband.
M other’s Attitude
Mothers also revealed personal attitudes that they found very useful in
managing daily family routines. Appendix I lists the attitudes that mothers
described during interviews. Seventy-two percent of the mothers in this study
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noted that, by keeping a “flexible attitude,” they were able to decrease their
perceptions of stress during daily family routines. This flexible attitude was
characterized by organizing some routine activities by “if we feel like it,” especi
ally if the routine was not constrained by time. Routines such as cooking or not
cooking a meal or walking versus playing with the children as an after-dinner
family activity were much more conducive to choice than were many tasks
included in daily morning routines. This type of attitude allowed mothers to
construct a responsive schedule (Segal, 1995) of activities.
One mother described the family weekend routines as “we just let it happen;
we don’t plan very much for the weekend,” which contrasted sharply with another
mother’s description that the “weekend rushes more than the weekday.” This
mother of a toddler and first grader described the weekend as the family eating
together at breakfast, ballet class, errands until late afternoon on Saturday, and then
Sunday school and church, dinner as a family, and then “we try to do something as
a family on Sunday afternoon.” This mother expressed an increased perception of
stress during weekends, as the weekends tended to involve so much activity.
Another attitude that many mothers described as helping to manage the
perceptions of stress when completing daily routine tasks was being responsive to
the children’s moods. Thirty-seven percent of all mothers mentioned that they
encouraged a task or continued an activity if the children were able to behave them
selves or were in a good mood. One mother noted that her 5-year-old son was quite
moody and that she often never knew how he was going to behave when he awoke.
She related that he sometimes got dressed before coming downstairs for breakfast,
but at other times he waited until after breakfast to dress and brush his teeth. This
mother “mostly let him have his own way. He tends to be quite moody.”
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The mother of a preschooler and a 12-month-old reported a highly flexible
routine in response to the children’s moods. She let the children awaken naturally,
they dressed and ate breakfast in their own time, and they arrived at preschool
between 8:30 and 9:30. “We eat when we get hungry and I let them nap when
they’re tired. Life is better when the children are better” seemed to sum up her
attitude toward daily family life.
M other’s Accommodations
Some mothers described major family accommodations as having a great
effect on their perceptions of stress in daily family life. The accommodations listed
in appendix I were described as decreasing the mothers’ perceptions of stress and
allowing the family to function better. One quarter of the mothers (17) revealed
that they had changed jobs to allow more flexibility in their working hours or they
worked only when the children were in school. One mother worked at a local
library and she was able, with great planning, to work only when the children were
in school, with occasional weekend hours. She said that she stayed with the job
because she was able to change her hours to meet the demands of her family.
Another mother obtained a teacher’s aide position at her daughter’s school when
her daughter entered kindergarten. This enabled her to work only during school
hours and to have time off from work during school vacation time. Flexible
working hours for mothers working outside the home was an important factor for
some mothers to consider as they managed family routines.
One mother, who had three children between ages 2 and 6 years, emphatic
ally stated that the only way to decrease stress and have everything function better
was to “stop working.” She stated that she had worked for a while after the birth of
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her first child but that everything seemed to be so rushed and that there never
seemed to be enough time. After stopping work, this mother noted that the family
was “so much better” and that things got done around the house.
While all of the strategies and routines listed in appendix I were mentioned
as means that seemed to improve routine family life for some mothers, there may
be other strategies that work for mothers. By identifying successful routines for
some mothers and noting strategies that some mothers have used to decrease their
perceptions of stress during daily family activities, professionals involved with
providing care for families with young children may be able to assist mothers to
generate potential improvements to problematic daily routines.
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CHAPTER 6
DISCUSSION
The major purpose of this study was to determine the relationship between
daily family routines and mothers’ stress during family routines in families with
young children with and without disabilities. Mothers with children with dis
abilities noted significantly greater stress related to daily routines and significantly
more general parenting stress than did mothers of children without disabilities. In
general, the mothers described various strategies to manage daily family routines.
This discussion of each research question explores the most salient features
revealed by the study.
Research Question 1: Most and Least Stressful Routines
In general, mothers in this study identified similar most and least frequent,
most and least important, and most and least stressful routines, regardless of group.
As noted when identifying the most frequent routines by mean score, the mothers
with children with disabilities reported more frequent participation in child-focused
activities and felt those to be more important than did the mothers of children
without disabilities. This is not surprising, because all of the mothers of children
with disabilities regularly had their children in some type of therapeutic interven
tion service. This increased frequency of attending regularly scheduled activities
potentially impacts daily routine stress and even general parenting stress. These
mothers had to schedule and coordinate more activities that required more
coordination between both the anchored and responsive (Segal, 1995) family
schedules.
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The mothers with children with disabilities described the daily routine that
involved completing regular activities with the child as suggested by teachers,
therapists, or others (item 29) as the 4th most stressful daily routine (mean = 2.19);
mothers of children without disabilities reported this as the 15th most stressful
routine (mean = 1.53). The completion of these suggested therapeutic activities
that seem to increase mothers’ perceptions of stress within a daily routine also
potentially impact mothers’ reports of increased general parenting stress. By virtue
of completing additional and even quite complex or extensive tasks, such as
positioning a child in an adaptive chair or providing a certain texture of food for the
child’s meal, these mothers may perceive an additional burden related to the care
and nurturing of a child with a disability (Hinojosa, 1990). This extra burden of
care could surely be reported as increased stress related to daily routines as well as
increased general parenting stress.
However, it is interesting to note that mothers in both groups generally
reported very similar most and least stressful routines. Four of the five most
stressful routines, by mean ranking, were the same for both groups: routine 27
(Parents have certain things they always do each time the children get out o f line),
routine 28 (Children do regular household chores), routine 2 (Parents have certain
things they do every morning while getting ready to start the day), and routine 18
{Children go to bed at the same time every night). It is not surprising that disciplin
ary, chore-related, morning, and bedtime routines would generally be described as
more stressful routines for all mothers. These routines impose parental, or
maternal, structure and expectations on children; the very nature of the parent-child
interaction during these types of routines may imply opposition, and the interaction
is often dependent upon the temperaments of both mother and child. For example,
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one mother described a method to manage her child’s moodiness upon awakening
in the morning. She did not impose the strict routine of getting dressed before
breakfast—a routine that she preferred. This mother noted that she let her child
“mostly have his own way” in the morning, choosing whether to get dressed first or
eat breakfast before getting dressed. This flexible attitude toward accomplishing
the morning routine was noted by this mother as a way to decrease her perception
of stress related to the morning activities.
Another mother noted that she was able to decrease her perception of stress
related to both morning and bedtime routines when she was able to “stop working.”
She described a rushed, harried day when she was working full time as she tried to
manage all of the morning and evening activities to assure that everyone was on
time to work, school, and day care. When she stopped working altogether, she
described a sense of relief and a great decrease in her overall stress level. She
noted that she was able to guide her children more easily through the morning
routines and had fewer household chores that needed to be temporally unfolded
(Segal, 1995) to the end of the day. While this is a major accommodation in
maternal lifestyle, these two examples illustrate both minor and major strategies
that mothers could use to help to decrease their perceptions of stress within daily
family routine life.
Research Question 2: Presence of a Disability
Mothers of children with disabilities did not report significantly increased
frequency of routines nor did they value routines more than mothers of children
without disabilities. The mothers in this study were a homogenous group from one
area of the country who volunteered to participate. Most of them were engaged in
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providing their children with enrichment activities outside of the home. The
culturally defined round of activities in which they all participated appeared to be
similar within this ethnic group.
Perhaps it is not the frequency of routine that is different; maybe, the
amount of time spent in the completion of routines varies more between mothers of
children with disabilities and those with children without disabilities. Although
this was not the subject of this study, Johnson and Dietz (1985) and Smith (1986)
studies support this premise, at least for mothers of children with physical disabili
ties. In their studies, mothers of children with a physical limitation spent signifi
cantly more time providing daily routine care to their children than did mothers of
children without disabilities.
Time-intensive routines were also described at interview by two mothers of
children with severe developmental disabilities. One mother related an extensive
morning routine that involved special medicine and positioning during feeding.
The set-up for medicine and breakfast took over an hour and required assistance
from the father in order to complete the routine in time for school. Another mother
reported having an extended family dinner time because of special food prepara
tions and her child’s slow chewing and swallowing. She described her son as forc
ing them “to have a quality family eating time” because of the hour or longer that it
took for a family meal. So, while all of the mothers described frequent consistent
daily family routines, mothers of children with disabilities may be involved in
time-intensive and extensive daily care tasks with their children that are not
required for children without disabilities.
The age of the children in the study appears to be a limiting factor. Young
children, whether or not they have a disability, require parental care in all aspects of
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their lives, from self-care to play. As all of the children in the study were quite
young (mean age of target children was 37 months), mothers in both groups might
be expected to have frequent child care tasks based solely on the young age and
developmental needs of their children.
Research Question 3: Disability
and General Parenting Stress
As expected, mothers of children with disabilities reported significantly
more stress related to routines and more general parenting stress than did mothers
of children without disabilities. Analysis of the mothers’ reported general parent
ing stress (PSI subscale scores) revealed that mothers with children with disabilities
had significantly more parental distress (the amount of stress that a parent experi
ences in the parent role as a result of personal factors) than did mothers of children
without disabilities. Mothers of children with disabilities also generated scores
indicating more parent-child dysfunctional interaction and difficult children than
did mothers of children without disabilities. Mothers of children with disabilities
were generally coping with children who were exceptionally difficult, either in
temperament or with respect to physiological issues. These challenges of parenting
such difficult children seemed to have a negative impact on the parent-child inter
action and their overall sense of competence as parents.
