http://doi.org/10.33698/NRF0065  K.Vijayalakshimi,Chellarani Vijaya Kumar, Helen Rajamanickm, Alice Cherian

 

Abstract : Mental health is an essential component of health. Child rearing practices play an important role in shaping one’s behaviour and personality of the individual. This study was conducted to find out the association of child rearing practices with psychological problems of the children. Retrospective, case control study was conducted in Christian Medical College and Hospital (CMCH), Vellore, Tamil Nadu in the year 1999. Targeted population for this study was parents of, children with psychological problems, who attended Child psychiatric OPD (cases) and parents of, children without psychological problems, who attended pediatric OPD for minor physical ailments (controls). Sixty samples (30 cases and 30 controls matched for age and gender) were studied by using purposive sampling technique. Pretested, locally developed interview guide was used to collect data. There was significant difference in child rearing practices between cases and controls. Mean score of child rearing practices was higher in controls than cases. Results of this study stress the influence of child rearing practices on behavior of the children. Parents should be made aware of this fact by using different approaches by which the incidence of childhood psychological problems can be reduced

Key words :

Child rearing practices, psychological problems, children

Correspondence at :  Vijayalakshmi,

Asst. Professor,  Dept. of Psychiatric Nursing, College of Nursing BPKIH, Nepal

Introduction

Train up a child in the way he should go and When he is old he will not part from it.

(Bible proverb)

It is a well recognized fact that children of today are the citizens of tomorrow. The prosperity of the nation depends upon the health of its future citizens. This is true especially for India where this segment constitutes about 40% of tbe total population.1 Children with a sound mind in sound body are essential for the future development of the country. Mental health is a critical component of children’s general health. Children’s mental health has serious implications for mental health of future adults. Fostering social and emotional health in children as a part of healthy child development must therefore be a national priority. 2

The child who is the product of complex interaction between his inherited potentialities and the influence of his social and physical environment faces mild to serious psychological disturbances in life. 3 Early life experiences are critical in preparing a child for self sufficient role in society. A child is highly dependent on his family for meeting his needs such as nutrition, health, security, protection, recreation etc. It is also true that children have no control over their environment and may suffer due to actions of others around them. Each moment of a child’s life that he spends with his parents has effect on both his present behavior and his potential future actions. 4

If family serves as a unit of socialization for the child through positive child rearing practices by which the child gains self knowledge. Through family, child also learns about other people, cultivates interpersonal relationship, experience pleasure, give and receive affection. So the family environment and child rearing practices related to consistency, warmth, interaction between family members and the child helps a child to become confident and eventually a productive member.. of society. These all play important role in the adjustment of the child to the environment. 4

In contrast mixed or ambivalent attitude of parents, rejection or over protection, unmet needs of the child and neglected child may contribute in development of psychological problems in children. It is also true that children are like wet cement; whatever falls on them make an impression. Psychological problem in childhood may lead to limited functional capacities in adulthood. 2

Children under 15 years of age constitute approximately one third of the World’s population. Among them 5-15% of the children are affected by some type of psychological disorder. Prevalence rate of childhood psychological problems in India ranges from 50-150\1000.1 A study conducted by Rai et al showed that 22% of children are suffering from some type of behavioral problems.5 Since the prevalence rate of childhood psychological problems is high, there is an urgent need to analyze various factors responsible for causing problems so as to plan for the measures to prevent these problems in children.

Singh (1965) stated that though the childhood psychological problems can be due to multiple factors, the origin of most cases of mental ill health can be traced to child rearing practices to which an individual has been subjected.6 According to Worley7, the most modern approach is a preventive approach through mental hygiene principles. Preventive mental hygiene begins at home.7 It is a known fact that child rearing in today’s context is challenging and stressful. But it is also true that the younger the child the easier it is to mould them.8 The family and child rearing practices play an important role in shaping one’s behavior and personality of the individual. By studying the influence of child rearing practices on behavior of the child, awareness can be created among parents regarding healthy child rearing practices, so as to reduce the incidence of psychological problems in children. Thus this study was undertaken to identify the child rearing practices and its relationship with psychological problems in children. Most parents can be helped to identify their children’s problem, and modify their attitudes and practices for the mutual benefit of themselves and their children.

Materials and Methods

Retrospective , case control study was conducted in Christian Medical College and Hospital (CMCH), Vellore in the year 1999. Targeted population for this study was parents of children with psychological problems (cases) and parents of children without psychological problems (controls). Sixty samples were studied by using purposive sampling technique. Cases included 30 children aged 4-12 years and their parents attending child psychiatric OPD of Mental health centre at CMCH. Controls were equal number of samples, attending Pediatric OPD of CMCH for minor physical ailments and were matched for age and gender. Exclusion criteria included any cases with psychotic disorders, epilepsy and\or mental retardation and controls who were suffering from any psychological problem. (By using screening tool for psychological problem).

