PERSONALITY MEASUREMENT I N PARENTS O F RETARDED AND EMOTIONALLY DISTURBED CHILDREN:

A REPLICATION WILLIAM H. MILLER AND WILLIAM C . KEIRN

Neuropsychiatric Institute, UCLA

Replicated Erickson’s (1968, 1969) studies that compared MMPI profiles of parents of emotionally and behaviorally disturbed (ED), mentally retarded (MR), and non-clinic (N) children. In general, Erickson’s findings that the MR and ED parents did not differ, but that both showed elevated profiles relative to N, were confirmed. The results were interpreted to rovide partial support for Erickson’s “stress reaction hypothesis,” whereby t i e well-known clinic parent MMPI elevations presumably reflect the parents’ stress BS a result of having a disturbed or handicapped child.

A number of studies have shown MMPI elevations on clinical scales by child clinic parents as compared with profiles of non-clinic parents (Hafner, Butcher, Hall, &, Wentworth, 1969). One interpretation of these different test results has been that the clinical elevations reflect the clinic parent’s personality problems that are contributory to the child’s aberrant behavior. Erickson (1968, 1969), however, has posited the “stress reaction hypothesis” to account for the data by which the MMPI elevations are said to reflect the clinic parents’ pathological reactions to the presence of a disturbed child. As a test of her hypothesis, Erickson (1968) compared 12 parents of young retarded children (MR), 12 parents of emo- tionally disturbed children (ED), and a large group of non-clinic male and female adults (N). Because Erickson found that the MR and E D parents did not differ from each other, but did show significantly increased clinical scales relative to N parents, she hypothesized that the elevations in clinic parents might reflect a common stress reaction rather than preexisting personal psychopathology. She argued that because the MR parents did not produce their child’s mental retardation, their RIMPI elevations might represent a reaction to, rather than a cause of the retar- dation. By extension, it also was argued that the E D parents were reacting simi- larly to the stress of a child with a handicap, albeit emotional and behavioral in nature. In a further study, Erickson (1969) examined a larger group of parents of young MR children and again found significant MMPI elevations relative to the Dahlstrom and Welsh (1960) adult norms. In the 1969 study, the significant MR parent elevations (using the p < .01 level of significance) were on MMPI scales 2 (Depression), 3 (Hysteria), 4 (Psychopathic Deviate), 6 (Paranoia), and 7 (Psychasthenia). Again applying the conservative p < .01 criterion to Erickson’s (1968) data, only scale 4 was elevated in the MR X N comparison. According to Erickson’s elinical interpretation of the MMPI differences, the MR parents showed neurotic symptoms related to aggression, anxiety, and depression.

The present study reexamined the stress reaction hypothesis by attempting to replicate Erickson’s (1968) MR X ED X N comparisons, with several impor- tant procedural variations. First, Erickson’s MR children were all very young (under 3 years of age), which means that the parents’ reactions might be rela- tively short-term and of questionable meaning as their -children grew older. In the present study, older MR children (mean age = 6 years) were included.

Second, a special problem is represented by Erickson’s choice of a control group. She used the MMPI adult norms, which contained both parents and non- parents, and the sample size of which varied (by MMPI scales) between two and five times the size of Erickson’s MR and ED samples. Thus her “normal” control Ss were from a very different population and community and were a statistically imbalanced sample as well. In the present study, all parents were from the same

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Personality Measurement in Parents 687

geographic community, and the sample sizes of the groups studied are statisti- cally similar.

Finally, Erickson accepted the p < .05 level of significance in her studies, and to some extent her conclusions were based upon that significance level. It is suggested that for subjective data such as self-rated personality measurements the more conservative criterion of p < .01 should be applied. While the choice of confidence intervals is somewhat arbitrary, when the p < .01 criterion is applied to Erickson’s data, her two groups of the MR parents are quite different in that one (1969) shows a multiple MMPI MR X N elevations, while the other (1968) shows MR X N differences only on the PD scale. In the present study, the p < . O l criterion will be applied to determine which of Erickson’s MR X N contrasts is the more replicable.

METHOD Subjects and Procedure

The Ss consisted of three groups of families: M R group. Fifty families with a child diagnosed as mentally retarded in the

EMR (educable) range (I& range = 50-69). The diagnosis was based on the results of multiple psychometric tests administered at the Child Outpatient Clinic, Neu- ropsychiatric Institute, UCLA. A variety of adaptive, behavioral, and emotional problems were noted in these children, but the primary reason for referral to the clinic was the child’s developmental disability.

ED group. Fifty families with at least one child diagnosed in the clinic as having behavioral and emotional adjustment problems. The diagnosis was based on home and school observation, parents’ and teacher’s report, psychological, educational, and physical examinations, and at least four individual psychiatric interviews with the child.

N group. Fifty families recruited by local newspaper and telephone solici- tation. Families were accepted if they had a child in the appropriate age range who had never been referred for professional help for adjustment or developmental problems, and who never had been diagnosed or treated for any psychological problems.