The perception of stress during routines was significantly positively corre
lated with parenting stress. However, it was impossible to discern whether this
correlation reflects a causative relationship: Does a mother who is not feeling
exceptionally competent as a parent perceive more stress during routines because of
that feeling or does she feel less competent as a parent because the daily routines in
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which she engages are continuously stressful? Indeed, the relationship between the
two factors is probably highly intertwined.
Some literature notes that parents of children with disabilities have stress
related to caregiving demands (Breslau et al., 1982; Frey, Greenberg, et al., 1989).
There is more extensive literature noting increased parental stress, both maternal
and paternal, related just to the presence of a child with a disability within the
family (Crowe, 1993; Dyson, 1991; Hinojosa, 1990; Sloper & Turner, 1993; Smith,
1986). This study highlighted a probable link between the increased caregiving
demands and increased general parenting stress that mothers of children with
disabilities perceive within their daily lives.
During the interviews, some mothers of children with disabilities articulated
clear strategies that they employed to assist with managing their perception of
stress related to daily family routines. For example, many mothers noted that they
relied on the school or intervention program to provide breakfast, lunch, and snacks
for their children. This concept of unfolding by inclusion (Segal, 1995)—that is,
relegating a particular task to another—was especially effective in decreasing the
time spent in both morning and evening preparation routines. Mothers noted that
they did not have to prepack lunches and snacks and did not have to worry about
feeding breakfast to their children. They were also comfortable that the school and
teachers would provide the proper food and positioning that the children required
while eating. This ability to unfold by inclusion seemed to be an effective strategy
for many mothers.
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Research Question 4: Mediating Role of Age
All mothers of young children in this study, whether or not they had child
ren with disabilities, had similar daily family routines and deemed those routines to
be of similar importance. Although it was expected that mothers with younger
children would have more frequent routines as well as increased stress related to
those routines, there were no significant relationships between the ages of the
children and the reports of frequency, importance, or stress of the routines. The
mean age of the youngest children in the families was 31.78 months; the oldest
children included in the study were 8 years old. Although some researchers have
suggested that parental care decreases as children get older (Lawson & Ingleby,
1974), no age effect was detected in this study. Bristol and Schopler (1984)
suggested that the demand for parental involvement in caregiving tasks does not
significantly decrease until after the age of 9 years, so this may be is why age-
related differences were not apparent.
Research Question 5: Severity of the
Disability and Routines
Supporting a study by Frey, Greenberg, et al. (1989) and the expectations
state in this study, there seemed to be some links between the severity of a child’s
disability and the mother’s report of stress related to daily routines. However,
many of these relationships were minimal. Mothers of children with disabilities
revealed that some child disability factors influenced their perceptions of stress
during routines. When children were more functional in both mobility and self-
care skills, the mothers’ perception of stress related to routines could be predicted
to increase. Also, when children required more intense caregiving from mother
(handling, feeding, carrying), mothers’ stress related to daily routines could be
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predicted to increase. It may be that both the emotional and physical demands of
caring for a child with a disability involve slightly different aspects of care but both
may affect the mother’s perception of stress in daily routines. The children in this
study were young children, and young children, overall, regardless of the type and
severity of their disability, require much assistance and guidance throughout all
activities. This may have contributed to the lack of strong correlations among
function, caregiving, and mother’s routine stress.
Research Question 6: General Parenting
Stress and Routines
There was a significant negative correlation between frequency of routines
and general parenting stress. This relationship was not expected. Mothers tended
to report less parenting stress when they completed routines more frequently or,
conversely, reported more parenting stress when they completed routines less
frequently. This suggests an element of organization and planning within the
mother’s day that can assist in decreasing the perception of stress related to daily
routines.
Lubeck and Chandler (1990) seemed to support this premise, citing that
lack of regularity in caring for young children seems to create increased stress for
caregivers and may promote feeding and sleep problems for the children. Child
and family wellness was positively affected when families reported more frequent
routines (Keltner, 1992; Keltner et al., 1990; McCubbin & McCubbin, 1988). This
study further links the importance of family routinization in promoting wellness
within the family. This study also identified maternal strategies to assist in helping
to decrease the mother’s perceived stress during completion of the daily family
routines.
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Research Question 7: Maternal Strategies
to Manage Daily Routines
Much interesting and useful information was garnered from the interview
data. Six main strategies, or methods, categorized mothers’ reports of ways to
manage daily family routines. Unfolding, both temporally and by inclusion,
enfolding, chunking, organizing and planning, the mother’s attitudes, and the
mother’s accommodations were reported by mothers as the means that they used to
orchestrate their family lives. Segal (1995) described the enfolding and unfolding
of routines evident in families with a child with ADHD. The present study noted
that these strategies were used in families with children without disabilities as well
as in families with children with many types of disabilities.
Mothers seem to orchestrate a finite number of daily routines based on their
preferences as well as in response to the external cultural environment—what Segal
(1995) described as the anchored and responsive schedules. Segal’s description of
anchored and responsive family schedules complements Zerubavel’s (1981) frame
work of temporal complementarity and the use of schedules. The mothers in this
study relied on many strategies to manage the demands of the cultural temporal
order.
Sixty percent of the mothers in this study relied on wall calendars and daily
schedulers. Some mothers faithfully reviewed the daily schedule of events
monthly, weekly, the evening before, and during the day. Other mothers noted
particular events that were out of the ordinary or not regularly scheduled, such as
soccer games or doctor’s appointments, and highlighted those on a wall calendar.
No fathers were described as the family “schedule keeper.” Mothers consistently
identified themselves as the temporal coordinator within the family, organizing
both the unusual events and scheduling the chunking of routine occupations.
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The attitude of the mother regarding daily family routines appeared to be an
important way for mothers to manage the minor family crises that occurred on a
daily basis. A flexible attitude toward daily events was described by over 70% of
the mothers in this study. If plans were made to go on a family outing or get the
children to bed at a particular time, many mothers described the quick change of
plans that occurred in order to manage a whiny, cranky child. One mother noted
that “we just play it by ear,” while another stated that an “if we feel like it” attitude
often permeated their reaction toward particular occupations. This more carefree
stance was most suited to family routines that were not bound by anchored
schedules.
Implications for Occupational Science
and Occupational Therapy
This study provides extensive information about the selection, importance,
and orchestration of daily routines within married two-parent families with or with
out an exceptional child. Families with young children with or without disabilities
were more similar than different in their orchestration of family life. The mother
appeared to compose the daily life of the family, selecting the activities and
routines and directing the rhythms of everyday life.
It became clear in this study that the use of unfolding as a daily manage
ment strategy was used not only within families with ADHD (Segal, 1995) but also
in families with children with other types of disabilities and in families with child
ren with no disabilities. Families of all types used many strategies as they orches
trated their daily lives. Unfolding was only one type of strategy that appeared to
effectively decrease the perception of stress that some mothers reported as they
produced daily family routines.
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Occupational therapists should be cognizant and concerned about when and
how they ask mothers of children with disabilities to include therapeutic activities
in their family lives. As Hinojosa (1990) noted, mothers of children with cerebral
palsy often did not follow through with home activities recommended by the thera
pists, primarily because of lack of time. Mothers need to know that, indeed, all
mothers have similar difficulties when attempting to orchestrate a well-organized,
smooth day. Small and large crises arise in all families. Many mothers should
receive the acknowledgment from professionals that it is acceptable to select the
most important family routines and that, if family life is very stressful, there are
management strategies that they may be able to employ to reduce or manage stress
associated with the orchestration of family routines within daily life. It is important
for mothers with a child with a disability to explore the parts of their day involving
those family co-occupations that seem to be very stressful. By examining daily
family routines in detail with mothers, therapists can help them to identify routines
that might be able to be unfolded (either temporally or by inclusion), chunked, or
scheduled more efficiently, and thus assist them with managing daily life. They
can also assist parents with routinizing family activities. By encouraging parents to
be more consistent in organizing and completing routine family activities, they may
be able to help mothers to manage better the stresses that frequently occur in daily
family routines.
Conclusions and Recommendations
This study highlighted some of the similarities and differences between
families with young children with disabilities and families with children without
disabilities. All of the families in this study, with young children with disabilities
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or not, were more similar than different in their approach to orchestrating daily
family life. Mothers identified similar strategies as they managed daily family life
in a home with young children, whether or not with disabilities. However, mothers
of children with disabilities reported more stress related to daily routines than did
mothers of children without disabilities. Much of that stress seemed to be related to
the presence of a more difficult child, impacting the mother-child interactions.
In order to explore further the orchestration of family routines, co-occupa
tions, and the stressors related to the production of daily occupations, studies
involving single parents, working mothers, parents from varied ethnic backgrounds,
and fathers who provide primary child and home care would add a broader dimen
sion to the understanding of orchestration of family routines in many types of
families. Further research should include interviews with fathers to explore their
perceptions of their involvement in the routines of family life. Gaining the fathers’
stories of daily family life would provide a clearer picture of the overall orchestra
tion of family routines
Examining the parents’ attitudes to daily life as they participate in daily
family routines would add a depth of understanding not found in contemporary
research. Exploring parental attitudes, such as flexibility or organizational style,
would provide greater insight into the orchestration of daily life. Qualitative
methods as well as the experience sampling method would develop a broader
appreciation of the personal engagement and meaning within the daily routine.