Data was collected by using pretested, locally developed interview schedule based on extensive review of literature and experts’ opinion in the field. It consisted of three parts. Part 1: demographic characteristics of parents and children. Part 2: screening test for psychological problems. (Used only for controls to exclude children with any psychological problems) Part 3: Structured interview schedule to assess the child rearing practices ‘on different aspects such as nutrition and general aspects ( 16 items), Emotional responsiveness (11 items), Disciplining (11 items), Communication (5 items), Play (7 items) and Leisure activities (6 items). Scoring was done based on the responses of parents. Higher scores indicated better practices. Interpretation of scores was done as poor practices: 0-50% , average practices: 51-65, Good practices: 66-80%, Excellent practices: 81-100% Study was conducted after the approval of concerned authorities and data was collected from the participants after obtaining consent from each participants.

Data was analyzed by using descriptive statistics such as frequency, percentage to describe the socio-demographic characteristics, and level of child rearing practices. Inferential statistics- chi square test was used to find out the significant difference between ‘cases and controls with respect to socio-demographic characteristics. Significant difference in mean score of child rearing practices between cases and controls was analyzed by using ‘t’ test.

Results

The socio-demographic characteristics of children and parents (cases and controls) are shown in Table-I. There was no significant difference between cases and controls (matched for age and gender) on the basis of number of children in the family, parents’ education, family income and family type. But number of male children attending child psychiatric OPD was higher (70%) than female children (30%).

Table – 1:    Comparison of cases and controls with respect to sociodemographic characteristics.

 

Variables Cases (%) n=30 Controls n=30 P value
Gender of the child 21 (70.00) 21 (70.00)  
Male    
Female 9 (30.00) 9 (30.00)  
Age of the child( in years)      
4-6 2 (06.66) 2 (06.66)  
7-9 9 (30.00) 9 (30.00)
10-12 19 (63.33) 19 (63.33)  
Number of children in the family      
one 5 (16.66) 2 (06.66)  
two 13 (43.33) 17 (53.33) NS
more than two 12 (40.00) 11 (40.00)  
Educational status of mother      
llliterate 2 (06.66) 2 (06.66)  
Primary & Secondary 11 (36.66) 19 (56.66)  
Higher Secondary & 17 (56.66) 9 (36.66) NS
above      
Educational status of father (n=25)* ..    
Illiterate 5 (20.00) 2 (06.66)  
Primary & Secondary 5 (20.00) 19 (63.33)  
Higher Secondary & 15 (60.00) 9 (29.99) NS
above      
Type of family      
Nuclear 20 (66.66) 18 (60.00) NS
Joint 10 (33.33) 12 (40.00)  

* n=25, due to death of the father or divorce, NS – Not Significant

Table-2 shows the difference in mean score of child rearing practices between cases and controls. There was significant difference in overall mean score as well as in specific areas of child rearing practices such as Nutrition and general aspects (p<O.0I), Emotional responsiveness (p<.00I), Disciplining (p<O.0I), Communication (p<O. 00I), Play (p<O. 0I), Leisure activities (p<O.OOI) and Total score (p<O.OOI) between cases and controls. Mean score of child rearing practices was significantly higher in controls (overall as well as in specific areas) indicating the unhealthy child rearing practices followed among cases

Table – 2 : Comparison of mean score of child rearing practices between cases and controls.

 

 

Child rearing practices

 

Maximum score

Cases (n = 30) Controls (n = 30)  

P Value

Mean score SD Mean Score SD
Nutritional and general aspects 26 19.63 02.97 21.90 01.79 P<O.OI
Emotional Responsiveness 11 05.80 02.20 08.20 01.73 P<O.OOl
Discipline 11 05.13 01.50 06.13 00.97 P<O.Ol
Communication 5 02.71 01.08 03.80 01.09 P<O.OOI
Play 7 03.00 00.90 03.80 00.96 P<O.OOI
Leisure activities 6 03.03 01.27 04.30 61.40 P<O.OOI
Total score 66 39.50 07.52 48.23 05.12 P<O.OOI

Figure 1 shows the level of overall child rearing practices among cases and controls. Results indicate that among cases none of the parents followed excellent practices comparing to 13.33% in control group. Similarly among cases only 36.33% followed good practices whereas among control 70% of them followed good practices.

Discussion

Child rearing practices of parents were assessed by interviewing the parents by using predesigned interview guide. Socio- demographic characteristics of cases and controls were comparable. Regarding gender of the children, it was observed that the percentage of male children attending child psychiatric unit (70%) was higher than the girl children (30%). Similar findings were reported in various other studies 5, 9, 10 which indicate higher prevalence rate of behavioral problems among male children. Yet no adequate explanation was given, although it has been proved universally. It may be due to externalizing behavior of male child which may be obvious and noticed by the parents. There is also chance of under recognizing and underreporting of the problems by parents in case of girl child which may be due to internalizing behavioral tendency of girl child and also gender bias in child rearing. Study findings indicate that there is significant difference in mean score of child rearing practices in specific areas such as nutrition and general aspects (p<O.OI), Emotional responsiveness (p<O.OOI), Disciplining (p<O.OI), Communication (p<O.OOI), Play (p<O.OI), Leisure activities (p<.OOI) and Total score (p<O.OOI) between cases and controls. This finding is consistent with studies conducted by Kulkarni13 and Indiramma (as cited by Kapur) 12 where they reported significant difference in pattern of interaction among families between these groups. This finding also supports the statement of Saxena 13 who stated that “there is every possibility that children with behavior problems have mothers who use unhealthy child rearing practices”. The behavior of the parents with their children, plays a vital role in shaping their child’s personality. These include parent’s interaction with children, providing stimulating environment, meeting basic needs of the children, providing appropriate play and leisure activities etc.