TABLE 1

SAMPLE CHARACTERISTICS

Variable MR group ED group N group

age mother x age father x number of sibs x age of child I& of child Socioeconomic status

(Hollingshead Two Factor Index)

34.8 33.8 36.7 38.4 36.9 40.7

1 .9 1.3 1 . 8 6.01 6 .6 6.9’

58.0 103.1 110.2*

x years education of mother 12.8 12.6 14.5 x years education of father 13.3 13.2 15.9 Nnmber of mothers 44 45 41 Number of fathers 14 17 37

*In the N sample a representative child WBS selected and tested. **Myers, Bean, 6 Pepper (1968).

Journal of Clinical Psychology, July , 1978, Vol. 34, N o . 3.

Table 1 summarizes important sample characteristics of these groups. No data are presented for 6 MR, 5 ED, and 9 N parents, due to incomplete responses t o the questionnaires. The large difference between participating fathers in MR and ED groups relative to the N group reflects the high incidence of single parent, mother-only families who apply to the UCLA Child Psychiatry Clinic.

After the initial intake interview, each parent was asked to complete the MMPI and biographical questionnaires in the clinic waiting room, at which time the child was administered an I& test.

RESULTS AND DISCUSSION Mean T-scores of the 13 validity and clinical scales for the mothers and fathers

in the three groups are presented in Tables 2 and 3. Scores reflect conventional k-corrections as appropriate. The p < .01 level of statistical significance was cho- sen for all analyses in the study.

TABLE 2

MMPI SCORE MEANS, STANDARD DEVIATIONS, AND SIGNIFICANCE TESTS OF DIFFERENCES FOR MOTHERS OF MR. ED. AND N CHILDREN

MR ED N Scale mothers mothers mothers 1-test

M SD M SD M SD MR-ED MR-N ED-N

L F K Hs D HY

MF P D

PA PT sc MA SI

51.70 8 .68 54.40 12.33 53.60 9 .77 52.75 10.37 56.23 10.33 59.25 10.95 58.91 11.16 48.52 10.33 54.90 8 .97 52.63 8.11 55.73 8.89 55.75 9 . 5 0 55.86 10.92

50.48 6 .21 55.71 10.40 54.51 8 .72 54.46 10.95 58.84 1 1 . 0 9 61.20 9.29 63.37 12.22 47.76 10.10 56.66 9 .61 55.31 11.54 57.28 10.83 57.51 11.50 53.87 10.90

47.89 52.19 59.97 53.40 53.24 58.19 56.84 45.62 55.05 52.35 34.76 50.08 60.89

7.04 7 .76 9 .49 2.97' 2 .69* 9 . 7 3 7 .30 2.64* 7 .59 7 .15 2.87' 8 .99 8 . 5 4 7 .24 7 .05 7 .94 2.93* 3.45* 8 . 6 9

Using a multivariate ANOVA, several differences were found between the MR x N contrasts for mothers, but no differences were found for fathers. N mo- thers scored higher than either MR or E D mothers on the K scale ( p < .005), E D mothers scored higher on scales 2 (Depression) and 4 (Psychopathic Deviate) than N mothers ( p < .005), and both MR and E D mothers scored higher on scale 9 (Hypomania) than N mothers ( p < .005). A suggestive trend was noted in that MR mothers showed somewhat higher scores on the Lie scale and scale 0 (Social Introversion) than N mothers.

It is not known for certain why the MMPI profiles of fathers in this study did not differ in the three group contrasts, and no studies of this problem were found in the literature. However, Tables 1, 2, and 3 show that with similar mean differences in several scales for both mothers and fathers, the lack of statistical significance for fathers probably reflects the small number of fathers in the clinic

Personality Measurement in Parents 689

TABLE 3 MMPI SCORE MEANS, STANDARD DEVIATIONS, AND SIGNIFICANCE TESTS OF DIFFERENCES FOR FATHERS OF MR, ED, AND N CHILDREN

MR ED N Scale fathers fathers fathers t-test

M SD M SD M SD ‘MR-ED MR-N ED-N

L F K Hs D HY

MF PD

PA PT sc MA SI

51.71 6.93 51.43 3.27 61.57 9.64 .52.79 10.23 55.50 8.97 58.93 9.80 61.57 10.51 60.21 7.40 53.64 9.01 53.86 10.63 53.43 10.33 55.79 9.52 46.93 7.27

48.24 6.68 54.41 7.34 55.88 9.58 58.52 9.04 59.82 10.31 61.41 8.15 63.18 8.95 64.71 10.80 52.06 7.12 56.59 8.82 57.53 10.67 59.76 10.86 55.59 12.61

49.98 51.68 58.98 56.22 57.56 60.12 56.22 62.80 55.07 53.39 52.66 54.44 48.51

-~

6.92 5.13 9.02

11.67 8.65 7.82 8.78 No significant contrasts 7.96 6.14 7.54 7.49 6.69 7.74

groups. Thus in other MMPI studies with more fathers represented, significant differences for both parents well might emerge.