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APPENDICES
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APPENDIX A
DEMOGRAPHIC INFORMATION FORM
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Demographic Information
NAME:______________________________ (to be deleted after study completion)
Age:______
1. Check the highest educational degree that you have attained?
None (if none, what is the highest grade in school you completed?
High school diploma
Associate degree
Vocational degree (e.g. beauty school, etc.)
Bachelor's degree
Master's degree
Ph.D., J.D., M.D., etc.
Other
2. What race do you consider yourself to be?
African American/Black
Caucasian/White
American Indian
Asian or Pacific Islander
Hispanic
Other (please specify)__________________
3. What is your marital status?
Married
Single
Divorced
Other (please specify)__________________
4. If you are married, what race do you consider your spouse to be?
Not married
African American/Black
Caucasian/White
American Indian
Asian or Pacific Islander
Hispanic
Other (please specify)___________________
5. How many people live in your home?_____
6. How many children live in your home?_____
7. What are the children's ages?___________________
8. Do either you (or your spouse, if married) have stepchildren who live with
you? yes no
9. Do the children have grandparents who live with you? yes no
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10. Think of all the income from persons who live in the same house with you.
Check the category that is closest to your household income last year.
$ 10,000 or below
$10,000-20,000
$20,000-30,000
$30,000-60,000
$60,000-80,000
$80,000- 100,000
Over $ 100,000
(Questions 11, 12, and 13 are for mothers of children requiring special services)
11. Types of therapy services received, such as OT, PT, Speech._____________
12. Number of therapy sessions per week(average):
0-1
2-3
4-5
More than 5
Every two weeks
Other (please specify)_______________________
13. Number of medical appointments per month(average) for______ as needed
irregular
0-1
2-3
4-5
more than 5
Other (please specify)_______________________
Comments:
By Valerie J. O’Brien
119
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APPENDIX B
LETTERS OF INTRODUCTION
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Family Routines Study
Valerie O’Brien, OTR
443 Graham Road
Ft. Sam Houston, TX 78234
Dear Director:
I am a Doctoral candidate in Occupational Science at the University of Southern
California and am currently completing my dissertation research project. As a
pediatric occupational therapist (and mother of three young children), I am seeking
access to mothers of young children with and without disabilities in order to
explore the organization and stress related to daily routines that occur within the
family.
Specifically, I am seeking married Caucasian mothers who have children aged 8
and under as participants in my study. The mothers will be requested to complete 3
questionnaires and an interview. Interviews can be conducted by phone, at the
activity center, or any convenient place at the mother's requested time. Mothers of
a child with a disability will be requested to complete an index that establishes the
functional abilities of their child. The entire process takes about an hour and a half.
I am hoping that you may be able to assist me with finding study participants.
There are various ways that some centers have allowed mothers access to my study.
One school sent my cover letter home with a note attached stating that the mothers
should contact me directly. Mothers called me and I sent them a questionnaire
packet that they completed at home. Another agency had therapists ask the
mothers during therapy sessions, providing them with questionnaire packets which
were completed and returned to me. Other activities have placed my introductory
letter in their waiting areas allowing prospective participants to contact me directly.
As you can understand that I would like to complete my research project in a timely
manner, I am available to assist you in any way that will help me achieve access to
possible study participants.
I have enclosed a description of my research project with samples of the informed
consent form and questionnaires. If you have any questions, please feel free to
contact me at xxx-xxxx.
Thank you.
Valerie J. O'Brien, MS, OTR
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Family Routines Study
Valerie O’Brien, OTR
443 Graham Road
Ft. Sam Houston, TX 78234
Dear Parent,
I am a graduate student (and mother of three young children) and a pediatric
occupational therapist studying daily family routines. I am conducting a research
project that involves the completion of 3 questionnaires and an interview. The
interview will focus on the types of routines that you organize within your family,
your perceptions of stress related to the routines, and strategies that you may use to
help your day run smoothly or things that cause your day to be really hectic. The
interview can be completed by phone, at your home, or any convenient place. Most
interviews have taken about 45-50 minutes. In order to complete the interview, I
need your phone number or a convenient point of contact where you can be reached
in order to schedule a convenient time to talk to you about your daily family life.
The information obtained in the study will be used to assist parents to identify
family routines that are potentially very stressful and to suggest adaptations that
may help to reduce the degree of stress associated with the routines.
Thank you for your assistance in this project.
Valerie O’Brien, OTR
Home: xxx-xxx-xxxx
Work: xxx-xxx-xxxx/xxxx
Phone number or point of contact where you can best be
reached:__________________
Best time to call to schedule an interview
is:____________________________________
You may complete the questionnaires at home and mail them to me. An envelope
is provided for your convenience. If you choose not to complete the
questionnaires, please return them to me so that I may distribute them to another
participant. Thank you.
122
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APPENDIX C
FAMILY ROUTINES INVENTORY
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Family Routines Inventory
Please read the follow in g statements and decide to what extent each o f these routines is p a rt o f your fam ily.
First, decide if this is a routine and how often it is a part of your daily life. Then circle the number that describes how often
your family participates in the routine.
Second, decide if the routine is important to your family life, that is, it helps you keep your family together and strong. Then,
circle the number that describes how important the routine is to your family.
Third, decide if the routine is stressful, that is, if it causes some distress or upset in your family. Then, circle the number that
describes your perception of the degree of stress related to that routine.
Is this a routine in
your family?3
How important
is this
routine for
keeping your
family strong
and together? b
Is this routine
stressful for
your family?0
ROUTINES A O S A X V S N X A O S A X
W ork Day Routines
1. Parent(s) have some time each day for just talking with the children 4 3 2 1 0 3 2 1 0 4 3 2 1 0
2. Parent(s) have certain things they do every morning while getting
ready to start the day 4 3 2 1 0 3 2 1 0 4 3 2 1 0
3. Working parent(s) has a regular play time with the children after
coming home from work 4 3 2 1 0 3 2 1 0 4 3 2 1 0
4. Working parent(s) takes care of the children some time every day 4 3 2 1 0 3 2 1 0 4 3 2 1 0
5. Children do the same things every morning as soon as they wake up 4 3 2 1 0 3 2 1 0 4 3 2 1 0
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Is this a routine in
your family? a
How important
is this
routine for
keeping your
family strong
and together? b
Is this routine
stressful for
your family?0
ROUTINES A 0 S N X V S N X A O S N X
6. Parent(s) and children play together some time each day 4 3 2 1 0 3 2 1 0 4 3 2 1 0
7. Non-working parent and children do something together outside
of the home every day (i.e. shopping, walking) 4 3 2 1 0 3 2 1 0 4 3 2 1 0
8. Family has a “quiet time” each evening when everyone talks or
plays quietly 4 3 2 1 0 3 2 1 0 4 3 2 1 0
Weekend and Leisure Time
9. Family goes some place special together each week 4 3 2 1 0 3 2 1 0 4 3 2 1 0
10. Family has a certain “family time” each week when they do things
together at home 4 3 2 1 0 3 2 1 0 4 3 2 1 0
Children’s Routines
11. Parent(s) read or tell stories to the children every day 4 3 2 1 0 3 2 1 0 4 3 2 1 0
12. Each child has some time each day for playing alone 4 3 2 1 0 3 2 1 0 4 3 2 1 0
13. Children take part in regular activities after school 4 3 2 1 0 3 2 1 0 4 3 2 1 0
14. Young children go to play-school the same days each week 4 3 2 1 0 3 2 1 0 4 3 2 1 0
K>
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Is this a routine in
your family? a
How important
is this
routine for
keeping your
family strong
and together?b
Is this routine
stressful for
your family?c
ROUTINES A O S N X V S N X A O S N X
15. Children do their homework at the same time each day or
night of the week 4 3 2 1 0 3 2 1 0 4 3 2 1 0
Parent(s) Routines
16. Parent(s) have a certain hobby or sport that they regularly do together 4 3 2 1 0 3 2 1 0 4 3 2 1 0
Bedtime Routines
17. Children have special things they do or ask for each night at
bedtime (i.e. a story, good-night kiss, a drink of water) 4 3 2 1 0 3 2 1 0 4 3 2 1 0
18. Children go to bed at the same time every night 4 3 2 1 0 3 2 1 0 4 3 2 1 0
Meals
19. Family eats at the same time each night 4 3 2 1 0 3 2 1 0 4 3 2 1 0
20. At least some of the family eats breakfast together every morning 4 3 2 1 0 3 2 1 0 4 3 2 1 0
21. Whole family eats dinner together every night 4 3 2 1 0 3 2 1 0 4 3 2 1 0
K >
ON
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Is this a routine in
your family?a
How important
is this
routine for
keeping your
family strong
and together? b
Is this routine
stressful for
your family?0
ROUTINES A 0 S N X V S N X A 0 S N X
Extended Family
22. At least one parent talks to his or her relatives regularly 4 3 2 1 0 3 2 1 0 4 3 2 1 0
23. Family regularly visits with the relatives 4 3 2 1 0 3 2 1 0 4 3 2 1 0
Leaving and Coming Home
24. Family checks in and out with each other when someone leaves
or comes home 4 3 2 1 0 3 2 1 0 4 3 2 1 0
25. Working parent(s) comes home from work at the same time each day 4 3 2 1 0 3 2 1 0 4 3 2 1 0
26. Family has certain things they always do to greet the working
parent(s) at the end of the day 4 3 2 1 0 3 2 1 0 4 3 2 1 0
Disciplinary Routines
27. Parent(s) have certain things they always do each time the children
get out of line 4 3 2 1 0 3 2 1 0 4 3 2 1 0
Chores
28. Children do regular household chores 4 3 2 1 0 3 2 1 0 4 3 2 1 0
- j
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ROUTINES
Is this a routine in
your family?a
A 0 S N X
How important
is this
routine for
keeping your
family strong
and together? b
V S N X
Is this routine
stressful for
your family?0
A O S N X
Education or Therapy Related Routines
29. Parent(s) do regular activities with the children such as those
suggested by teachers, therapists, or others
30. Family members have a regular schedule of child-oriented or
educational activities, or therapy appointments
4 3 2 1 0
4 3 2 1 0
3 2 1 0
3 2 1 0
4 3 2 1 0
4 3 2 1 0
From “The Family Routines Inventory: D evelopm ent and Validation, ” by E. W. Jensen, S. A. James, W.