Overall it shows that among controls parents followed better practices than cases indicating the influence of child rearing practices in promotion of mental health in children. In this study findings show that, disciplining is the most problematic area in both the groups even though there is significant difference. Punishment was used by parents more often to correct the behavior of the child. It is known fact that discipline is very essential and it is one of the basic emotional needs of the growing child, but it should be developed by kindness and understanding combined with firmness.

Play is the another area where mean score was less comparing to other areas even though it was significantly higher in controls(3.8) than cases(3). Parents were not aware that play is very important in child’s life through which the child grows physically, emotionally and socially. It was pointed out by one mother that, their seven year child goes to school at 8 A.M, returns back at 4.30 P.M, then has two hours of additional tuition followed by two hours of home work and goes to the bed at 10 P.M after dinner. It may be probably true in many other cases also, even though it was not probed individually. This also indicates that parents put too much of stress on academic activities, and they hardly get any time for play or even just being with parents and having a good time and other important balanced activities which are thought to be essential for maintenance of sound body in sound mind.

Emotional responses and communications were other two areas where mean score was significantly lower in cases (5.8) than controls (8.2). Appreciation, rewards, showing love and affection, giving importance to child’s wishes, and patterns of other social interaction were focused in relation to these areas. It supports the statement of Kuppusamy that, non satisfaction of emotional needs and lack of social interaction between parents and children leads to emotional maladjustment and behavioral problems.4

Present day nuclear families might have double income, but children are often latch-key kids with just the television or computer for the company. Even when the parents get back home, they are often struggling with a hang from punishing deadlines or compulsory socializing. Given this situation, the practice of parenting needs some attention. 8

Overall it is also important to be addressed that, even though study findings has brought out the influence of child rearing practices on mental health of children, study findings can not be generalized, due to small sample size. Thus similar kind of studies should be replicated in large number of samples and also various other contributing factors must be explored, so that independent contribution and interaction effects of different factors including child rearing practices can be understood in a better sense.

Whatsoever it is, there is a popular ‘saying’ that explains the effect of each moment of the child (which is part of parent child interaction) on psychological well being of the child.

“If a child lives with criticism he learns to condemn If a child lives with hostility he learns to fight

If a child lives with ridicule he learns to be shy If a child lives with shame he learns to be guilty

If a child lives with encouragement he learns to be confident

If a child lives with praise he learns to appreciate If a child lives with security he learns to have faith

If a child lives with approval he learns to like himself If a child lives with acceptance and friendship he learns to find love in the world.”

(Anonymous)

Overall it can be concluded that ‘How to bring a child’ is a very complicated question in itself. Everyone has his\her own problems, views, preferences and priorities but for every parent, child is above all the earthly gifts one is endowed with. In today’s world which is full of contradictions, disagreements and conflicts, materialism and modernism leading to degeneration of morality and ideologies, bringing up a child is not an easy task. Therefore it is challenging task for the nurses to take initiative, in arranging more awareness programs on child rearing and other mental health issues of children by using different innovative approaches in various settings.

References

  1. Malhotra S, Malhotra A, Varma Child Mental Health in India. Machmillan India Limited, 1992.
  2. Deviasgamani TR, Child Mental Health: Indian perspective-Presidential address in 18th Indin Psychiatric Society – Tamil Nadu Branch. 2003.
  3. Ninan An exploratory study of the nature and extent of behavioural problems among urban primary school children. Unpubulished Master’s Thesis, Madras University, 1971.
  4. Kuppusamy A text Book of child Behaviour and Development. Vikas Publishing House: 1984.
  5. Rai S, Malik, Walker Behavioural problems among preschool children Indian Pediatrics 1993;30:475-476.
  6. Singh H. Mental Health of Child. Indian Jouranl of Psychiatry 165; 7(1) 37-46.
  7. Worley NK. Mental Health Nursing in Community Mosby: 1996
  8. Luke Positive parentiong overview. Health Dialogue 2004;39:2-4.
  9. Richman Stevanson J, Grahan P. Prevalence of behaviours problems in 3-years children. J Child Psychol Psychiatry 1975; 16: 277-287.
  10. Jenkins S, Bax M, Hart Behaviour Problems in Preschool Children. J. Child Psychol Psychiatry 1980; 21: 5-17.
  11. Kulkarni BG. Child rearing practices of parents of chilren with behaviour disorders. NIMHANS Journal 1995; 13 (1) :
  12. Kapur Mental Health of Indian Children. New Delhi, Sage Publication : 1994.
  13. Saxena Happy home, happy child?, Social Welfare 1994; 41 (4) 23-26