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Associations Between Parenting Stress at School Entry and Later Psychosocial Adjustment: A Longitudinal Study of Children With Congenital Craniofacial Anomalies

Objective: To examine the reciprocal relationships between parenting stress and psychosocial adjustment of children with congenital craniofacial anomalies (CFAs) at 2 time points: school entry and approximately 2.5 years later, after children had time to adjust to school. Design: Retrospective review of medical charts of children with CFAs. Setting: Department of reconstructive plastic surgery at an urban medical center. Participants: Parents of 42 children aged 3.9 to 6.5 years at time 1 and 6.5 and 9.8 years at time 2. Main Outcome Measures: Parenting Stress Index/Short Form and Child Behavior Checklist (CBCL), both completed by parents at time 1 and time 2. Results: Compared to norms, more parents scored in the clinical range on parenting stress both at time 1 and time 2. Parenting stress remained stable across the 2 time points. Although rates of psychosocial problems for boys were comparable to those of the CBCL normative sample, higher-than-expected rates of clinically significant internalizing and externalizing were found for girls at time 2. Parenting stress at time 1 was associated with child internalizing and externalizing problems at time 2. Whereas child externalizing problems at time 1 predicted parenting stress at time 2, child internalizing at time 1 showed trivial effects on time 2 parenting stress. Conclusions: Early school years may be a period that is particularly stressful for parents of children with CFAs. There appears to be a transactional relationship between parenting stress and child psychosocial adjustment during the early school years.