T. Boyce, & S. A. Hartnett, 1983, Social Science and Medicine, \1(4), 201-211. R eprinted by permission.
a A = Almost Always, O = Often (3-5 times/week), S = Sometimes (1-2 times/week), N = Almost Never, X = Not Applicable.
b V = Very Important, S = Somewhat Important, N = Not At All Important, X = Not Applicable. e A = Almost Always, O =
Often (3-5 times/week), S = Sometimes (1-2 times/week), N = Almost Never, X = Not Applicable.
to
00
APPENDIX D
INTERVIEW GUIDE
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Interview Guide
Each mother will be asked about routine occupations listed on the inventory as they apply to
understanding of orchestration of daily life within the family.
1. Describe a typical week or work day for you and your family.
a. prompts for detail throughout daily routines
b. what do you find is stressful during the day?
c. what is not stressful?
d. to particular routines, what makes it difficult?
e. Prompt: have you found things that make daily routines easier for you? family?
f. prompt for approach to organizing/schedules?
g. prompts throughout-who involved in routines, where?
i. prompts throughout if not clear- father and other family roles in daily routine.
2. Tell me about a weekend?
a. how does it differ from weekday?
b. father’s role?
c. planned or unplanned activities?
d. prompt-stressful times/non-stressful?
3. Do you have anything else that you can think of that makes (or has made) your daily family
life more or less stressful?
4. Child with a disability— if not clear within daily routines, expound on child with a disability,
functional level in response to PEDI.
By Valerie J. O’Brien
130
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APPENDIX E
INFORMED CONSENT FORM
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INFORMED CONSENT
Title of Project: The Relationship Between Family Routines and Perceived Maternal Stress in
Families with Children with and without Disabilities
Principal Investigator: Valerie J. O'Brien. MS. OTR
Department: Occupational Therapy Department. University of Southern California. Los Angeles
24 Hour Telephone Number: (2101-637-8397 or 011-49-6333-60005 (collect)
PURPOSE: You are being invited to participate in a study of family routines. I am an Occupa
tional Therapist and graduate student conducting a study to learn about the day to day lives of fami
lies with children with and without disabilities. I hope to gain your view of family life and the daily
routines that you use in order to understand how routines are managed within families. You are
being invited as a possible participant in this study because you are the mother of a child between 1
and 8 years old who is involved in a children’s activity or therapy.
PROCEDURE: If you decide to participate in this study, I will have you complete the:
1. Demographic Information Form which will describe your education, ethnic background,
marital status, age, family income, and family size.
2. Family Routines Inventory which will describe some of your daily routines and your per
ception of stress related to those routines.
3. Parenting Stress Index which will describe some of the general feelings about being a parent.
Completion of these three inventories should take no more than 30 minutes.
If you have a child with a disability, I will have you assist in the completion or consent to having
your child’s therapist assist in the completion of the:
4. Pediatric Evaluation of Disability Index (PEDD. This scale will ask questions that are re
lated to the ability of your child to perform daily living skills, such as dressing or eating as
well as questions pertaining to the amount of assistance that you must provide to your child
when completing those daily care tasks. This index should take no more than 45 minutes to
complete.
After completion of all forms and inventories, I will have you complete an:
5. Audio-taped Interview. This audio-taped interview will focus on daily routines within your
family. The interview should last no more than 1-2 hours and will be conducted at your
convenience.
RISKS: The forms, inventories, and indexes may ask you to respond to questions that may be un
comfortable for you to answer. You may refuse to answer questions at any time. During the audio
taped interviews, you may be asked questions about your daily routines and stress that may cause
anxiety or discomfort. You may refuse to answer questions at any time. You may also request that
audio-taping not be done or be discontinued at any time during the interview. Additionally, your
participation in this study may involve up to 3 V i hours of your time.
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BENEFITS: While the information gained from this study will probably not affect you directly, it
may help professionals to understand how their services could affect daily family life. Also, other
mothers may benefit from the information by understanding how other families have changed rou
tines to allow their children to be involved in activities or therapy.
CONFIDENTIALITY STATEMENT: Any information obtained in connection with this study
and that can be identified with you will remain strictly confidential.
COERCION AND WITHDRAWAL: Your decision to participate or not in this study will not
interfere with your future care or involvement with this facility. If you decide to participate, you are
free to withdraw your consent or discontinue participation at any time.
INJURY STATEMENT: If you require medical treatment as a result of injury arising from your
participation in this study, the financial responsibility for such care will be yours.
CALIFORNIA LAW REQUIRES THAT YOU MUST BE INFORMED ABOUT:
1. The nature and purpose of the study.
2. The procedures in die study and any drug or device to be used.
3. Discomforts and risks to be expected from the study.
4. Benefits to be expected from the study.
5. Alternative procedures, drugs or devices that might be helpful and their risks and benefits.
6. Availability of medical treatment should complications occur.
7. The opportunity to ask questions about the study or the procedure.
8. The opportunity to withdraw at any time without affecting your future care at this
institution.
9. A copy of the written consent form for the study.
10. The opportunity to consent freely to the study without the use of coercion.
11. Statement regarding liability for research-related injury, if applicable.
QUESTIONS: If you have any questions relating to this study, please feel free to ask them at any
time. Any questions or concerns that you may have about problems or injuries related to participa
tion in this study should be discussed with the undersigned Principal Investigator at xxx (collect). If
you have any questions regarding your rights as a study subject, you may contact the Institutional
Review Board at 323-223-2340. You will be given a copy of this form to keep.
AGREEMENT:
YOUR SIGNATURE INDICATES THAT YOU HAVE DECIDED TO PARTICIPATE HAVING
READ AND UNDERSTOOD THE INFORMATION PROVIDED ABOVE.