MR mothers did not differ from ED mothers in this study, and on several scales both groups showed significant scale increases as compared with N mothers. This finding, that mothers of clinic children scored higher on MMPI scales than N mothers, has been reported often (Hafner et al., 1969). However, in this study the E D X N contrasts contained more differences than did the MR X N contrasts. The particular scale elevations found in these ED mothers indicate that they are more emotionally reactive (scale 2), more concerned with interpersonal control issues (scale 4), less behaviorally stable (scale 9), and have less need for social desirability (K scale).

Of possible concern were two pretest differences in the three groups (Table 1). N parents showed more intact marriages and higher social class ratings (primarily based on higher educational levels) than did clinic parents. The class differences reflect the fact that while clinic parents were community-wide in origin, N par- ents were largely from the available University community near the hospital and generally were better educated. It is not known whether minor educational dif- ferences (2 years or less) can produce the MMPI elevations noted in this study. Similarly, for the intact marriage issue, it is not known whether the MMPI ele- vation difference noted for N and clinic families is caused by, or is a cause of, the large number of clinic divorces and separations. However, several reports reviewed by Hafner et al. (1969) studied families of differing social class and marriage status and generally found MMPI differences similar to those reported here. None- theless, these two factors should be investigated in their own right.

In general, the results of this study replicate those of Erickson (1968, 1969). As Erickson found, on the MMPI MR mothers score more like E D mothers than N mothers, although in terms of total scale elevations they fall somewhere in be- tween the two other groups. Also, the MR mothers studied here showed only a few scale elevations and were thus more like Erickson’s 1968 sample. Nonetheless, Erick- son’s results take on added significance because they withstood the p < .01 cri-

690 Journal of Clinical Psychology, July, 1978, Vol. 34, N o . 3.

terion applied to the critical group contrasts both in her studies and in the present one. Further, the present study replicates Erickson’s findings even though a more appropriate normative group was used here, and even though the children in the present study were twice as old (6 years vs. 3 years) as her Ss.

While Erickson’s “stress reaction hypothesis” cannot be confirmed or rejected by these results, the evidence for it is strengthened in that MR and E D parents do show MMPI elevations relative to N. Further support comes from Dee and Dee (1972), who found that when parents of E D boys were compared with par- ents of children with severe motor handicaps, few meaningful MMPI scale dif- ferences emerged. Apparently, increased parental MMPI elevations are asso- ciated with a variety of child handicaps.

A related finding comes from the literature review by Hafner et al. (1969), who concluded that adults with psychiatric disturbance show higher MMPI ele- vations than do child clinic parents. McAdoo and Connally (1975) have confirmed this observation and have noted that on MMPI scales “Child guidance parents appear to be more similar to parents of children without behavioral problems than to adult outpatient parents [p. 2701.”

Some hypothetical closure on the meaning of clinic parental MMPI elevation is possible when all these findings are taken together. As Erickson (1969) notes, clinic parents both react to and in some ways contribute to their children’s aberrant behavior. But it also seems likely that a spectrum of parent psychopathology exists, which ranges from parents with no personal psychopathology or excessive ex- ternal (child) stressors, to a middle range determined by the parent’s reactivity to child stressors that vary in intensity, to parents who are disturbed or symptom- atic enough to request treatment for themselves. Presumably, the clinic parents on this spectrum would score with increasing elevations on MMPI clinical scales as their children showed increasingly stressful handicaps’ and this notion is sup- ported in part by the results reviewed and reported here. Finally, this hypothe- tical spectrum helps to organize some of the diverse findings in the literature and provides logical means for further study of the internal-external stress responses assessed by parental MMPIs.

REFERENCES DAHLSTROM, W. G., & WELSH, G . S. A n MMPI handbook: A gu ih to use in clinical practice and

research. Minneapolis : University of Minnesota Press, 1960. DEE, C., & DEE, H. L. MMPIs of parents of emotionally disturbed, motor dysfunctional, and

normal children. Journal of Consulting and Clinical Psychology, 1972, 38, 464. ERICKSON, M. T. MMPI comparisons between parents of young emotionally disturbed and organi-

callv retarded children. Journal of Consultina and Clinical Psucholoau. 1968. 38. 701-706. I ”1, I ,

ERICKS~N, M. T. MMPI profiles of paients of y o k g retarded children. American Journal of Mental Deficiency, 1969, 73, 728-732.

HAFNER, A., BUTCHER, J. NALL, M., & WENTWORTH, . Parent personality and childhood disorders:

MCADOO, W., & CONNALLY, F. MMPIs of parents in dysfunctional families. Journal of Consulting

A review of MMPI hndings. In J. N. Butcher (E 7 .), M M P I : Research developments and clinical applications. New York: McGraw-Hill, 1969.

and Clinical Psychology, 1975, 43, 270. MYERS, J., BEAN, L., & PEPPER, M. A decade later: A follow-up of social class and mental illness.

New York: John Wiley, 1968.