Parenting and childhood atopic dermatitis: A cross-sectional study of relationships between parenting behaviour, skin care management, and disease severity in young children.
BACKGROUND
The development of child behaviour and parenting difficulties is understood to undermine treatment outcomes for children with atopic dermatitis. Past research has reported on correlates of child behaviour difficulties. However, few research studies have sought to examine parenting confidence and practices in this clinical group.


OBJECTIVE
To examine relationships between child, parent, and family variables, parent-reported and directly-observed child and parent behaviour, parents' self-efficacy with managing difficult child behaviour, self-reported parenting strategies, and disease severity.


METHODS
Cross-sectional study design.


METHODS
Parent-child dyads (N=64) were recruited from the dermatology clinic of a paediatric tertiary referral hospital in Brisbane, Australia. Children had a diagnosis of atopic dermatitis of ≥3months and no other chronic health conditions except asthma, allergic rhinitis, or allergy.


METHODS
Parents completed self-report measures assessing child behaviour; parent depression, anxiety, and stress; parenting conflict and relationship satisfaction; self-efficacy with managing difficult child behaviour, and use of ineffective parenting strategies; and self-efficacy for managing atopic dermatitis, and performance of atopic dermatitis management tasks. The Scoring Atopic Dermatitis index was used to assess disease severity. Routine at-home treatment sessions were coded for parent and child behaviour.


RESULTS
Pearson's and Spearman's correlations identified relationships (p<0.05) between self-efficacy with managing difficult child behaviour and child behaviour problems, parent depression and stress, parenting conflict and relationship satisfaction, and household income. There were also relationships between each of these variables and use of ineffective parenting strategies. Greater use of ineffective parenting strategies was associated with more severe atopic dermatitis. Using multiple linear regressions, child behaviour and household income explained unique variance in self-efficacy for managing difficult child behaviour; household income alone explained unique variance in use of ineffective parenting strategies. Self-efficacy for managing difficult child behaviour and self-efficacy for managing atopic dermatitis were positively correlated (rho=0.48, p<0.001), and more successful self-reported performance of atopic dermatitis management tasks correlated with less permissive (r=0.35, p=0.005) and less authoritarian (r=0.41, p=0.001) parenting. Directly observed aversive child behaviour was associated with more severe atopic dermatitis, parent stress, and parent-reported child behaviour problems.


CONCLUSIONS
This study revealed relationships between parents' self-efficacy and parenting practices across the domains of child behaviour management and atopic dermatitis management. Parents of children with more severe atopic dermatitis may have difficulty responding to child behaviour difficulties appropriately, potentially impacting on illness management. Incorporating parent and parenting support within treatment plans may improve not only child and family wellbeing, but also treatment outcomes.
Parenting and Family Support Centre, School of Psychology, The University of Queensland, St. Lucia QLD 4072, Australia. Electronic address: a.mitchell5@uq.edu.au.
Amy E
AE
Mitchell
Sydney Nursing School, the University of Sydney, NSW 2006, Australia. Electronic address: jennifer.fraser@sydney.edu.au.
Jennifer A
JA
Fraser
Parenting and Family Support Centre, School of Psychology, The University of Queensland, St. Lucia QLD 4072, Australia. Electronic address: alina@psy.uq.edu.au.
Alina
A
Morawska
School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD 4059, Australia. Electronic address: j.ramsbotham@qut.edu.au.
Joanne
J
Ramsbotham
School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD 4059, Australia. Electronic address: p.yates@qut.edu.au.
Patsy
P
Yates
D000328:Adult; D001315:Australia; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003876:Dermatitis, Atopic / Q000628:therapy*; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D016487:Parenting / Q000523:psychology*; D020377:Self Efficacy; D012720:Severity of Illness Index; D017592:Skin Care / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
Atopic; Child behaviour; Chronic disease management; Cross-sectional studies; Dermatitis; Eczema; Parenting; Self-efficacy