Signature of participant Date
Signature of Witness
Signature of Principal Investigator
Revised August 1998
133
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APPENDIX F
RANK ORDER OF ROUTINES FOR MOTHERS
WITH CHILDREN WITHOUT DISABILITIES
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Table FI
Rank Order ofFrequency o f Routines: Without Disability
Rank Routine M ean
1 24. Family checks in and out with each other when someone
leaves or comes home 3.97
2 2. Parent(s) have certain things they do every morning while
getting ready to start the day 3.90
3 17. Children have special things they do or ask for each night at
bedtime (i.e. a story, good-night kiss, a drink of water) 3.87
4 1. Parent(s) have some time each day for just talking with the children 3.82
5 11. Parent(s) read or tell stories to the children every day 3.75
6 18. Children go to bed at the same time every night 3.65
7 27. Parent(s) have certain things they always do each time the
children get out of line 3.62
8 6. Parent(s) and children play together some time each day 3.60
9 5. Children do the same things every morning as soon as they wake up 3.57
10 22. At least one parent talks to his or her relatives regularly 3.52
11 14. Young children go to play-school the same days each week 3.51
11 7. Non-working parent and children do something together outside
of the home every day (i.e. shopping, walking) 3.51
13 12. Each child has some time each day for playing alone 3.47
14 19. Family eats at the same time each night 3.37
15 26. Family has certain things they always do to greet the working
parent(s) at the end of the day 3.30
16 4. Working parent(s) takes care of the children some time every day 3.22
17 8. Family has a “quiet time” each evening when everyone talks or
plays quietly 3.10
18 20. At least some of the family eats breakfast together every morning 3.07
19 15. Children do their homework at the same time each day or
night of the week 3.00
20 9. Family goes some place special together each week 2.97
21 29. Parent(s) do regular activities with the children such as those
suggested by teachers, therapists, or others 2.87
22 3. Working parent(s) has a regular play time with the children after
coming home from work 2.82
22 21. Whole family eats dinner together every night 2.82
24 23. Family regularly visits with the relatives 2.78
25 25. Working parent(s) comes home from work at the same time each day 2.70
26 10. Family has a certain “family time” each week when they do things
together at home 2.67
27 13. Children take part in regular activities after school 2.62
28 30. Family members have a regular schedule of child-oriented or
educational activities, or therapy appointments 2.58
29 28. Children do regular household chores 2.41
30 16. Parent(s) have a certain hobby or sport that they regularly do together 1.82
135
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Table F2
Rank Order ofImportance o f Routines: Without Disability
Rank Routine Mean
1 1. Parent(s) have some time each day for just talking with the children 2.97
2 24. Family checks in and out with each other when someone
leaves or comes home 2.90
3 11. Parent(s) read or tell stories to the children every day 2.87
4 6. Parent(s) and children play together some time each day 2.85
4 12. Each child has some time each day for playing alone 2.85
4 27. Parent(s) have certain things they always do each time the
children get out of line 2.85
7 23. Family regularly visits with the relatives 2.84
8 22. At least one parent talks to his or her relatives regularly 2.82
9 18. Children go to bed at the same time every night 2.80
10 3. Working parent(s) has a regular play time with the children after
coming home from work 2.75
10 4. Working parent(s) takes care of the children some time every day 2.75
10 21. Whole family eats dinner together every night 2.75
13 17. Children have special things they do or ask for each night at
bedtime (i.e. a story, good-night kiss, a drink of water) 2.70
14 7. Non-working parent and children do something together outside
of the home every day (i.e. shopping, walking) 2.65
15 9. Family goes some place special together each week 2.60
16 14. Young children go to play-school the same days each week 2.59
27 29. Parent(s) do regular activities with the children such as those
suggested by teachers, therapists, or others 2.56
18 8. Family has a “quiet time” each evening when everyone talks or
plays quietly 2.55
19 10. Family has a certain “family time” each week when they do things
together at home 2.52
20 15. Children do their homework at the same time each day or
night of the week 2.50
21 19. Family eats at the same time each night 2.40
22 28. Children do regular household chores 2.38
23 2. Parent(s) have certain things they do every morning while getting
ready to start the day 2.30
23 30. Family members have a regular schedule of child-oriented or
educational activities, or therapy appointments 2.30
25 5. Children do the same things every morning as soon as they wake up 2.20
25 25. Working parent(s) comes home from work at the same time each day 2.20
25 26. Family has certain things they always do to greet the working
parent(s) at the end of the day 2.20
28 13. Children take part in regular activities after school 2.15
29 20. At least some of the family eats breakfast together every morning 2.02
30 16. Parent(s) have a certain hobby or sport that they regularly do together 1.87
136
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Table F3
Rank Order o f Stress Related to Routines: Without Disability
Rank Routine Mean
1 27. Parent(s) have certain things they always do each time the children
get out of line 2.02
2 28. Children do regular household chores 1.85
3 2. Parent(s) have certain things they do every morning while getting
ready to start the day 1.82
3 18. Children go to bed at the same time every night 1.82
5 19. Family eats at the same time each night 1.72
6 9. Family goes some place special together each week 1.67
6 21. Whole family eats dinner together every night 1.67
8 25. Working parent(s) comes home from work at the same time each day 1.64
9 4. Working parent(s) takes care of the children some time every day 1.62
9 15. Children do their homework at the same time each day or
night of the week 1.62
1 1 17. Children have special things they do or ask for each night at
bedtime (i.e. a story, good-night kiss, a drink of water) 1.60
12 5. Children do the same things every morning as soon as they wake up 1.57
12 7. Non-working parent and children do something together outside
of the home every day (i.e. shopping, walking) 1.57
14 3. Working parent(s) has a regular play time with the children after
coming home from work 1.55
15 29. Parent(s) do regular activities with the children such as those
suggested by teachers, therapists, or others 1.53
16 30. Family members have a regular schedule of child-oriented or
educational activities, or therapy appointments 1.52
17 10. Family has a certain “family time” each week when they do things
together at home 1.40
18 13. Children take part in regular activities after school 1.38
19 16. Parent(s) have a certain hobby or sport that they regularly do together 1.37
19 23. Family regularly visits with the relatives 1.37
21 6. Parent(s) and children play together some time each day 1.32
22 1. Parent(s) have some time each day for just talking with the children 1.30
22 12. Each child has some time each day for playing alone 1.30
24 14. Young children go to play-school the same days each week 1.28
25 20. At least some of the family eats breakfast together every morning 1.27
26 22. At least one parent talks to his or her relatives regularly 1.22
27 8. Family has a “quiet time” each evening when everyone talks or
plays quietly 1.20
27 24. Family checks in and out with each other when someone leaves
or comes home 1.20
29 11. Parent(s) read or tell stories to the children every day 1.17
30 26. Family has certain things they always do to greet the working
parent(s) at the end of the day 1.08
137
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Table F4
Rank Order ofFrequency o f Routines: With Disability
Rank Routine Mean
1 2. Parent(s) have certain things they do every morning while getting
ready to start the day 3.82
2 17. Children have special things they do or ask for each night at
bedtime (i.e. a story, good-night kiss, a drink of water) 3.78
3 1. Parent(s) have some time each day for just talking with the children 3.75
4 24. Family checks in and out with each other when someone leaves
or comes home 3.66
5 6. Parent(s) and children play together some time each day 3.63
6 29. Parent(s) do regular activities with the children such as those
suggested by teachers, therapists, or others 3.59
7 18. Children go to bed at the same time every night 3.56
7 22. At least one parent talks to his or her relatives regularly 3.56
9 30. Family members have a regular schedule of child-oriented or
educational activities, or therapy appointments 3.50
10 27. Parent(s) have certain things they always do each time the children
get out of line 3.47
1 1 11. Parent(s) read or tell stories to the children every day 3.44
12 14. Young children go to play-school the same days each week 3.43
13 5. Children do the same things every morning as soon as they wake up 3.41
13 12. Each child has some time each day for playing alone 3.41
15 4. Working parent(s) takes care of the children some time every day 3.35
16 15. Children do their homework at the same time each day or
night of the week 3.33
17 7. Non-working parent and children do something together outside
of the home every day (i.e. shopping, walking) 3.00
18 19. Family eats at the same time each night 2.97
19 28. Children do regular household chores 2.96
20 25. Working parent(s) comes home from work at the same time each day 2.78
21 9. Family goes some place special together each week 2.75
21 20. At least some of the family eats breakfast together every morning 2.75
21 26. Family has certain things they always do to greet the working
parent(s) at the end of the day 2.75
24 3. Working parent(s) has a regular play time with the children after
coming home from work 2.69
25 21. Whole family eats dinner together every night 2.62
26 13. Children take part in regular activities after school 2.35
27 8. Family has a “quiet time” each evening when everyone talks or
plays quietly 2.28
27 10. Family has a certain “family time” each week when they do things
together at home 2.28
29 23. Family regularly visits with the relatives 1.90
30 16. Parent(s) have a certain hobby or sport that they regularly do together 1.56
138
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Table F5
Rank Order ofImportance o f Routines: With Disability
Rank Routine Mean
1 1. Parent(s) have some time each day for just talking with the children 3.00
2 6. Parent(s) and children play together some time each day 2.97
3 25. Working parent(s) comes home from work at the same time each day 2.84
4 17. Children have special things they do or ask for each night at
bedtime (i.e. a story, good-night kiss, a drink of water) 2.78
4 22. At least one parent talks to his or her relatives regularly 2.78
4 24. Family checks in and out with each other when someone leaves
or comes home 2.78
4 29. Parent(s) do regular activities with the children such as those
suggested by teachers, therapists, or others 2.78
8 18. Children go to bed at the same time every night 2.75
9 11. Parent(s) read or tell stories to the children every day 2.72
10 4. Working parent(s) takes care of the children some time every day 2.71
1 1 3. Working parent(s) has a regular play time with the children after
coming home from work 2.62
12 12. Each child has some time each day for playing alone 2.53
12 21. Whole family eats dinner together every night 2.53
12 23. Family regularly visits with the relatives 2.53
15 7. Non-working parent and children do something together outside
of the home every day (i.e. shopping, walking) 2.52
16 2. Parent(s) have certain things they do every morning while getting
ready to start the day 2.50
16 5. Children do the same things every morning as soon as they wake up 2.50
16 28. Children do regular household chores 2.50
16 30. Family members have a regular schedule of child-oriented or
educational activities, or therapy appointments 2.50
20 9. Family goes some place special together each week 2.47
20 27. Parent(s) have certain things they always do each time the children
get out of line 2.47
22 15. Children do their homework at the same time each day or
night of the week 2.44
23 10. Family has a certain “family time” each week when they do things
together at home 2.34
24 19. Family eats at the same time each night 2.31
25 14. Young children go to play-school the same days each week 2.30
26 8. Family has a “quiet time” each evening when everyone talks or
plays quietly 2.29
27 26. Family has certain things they always do to greet the working
parent(s) at the end of the day 2.25
28 16. Parent(s) have a certain hobby or sport that they regularly do together 2.16
29 20. At least some of the family eats breakfast together every morning 2.08
30 13. Children take part in regular activities after school 1.95
139
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Table F6
Rank Order o f Stress Related to Routines: With Disability
Rank Routine Mean
1 27. Parent(s) have certain things they always do each time the children
get out of line 2.44
2 28. Children do regular household chores 2.37
3 2. Parent(s) have certain things they do every morning while getting
ready to start the day 2.19
3 29. Parent(s) do regular activities with the children such as those
suggested by teachers, therapists, or others 2.19
5 4. Working parent(s) takes care of the children some time every day 2.13
5 18. Children go to bed at the same time every night 2.13
7 15. Children do their homework at the same time each day or
night of the week 2.11
8 23. Family regularly visits with the relatives 2.07
9 21. Whole family eats dinner together every night 2.06
10 5. Children do the same things every morning as soon as they wake up 2.03
1 1 25. Working parent(s) comes home from work at the same time each day 2.00
1 1 30. Family members have a regular schedule of child-oriented or
educational activities, or therapy appointments 2.00
13 9. Family goes some place special together each week 1.87
13 19. Family eats at the same time each night 1.87
15 7. Non-working parent and children do something together outside
of the home every day (i.e. shopping, walking) 1.82
16 16. Parent(s) have a certain hobby or sport that they regularly do together 1.78
16 17. Children have special things they do or ask for each night at
bedtime (i.e. a story, good-night kiss, a drink of water) 1.78
18 3. Working parent(s) has a regular play time with the children after
coming home from work 1.75
19 1. Parent(s) have some time each day for just talking with the children 1.73
20 20. At least some of the family eats breakfast together every morning 1.62
21 1. Parent(s) have some time each day for just talking with the children 1.53
21 6. Parent(s) and children play together some time each day 1.53
21 12. Each child has some time each day for playing alone 1.53
24 14. Young children go to play-school the same days each week 1.52
25 24. Family checks in and out with each other when someone leaves
or comes home 1.47
26 8. Family has a “quiet time” each evening when everyone talks or
plays quietly 1.41
27 22. At least one parent talks to his or her relatives regularly 1.41
28 11. Parent(s) read or tell stories to the children every day 1.37
29 10. Family has a certain “family time” each week when they do things
together at home 1.28
30 26. Family has certain things they always do to greet the working
parent(s) at the end of the day 1.23
140
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APPENDIX G
RATING OF ROUTINES BY MEAN AND MODE
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Table G1
Rating o f Frequency o f Routines: All Mothers
Routine N Mean Mode
1. Parent(s) have some time each day for talking w/children 72 3.79 4
2. Parent(s) have certain things they do every morning 72 3.86 4
3. Working parent(s) has regular play time with children 72 2.75 3
4. Working parent(s) takes care of children some time each day 72 3.29 4
5. Children do same things every morning as they wake up 72 3.54 4
6. Parent(s) and children play together some time each day 72 3.62 4
7. Non-working parent & children do something outside home 54 3.30 4
8. Family has a “quiet time” each evening 72 2.69 4
9. Family goes some place special together each week 72 2.86 4
10. Family has a certain “family time” each week at home 72 2.48 4
11. Parent(s) read or tell stories to the children every day 72 3.60 4
12. Each child has some time each day for playing alone 72 3.44 4
13. Children take part in regular activities after school 48 2.64 4
14. Young children go to play-school same days each week 55 3.42 4
15. Children do homework at the same time each day/night 35 3.35 4
16. Parent(s) have hobby or sport they regularly do together 72 1.69 1
17. Children have special things each night at bedtime 72 3.83 4
18. Children go to bed at the same time every night 72 3.61 4
19. Family eats at the same time each night 72 3.17 3
20. At least some of family eats breakfast together every morning 72 2.91 4
21. Whole family eats dinner together every night 72 2.72 3
22. At least one parent talks to his or her relatives regularly 72 3.54 4
23. Family regularly visits with the relatives 69 2.34 1,4
24. Family checks in/out when someone leaves/comes home 72 3.82 4
25. Working parent(s) comes home at the same time each day 72 2.74 3
26. Family has certain things to greet working parent(s) 72 3.03 3
27. Parent(s) do certain things each time children get out of line 69 3.55 4
28. Children do regular household chores 58 2.69 3
29. Parent(s) do regular activities with the children 64 3.23 4
30. Regular schedule of child-oriented or educational activities 68 3.04 4
142
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Table G2
Rating o f Importance o f Routines: All Mothers
Routine N Mean Mode
1 . Parent(s) have some time each day for talking w/children 72 2.99 3
2. Parent(s) have certain things they do every morning 72 2.40 3
3. Working parent(s) has regular play time with children 72 2.69 3
4. Working parent(s) takes care of children some time each day 72 2.73 3
5. Children do same things every morning as they wake up 72 2.35 2
6. Parent(s) and children play together some time each day 72 2.91 3
7. Non-working parent & children do something outside home 54 2.59 3
8. Family has a “quiet time” each evening 72 2.39 3
9. Family goes some place special together each week 72 2.54 3
10. Family has a certain “family time” each week at home 72 2.43 3
11. Parent(s) read or tell stories to the children every day 72 2.80 3
12. Each child has some time each day for playing alone 72 2.69 3
13. Children take part in regular activities after school 48 2.05 3
14. Young children go to play-school same days each week 55 2.45 3
15. Children do homework at the same time each day/night 35 2.52 3
16. Parent(s) have hobby or sport they regularly do together 72 2.02 3
17. Children have special things each night at bedtime 72 2.74 3
18. Children go to bed at the same time every night 72 2.78 3
19. Family eats at the same time each night 72 2.36 2
20. At least some of family eats breakfast together every morning 72 2.01 2
21. Whole family eats dinner together every night 72 2.64 3
22. At least one parent talks to his or her relatives regularly 72 2.80 3
23. Family regularly visits with the relatives 72 2.69 3
24. Family checks in/out when someone leaves/comes home 72 2.84 3
25. Working parent(s) comes home at the same time each day 72 2.52 3
26. Family has certain things to greet working parent(s) 72 2.23 3
27. Parent(s) do certain things each time children get out of line 72 2.66 3
28. Children do regular household chores 58 2.44 3
29. Parent(s) do regular activities with the children 64 2.67 3
30. Regular schedule of child-oriented or educational activities 68 2.40 3
143
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Table G3
Rating o f Stress Related to Routines: All Mothers
Routine N Mean Mode
1. Parent(s) have some time each day for talking w/children 72 1.42 1
2. Parent(s) have certain things they do every morning 72 2.01 2
3. Working parent(s) has regular play time with children 72 1.65 1
4. Working parent(s) takes care of children some time each day 72 1.88 2
5. Children do same things every morning as they wake up 72 1.80 1
6. Parent(s) and children play together some time each day 72 1.43 1
7. Non-working parent & children do something outside home 54 1.70 2
8. Family has a “quiet time” each evening 72 1.31 1
9. Family goes some place special together each week 72 1.77 2
10. Family has a certain “family time” each week at home 72 1.34 1
11. Parent(s) read or tell stories to the children every day 72 1.27 1
12. Each child has some time each day for playing alone 72 1.42 1
13. Children take part in regular activities after school 48 1.55 1
14. Young children go to play-school same days each week 55 1.40 1
15. Children do homework at the same time each day/night 35 1.87 2
16. Parent(s) have hobby or sport they regularly do together 72 1.58 1
17. Children have special things each night at bedtime 72 1.69 2
18. Children go to bed at the same time every night 72 1.97 2
19. Family eats at the same time each night 72 1.80 2
20. At least some of family eats breakfast together every morning 72 1.45 1
21. Whole family eats dinner together every night 72 1.87 2
22. At least one parent talks to his or her relatives regularly 72 1.32 1
23. Family regularly visits with the relatives 72 1.72 1
24. Family checks in/out when someone leaves/comes home 72 1.34 1
25. Working parent(s) comes home at the same time each day 72 1.82 1
26. Family has certain things to greet working parent(s) 72 1.15 1
27. Parent(s) do certain things each time children get out of line 72 2.23 2
28. Children do regular household chores 58 2.11 2
29. Parent(s) do regular activities with the children 64 2.01 2
30. Regular schedule of child-oriented or educational activities 68 1.76 2
144
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Table G4
Rating o f Frequency o f Routines: Mothers o f Children Without Disability
Routine N Mean Mode
1 . Parent(s) have some time each day for talking w/children 40 3.82 4
2. Parent(s) have certain things they do every morning 40 3.90 4
3. Working parent(s) has regular play time with children 40 2.82 3
4. Working parent(s) takes care of children some time each day 40 3.22 4
5. Children do same things every morning as they wake up 40 3.57 4
6. Parent(s) and children play together some time each day 40 3.60 4
7. Non-working parent & children do something outside home 32 3.60 4
8. Family has a “quiet time” each evening 40 3.10 4
9. Family goes some place special together each week 40 2.97 4
10. Family has a certain “family time” each week at home 40 2.67 4
11. Parent(s) read or tell stories to the children every day 40 3.75 4
12. Each child has some time each day for playing alone 40 3.47 4
13. Children take part in regular activities after school 26 2.92 4
14. Young children go to play-school same days each week 32 3.40 4
15. Children do homework at the same time each day/night 16 3.37 4
16. Parent(s) have hobby or sport they regularly do together 40 1.82 1
17. Children have special things each night at bedtime 40 3.87 4
18. Children go to bed at the same time every night 40 3.65 4
19. Family eats at the same time each night 40 3.37 3
20. At least some of family eats breakfast together every morning 40 3.07 4
21. Whole family eats dinner together every night 40 2.82 4
22. At least one parent talks to his or her relatives regularly 40 3.52 4
23. Family regularly visits with the relatives 40 2.78 4
24. Family checks in/out when someone leaves/comes home 40 3.97 4
25. Working parent(s) comes home at the same time each day 40 2.70 4
26. Family has certain things to greet working parent(s) 40 3.30 4
27. Parent(s) do certain things each time children get out of line 40 3.62 4
28. Children do regular household chores 34 2.41 3
29. Parent(s) do regular activities with the children 32 2.87 4
30. Regular schedule of child-oriented or educational activities 36 2.58 4
145
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Table G5
Rating ofImportance o f Routines: Mothers o f Children Without Disability
Routine N Mean Mode
1 . Parent(s) have some time each day for talking w/children 40 2.97 3
2. Parent(s) have certain things they do every morning 40 2.30 2
3. Working parent(s) has regular play time with children 40 2.75 3
4. Working parent(s) takes care of children some time each day 40 2.75 3
5. Children do same things every morning as they wake up 40 2.20 2
6. Parent(s) and children play together some time each day 40 2.85 3
7. Non-working parent & children do something outside home 32 2.64 3
8. Family has a “quiet time” each evening 40 2.55 3
9. Family goes some place special together each week 40 2.60 3
10. Family has a certain “family time” each week at home 40 2.52 3
11. Parent(s) read or tell stories to the children every day 40 2.87 3
12. Each child has some time each day for playing alone 40 2.85 3
13. Children take part in regular activities after school 26 2.15 3
14. Young children go to play-school same days each week 32 2.59 3
15. Children do homework at the same time each day/night 16 2.50 3
16. Parent(s) have hobby or sport they regularly do together 40 1.87 2
17. Children have special things each night at bedtime 40 2.70 3
18. Children go to bed at the same time every night 40 2.80 3
19. Family eats at the same time each night 40 2.40 3
20. At least some of family eats breakfast together every morning 40 2.02 2
21. Whole family eats dinner together every night 40 2.75 3
22. At least one parent talks to his or her relatives regularly 40 2.82 3
23. Family regularly visits with the relatives 40 2.84 3
24. Family checks in/out when someone leaves/comes home 40 2.90 3
25. Working parent(s) comes home at the same time each day 40 2.20 2
26. Family has certain things to greet working parent(s) 40 2.20 3
27. Parent(s) do certain things each time children get out of line 40 2.85 3
28. Children do regular household chores 33 2.38 3
29. Parent(s) do regular activities with the children 32 2.56 3
30. Regular schedule of child-oriented or educational activities 36 2.30 3
146
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Table G6
Rating o f Stress Related to Routines: Mothers o f Children Without Disability
Routine N Mean Mode
1. Parent(s) have some time each day for talking w/children 40 1.30 1
2. Parent(s) have certain things they do every morning 40 1.82 2
3. Working parent(s) has regular play time with children 40 1.55 1
4. Working parent(s) takes care of children some time each day 40 1.62 1
5. Children do same things every morning as they wake up 40 1.57 1
6. Parent(s) and children play together some time each day 40 1.32 1
7. Non-working parent & children do something outside home 33 1.57 2
8. Family has a “quiet time” each evening 40 1.20 1
9. Family goes some place special together each week 40 1.67 2
10. Family has a certain “family time” each week at home 40 1.40 1
11. Parent(s) read or tell stories to the children every day 40 1.17 1
12. Each child has some time each day for playing alone 40 1.30 1
13. Children take part in regular activities after school 26 1.38 1
14. Young children go to play-school same days each week 32 1.28 1
15. Children do homework at the same time each day/night 16 1.62 2
16. Parent(s) have hobby or sport they regularly do together 40 1.37 1
17. Children have special things each night at bedtime 40 1.60 2
18. Children go to bed at the same time every night 40 1.82 2
19. Family eats at the same time each night 40 1.72 2
20. At least some of family eats breakfast together every morning 40 1.27 1
21. Whole family eats dinner together every night 40 1.67 2
22. At least one parent talks to his or her relatives regularly 40 1.22 1
23. Family regularly visits with the relatives 40 1.37 1
24. Family checks in/out when someone leaves/comes home 40 1.20 1
25. Working parent(s) comes home at the same time each day 40 1.64 1
26. Family has certain things to greet working parent(s) 40 1.08 1
27. Parent(s) do certain things each time children get out of line 40 2.02 2
28. Children do regular household chores 34 1.85 2
29. Parent(s) do regular activities with the children 32 1.53 1
30. Regular schedule of child-oriented or educational activities 36 1.52 1
147
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Table G7
Rating ofFrequency o f Routines: Mothers o f Children With Disability
Routine N Mean Mode
1. Parent(s) have some time each day for talking w/children 32 3.75 4
2. Parent(s) have certain things they do every morning 32 3.82 4
3. Working parent(s) has regular play time with children 32 2.69 2,3,4
4. Working parent(s) takes care of children some time each day 32 3.3 4
5. Children do same things every morning as they wake up 32 3.51 3
6. Parent(s) and children play together some time each day 32 3.63 4
7. Non-working parent & children do something outside home 22 3.00 3
8. Family has a “quiet time” each evening 32 2.28 1
9. Family goes some place special together each week 32 2.75 2,4
10. Family has a certain “family time” each week at home 32 2.28 2
11. Parent(s) read or tell stories to the children every day 32 3.44 4
12. Each child has some time each day for playing alone 32 3.41 4
13. Children take part in regular activities after school 22 2.35 4
14. Young children go to play-school same days each week 23 3.43 4
15. Children do homework at the same time each day/night 19 3.33 4
16. Parent(s) have hobby or sport they regularly do together 32 1.56 1
17. Children have special things each night at bedtime 32 3.78 4
18. Children go to bed at the same time every night 32 3.56 4
19. Family eats at the same time each night 32 2.97 3
20. At least some of family eats breakfast together every morning 32 2.75 4
21. Whole family eats dinner together every night 32 2.62 2,4
22. At least one parent talks to his or her relatives regularly 32 3.56 4
23. Family regularly visits with the relatives 32 1.90 1
24. Family checks in/out when someone leaves/comes home 32 3.66 4
25. Working parent(s) comes home at the same time each day 32 2.78 4
26. Family has certain things to greet working parent(s) 32 2.75 3
27. Parent(s) do certain things each time children get out of line 32 3.47 3
28. Children do regular household chores 24 2.96 4
29. Parent(s) do regular activities with the children 32 3.59 4
30. Regular schedule of child-oriented or educational activities 32 3.50 4
148
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Table G8
Rating ofImportance o f Routines: Mothers o f Children With Disability
Routine N Mean Mode
1 . Parent(s) have some time each day for talking w/children 32 3.00 3
2. Parent(s) have certain things they do every morning 32 2.50 3
3. Working parent(s) has regular play time with children 32 2.62 3
4. Working parent(s) takes care of children some time each day 32 2.71 3
5. Children do same things every morning as they wake up 32 2.50 3
6. Parent(s) and children play together some time each day 32 2.97 3
7. Non-working parent & children do something outside home 22 2.52 3
8. Family has a “quiet time” each evening 32 2.22 3
9. Family goes some place special together each week 32 2.47 3
10. Family has a certain “family time” each week at home 32 2.34 3
11. Parent(s) read or tell stories to the children every day 32 2.72 3
12. Each child has some time each day for playing alone 32 2.53 3
13. Children take part in regular activities after school 22 1.95 2
14. Young children go to play-school same days each week 23 2.30 3
15. Children do homework at the same time each day/night 19 2.44 3
16. Parent(s) have hobby or sport they regularly do together 32 2.16 3
17. Children have special things each night at bedtime 32 2.78 3
18. Children go to bed at the same time every night 32 2.75 3
19. Family eats at the same time each night 32 2.31 2
20. At least some of family eats breakfast together every morning 32 2.00 1,3
21. Whole family eats dinner together every night 32 2.53 3
22. At least one parent talks to his or her relatives regularly 32 2.78 3
23. Family regularly visits with the relatives 32 2.53 3
24. Family checks in/out when someone leaves/comes home 323 2.78 3
25. Working parent(s) comes home at the same time each day 32 2.84 3
26. Family has certain things to greet working parent(s) 32 2.25 3
27. Parent(s) do certain things each time children get out of line 32 2.47 3
28. Children do regular household chores 24 2.50 3
29. Parent(s) do regular activities with the children 32 2.78 3
30. Regular schedule of child-oriented or educational activities 32 2.50 3
149
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Table G9
Rating o f Stress Related to Routines: Mothers o f Children With Disability
Routine N Mean Mode
1 . Parent(s) have some time each day for talking w/children 332 1.53 1
2. Parent(s) have certain things they do every morning 323 2.19 2
3. Working parent(s) has regular play time with children 32 1.75 1
4. Working parent(s) takes care of children some time each day 32 2.13 2
5. Children do same things every morning as they wake up 32 2.03 1
6. Parent(s) and children play together some time each day 32 1.53 1
7. Non-working parent & children do something outside home 22 1.82 2
8. Family has a “quiet time” each evening 32 1.41 1
9. Family goes some place special together each week 32 1.87 2
10. Family has a certain “family time” each week at home 32 1.28 1
11. Parent(s) read or tell stories to the children every day 32 1.37 1
12. Each child has some time each day for playing alone 32 1.53 1
13. Children take part in regular activities after school 22 1.73 2
14. Young children go to play-school same days each week 23 1.52 2
15. Children do homework at the same time each day/night 19 2.11 2
16. Parent(s) have hobby or sport they regularly do together 32 1.78 1
17. Children have special things each night at bedtime 32 1.78 1
18. Children go to bed at the same time every night 32 2.12 2
19. Family eats at the same time each night 32 1.87 2
20. At least some of family eats breakfast together every morning 32 1.62 1
21. Whole family eats dinner together every night 32 2.06 2
22. At least one parent talks to his or her relatives regularly 32 1.41 1
23. Family regularly visits with the relatives 32 2.07 1
24. Family checks in/out when someone leaves/comes home 32 1.47 1
25. Working parent(s) comes home at the same time each day 32 2.00 1
26. Family has certain things to greet working parent(s) 32 1.22 1
27. Parent(s) do certain things each time children get out of line 32 2.44 2
28. Children do regular household chores 24 2.37 2
29. Parent(s) do regular activities with the children 32 2.19 2
30. Regular schedule of child-oriented or educational activities 32 2.00 2
150
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APPENDIX H
RESULTS OF ANALYSIS OF VARIANCE
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Table HI
Mothers ’ Strategies to Limit Stress: One- Way Analysis o f Variance Between
Groups
Measure SS
d f
MS F
Routine Frequency
Between Ss 65.78 1 65.78 .79
Within Ss 5775.90 70 82.51
Routine Importance
Between Ss 8.71 1 8.71 .13
Within Ss 4516.40 70 64.52
Routine Stress
Between Ss 1067.78 1 1067.78 9.26***
Within Ss 8072.78 70 115.31
Parenting Stress Index-SF
(PSI-SF)
Between Ss 3900.63 1 3900.63 12.27**
Within Ss 22254.88 70 317.93
Parenting Stress-Distress:
PSI-SF Subscale
Between Ss 535.34 1 535.34 11.36**
Within Ss 3298.65 70 47.12
Parenting Stress-Dysfunction:
PSI-SF Subscale
Between Ss 283.55 1 283.55 9.63***
Within Ss 2060.32 70 29.43
Parenting Stress-Difficult
Child: PSI-SF Subscale
Between Ss 594.18 1 594.18 6.62*
Within Ss 6281.59 70 89.74
152
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APPENDIX I
FREQUENCIES OF STRATEGIES TO
MANAGE STRESS REPORTED
BY MOTHERS
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Table II
Mothers ’ Strategies to Limit Stress: Temporal Unfolding Strategies
Number of mothers reporting strategy
Strategy
Child without
disability
(w = 36)
Child with
disability
(n = 32)
Total
(A T =68)
1. Choosing/preparing clothes
for the next day 19 16 35
2. Prepacking briefcases/backpacks
for the next day 18 16 34
3. Mom gets up earlier or stays up later
to complete self-care/quiet time/
exercise by herself 15 16 31
4. Prepacking lunches for the next day 16 12 28
5. Finish household tasks such as laundry
or putting away dishes at end of day
or on another day 6 8 14
6. Preparing food or setting the table for
next meal well in advance (night before
or 3-4 hours before) 8 3 11
7. Preparing/freezing meals on weekends
to be used during the week 3 4 7
8. Mother showers/bathes in evening in
prep for next day 6 1 7
9. Clean up after meals at a later time 2 4 6
10. Get children ready for bed right
after dinner 3 0 3
11. Tape TV shows to watch at a later time 0 1 1
154
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Table 12
Mothers ’ Strategies to Limit Stress: Unfolding by Inclusion Strategies
Number of mothers reporting strategy
Child without Child with
disability disability Total
Strategy (n = 36) ( n - 32) (N= 68)
1. Husband participates in children’s
bedtime routine 12 12 24
2. Children eat breakfast/lunch/snacks
provided by school/daycare, entailing
no meal preparation/planning 9 15 21
3. Hire others or have extended family/
neighbors complete household tasks
or childcare 9 10 19
4. Husband participates in children’s
morning routine 5 15 19
5. Husband participates in dinner cleanup 6 7 13
6. Husband makes dinner 5 6 11
7. Children assist with family chores 7 3 10
8. Husband engages children while mother
provides care to other children 2 6 8
9. Go out to eat during week, no preparation 5 2 7
10. Husband makes breakfast on weekday 3 3 6
11. Husband makes breakfast on weekend 3 2 5
12. Carpool with other families to school/
work/activity 1 3 4
13. Husband completes entire morning
routine with children 0 3 3
14. Husband participates in dinner preparation 1 2 3
15. Husband packs lunches for family 2 0 2
155
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Table 13
Mothers ’ Strategies to Limit Stress: Enfolding Strategies
Number of mothers reporting strategy
Child without Child with
disability disability Total
Strategy ( n - 36) (n = 32) (N = 68)
1. Children watch TV, nap, or play while
mother/father engaged in self-care or
home care tasks such as bathing,
cooking, laundry, cleaning 29 24 53
2. Children eat breakfast/lunch/snacks
provided by school/day care, entailing
no meal preparation or planning 9 15 24
3. Mother prepares self for work/day while
guiding children/husband through morning
tasks: preparing breakfast, dressing/feeding
children, making beds, putting things away
after breakfast, making/packing lunches 8 16 24
4. Mother/father drops off/picks up children
from school or daycare on way to work/home 11 13 24
5. Parents/children eat in car while driving to/
between work, school, afternoon, or evening
activities 1 3 3
6. Mothers assists with homework while
engaging younger children in activity or
while preparing meal 2 1 3
7. Children do homework while driving
to/between afternoon or evening activities 2 0 2
156
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Table 14
Mothers ’ Strategies to Limit Stress: Chunking Strategies
Number of mothers reporting strategy
Child without Child with
disability disability Total
Strategy (n = 36) (n = 32) (N = 68)
1. Outside-home errands (grocery shopping,
cleaners, appointments) chunked for ease
of completion, either on a particular day
or weekend, morning/afternoon hours, or
on the way home from work 19 18 37
2. Light cleaning/picking up of house done
at a particular time, either early morning
or after children in bed 9 5 14
3. Do errands on day off 5 6 11
4. Mother completes housework (vacuuming,
dusting, laundry) in the morning prior to
doing any other activities 8 0 8
5. Housework done upon arrival home
from work 2 3 5
6. Home business/desk work (e.g., bill paying)
completed during specific afternoon or
evening hours 3 0 3
7. Catch up on housework 3 times per week 0 3 3
157
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Table 15
Mothers ’ Strategies to Limit Stress: Organizing and Planning Strategies
Number of mothers reporting strategy
Child without Child with
disability disability Total
Strategy (n = 36) (n = 32) (N = 68)
1. Use of a calendar as a necessity 18 23 41
2. Clean up kitchen right after dinner 21 16 37
3. Have quiet time or play time at some
point during the day 15 21 36
4. Children complete dressing routine
prior to coming to breakfast 17 6 23
5. Prepare simple meals (like sandwiches)
especially during week when evenings can
be busy, don’t cook every day 11 8 19
6. Designated place in the home for backpacks,
briefcases, supplies that come and go to
school/home/daycare 8 9 17
7. Do errands/shopping without young children 8 8 16
8. Schedule couple time on regular basis 5 8 13
9. Plan weekly menu 5 5 10
10. Check children’s backpacks and do school
things immediately after they get home 5 3 8
11. Children do homework right after school 8 0 8
12. Family night or special day 6 1 7
13. Dinner by 6:00 p.m. 6 0 6
14. “Snuggle” time 3 3 6
158
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Table 15 (continued)
Number of mothers reporting strategy
Child without Child with
disability disability Total
Strategy (n - 36) (n = 32) (T V =68)
15. Use lists always 3 3 6
16. Review appointments/activities/menus
for next day on the night before 3 2 5
17. Limit children to one scheduled activity
outside the home 5 0 5
18. Don’t cook every day (or) cook only
three times per week 3 2 5
19. Try not to do errands on the weekend 2 3 5
20. Clean up kitchen later, not right after dinner 2 3 5
21. Homework area with all supplies such as
scissors, pencils, etc. in bins/boxes available
for children’s use 2 2 4
22. Clean up tasks as you go 2 0 2
23. Bathe children every other night 0 2 2
24. Eat when hungry/dinner planned
at the moment 2 0 2
25. Organize weekend/day around naps 2 0 2
26. Think about next day’s menu the night before 1 0 1
27. Coordinate errand completion with husband 1 0 1
28. Use sticky notes everywhere 1 0 1
29. Whoever gets home first, cooks 1 0 1
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Table 15 (continued)
Strategy
Number of mothers reporting strategy
Child without Child with
disability disability Total
(n = 36) (n = 32) (N = 68)
30. Never leave the house in the afternoon
with young children 1 0 1
31. Be sure that everything is put away
at the end of the day 1 0 1
32. Power nap 1 0 1
33. Prioritize tasks 1 0 1
160
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Table 16
Mothers ’ Attitudes About Daily Routines
Number of mothers reporting strategy
Attitude
Child without
disability
(n = 36)
Child with
disability
in = 32)
0 0
O II
1. Keep a flexible attitude, “play it by ear” 22 27 49
2. Complete activity/task depending upon
children’s mood 17 8 25
3. Try to avoid rushing, build in time for
little things that happen 5 2 7
4. Take time for “thinking” about things 3 0 3
5. Plan by “feeling” 3 0 3
6. Feel like there is a choice and
control in life 0 2 2
7. Feel better with more organization 1 1 2
8. Things seem to end up being
planned for us 1 1 1
9. Be very organized, “terribly compulsive” 1 0 1
10. Build in enough time for the little
things that happen
11. Think “survival things” 1 0 1
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Table 17
Mothers’ Accommodations to Limit Stress
Number of mothers reporting strategy
Child without Child with
disability disability Total
Accommodation (n = 36) (n = 32) (N = 68)
1. Change jobs to allow flexible hours 3 6 9
2. Work only when the children are in school 3 5 8
3. Work where the children go to school 1 1 2
4. Home school 1 1 2
5. Stop working outside the home 1 0 1
162
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Asset Metadata
Creator
O'Brien, Valerie J.
(author)
Core Title
The relationship between family routines and perceived stress in mothers with children with and without a disability
Degree
Doctor of Philosophy
Degree Program
Occupational Science
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
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education, early childhood,health sciences, rehabilitation and therapy,OAI-PMH Harvest
Language
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