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Submitted to American Journal on Intellectual and Developmental Disabilities
FAMILY RELATIONSHIPS AND THEIR ASSOCIATIONS WITH PERCEPTIONS OF
FAMILY FUNCTIONING IN MOTHERS OF CHILDREN WITH INTELLECTUAL
DISABILITY (ID)
Emma Langley, Vasiliki Totsika, Richard P Hastings, Tom Bailey
Corresponding author:
Dr Emma Langley, PhD
e.langley.1@warwick.ac.uk
Centre for Educational Development, Appraisal and Research (CEDAR)
University of Warwick
Coventry
UK
CV4 7AL
Dr Vasiliki Totsika, PhD, Division of Psychiatry, Faculty of Brain Sciences, University
College London, London, UK, WC1E 6BT and Centre for Educational Development,
Appraisal and Research (CEDAR), University of Warwick, Coventry, UK, CV4 7AL
Professor Richard Hastings, PhD, Centre for Educational Development, Appraisal and
Research (CEDAR), University of Warwick, Coventry, UK, CV4 7AL
Dr Tom Bailey, PhD, Centre for Educational Development, Appraisal and Research
(CEDAR), University of Warwick, Coventry, UK, CV4 7AL
Acknowledgements
This work was funded by an Economic and Social Research Council grant (Ref: 1501957)
and Cerebra, a charity for children with brain conditions.
2
Family Relationships and their Associations with Perceptions of Family Functioning in
Mothers of Children with Intellectual Disability (ID)
Abstract
We explored whether reports of three dyadic relationships (marital/partner, parent-
child, sibling) were related to perceptions of family functioning in 467 mothers of children
with Intellectual Disability (ID) aged 4-15 years. Structural equation models were fitted to
examine associations between relationship indicators and family functioning. The final
structural model showed that partner relationship satisfaction, partner disagreement, child-
parent conflict, and sibling relationship warmth accounted for the most variance in family
functioning, with partner relationship satisfaction having the strongest positive association.
Dimensions of dyadic relationships appear to be associated with broader constructs of family
functioning in this sample of mothers, signifying the potential for systemic intervention.
Key words: Family functioning, Intellectual Disability, confirmatory factor analysis,
structural equation modelling
3
Introduction
The aim of the current study was to explore whether functioning in three family subsystems
(marital/partner, parent-child, sibling) was associated with perceptions of overall family
functioning in mothers of children with Intellectual Disability (ID). According to Family
Systems Theory (FST), the family is a unit that can comprise a number of subsystems,
including the marital/partner, parental (parent-child), and sibling subsystem (Cox & Paley,
1997). From this perspective, the family is viewed as an interconnected system where raising
a child with a disability impacts on all family members in these subsystems (Seligman &
Darling, 2007). Much of the family research in the ID field has explored the individual as the
core unit of analysis, rather than the family (Davis & Gavidia-Payne, 2009; Hoffman et al.,
2006). While research focusing on interactions within and between family subsystems in
families of children with ID is growing, far less research has been conducted involving larger
triadic and whole-family questions, perhaps due to the level of complexity involved in
conceptualizing and measuring outcomes or functioning at the broader family system level
(Cox & Paley, 1997). Different knowledge can be gained from exploring experience at the
family rather than the individual or dyadic level (Zuna, Summers, Turnbull, Hu & Xu, 2010).
Broadening the unit from the ‘individual’ to the ‘family’ not only recognizes the impact on
other members within the family system, but how the well-being of other family members
and subsystems may in turn influence the outcomes of the child with a disability (Boehm &
Carter, 2019; Guralnick, 2001; Rolland, 2012).
Until recently, there have only been a few measures available to analyze functioning
or outcomes at the whole family level, and even fewer which are specific to families of a
child with a disability (Singer & Wang, 2014). One family-level construct that has emerged
as an important aspect to explore in the disability field is Family Quality of Life (FQOL)
(Brown et al., 2006; Turnbull, Summers, Lee, & Kyzar, 2007). FQOL has been defined as
4
“conditions where the family’s needs are met, and family members enjoy their life together as
a family and have the chance to do things which are important to them” (Park et al., 2003,
p.368). Whilst initial work focused primarily on the development of the FQOL construct and
how to measure it (Gardiner & Iarocci, 2012; Hastings, 2016), more recent studies have
explored variables associated with FQOL with parents of children with ID (Boehm et al.,
2015; Boehm & Carter, 2019; Ferrer, Vilaseca, & Olmos, 2017; Vanderkerken, Heyvaert,
Onghena & Maes, 2018). Work by Boehm and Carter (2019) with 529 parents of children
with ID, for example, found that overall FQOL was high, and that social relationships
accounted for 26% of the variance in this outcome.
Another family-level construct that has received some research attention is family
functioning, which arose from Family Systems Theory (Summers et al., 2005). Family
functioning can be defined in a variety of ways, but most definitions comprise the extent to
which members of the family unit communicate, build relationships, and manage daily life
(Jellett, Wood, Giallo, & Seymour, 2015). Family functioning has been found to be
associated with parent and child outcomes in families with typically developing children. For
example, using large-scale normative data of caregivers of typically developing children,
Renzaho, Mellor, McCabe, and Powell (2011) found that after controlling for socioeconomic
status (SES) and ethnicity, parents in more poorly functioning families were at greater risk of
psychological distress and had children with lower levels of prosocial behavior and higher
levels of behavioral difficulties.
The construct of family functioning appears particularly pertinent to families raising a
child with ID. Parents are often required to care for the child on an intensive basis, which can
impact family lifestyles (Brown et al., 2006), priorities, and interactions between family
members (McConkey, Truesdale-Kennedy, Chang, Jarrah, & Shukri, 2008). Family
functioning has been shown to be poorer in families of children with ID (Al-Krenawi,
5
Graham, & Al Gharaibeh, 2011; Rani et al., 2018) and Autism Spectrum Disorder (ASD)
(Pisula & Porębowicz-Dörsmann, 2017) when compared to families with typically
developing children. Work in this area has often focused on families of children with ASD,
with mothers of children with ASD reporting lower family adaptability and cohesion
compared to mothers of typically developing children (Gau et al., 2012; Higgins et al., 2005).
Interestingly, there have been found to be no differences in family functioning between
fathers with and without a child with ASD (Gau et al., 2012), which could be explained by
mothers’ greater involvement in the daily care of the child (Hartley, Mihaila, Otalora-Fadner,
& Bussanich, 2014), and changes to other life roles, like work (Gray, 2003), which require
significant adaptation. It is therefore possible that these changes in role for mothers implicate
their perceptions of how their family is functioning. While ASD often co-occurs with ID
(Tonnesen et al., 2016), further work is needed to explore what contributes to mothers’
perceptions of family functioning in families raising a child with ID. This would inform the
design and delivery of support which has the potential to impact outcomes of other family
members, based on the understanding that family subsystems are interconnected.
There is theoretical and empirical evidence to suggest that functioning in one family
subsystem can influence functioning in another. For example, there is some linkage between
marital relationships and parent-child relationships, where conflict in one subsystem can
affect another (Erel & Burman, 1995). Harley et al. (2016) used diary studies to capture the
positive and negative marital interactions and levels of parenting stress of 176 married
couples, and found that negative marital interactions ‘spilled over’ into parenting
experiences: a day with a high number of negative marital interactions was associated with a
higher level of parenting stress for both mothers and fathers of children with ASD. This
same-day ‘spillover’ was also found to flow bidirectionally for mothers and not fathers.
Currently there are no ID studies that have examined whether functioning at the subsystem
6
level is associated with functioning at the broader family system level. For example, it could
be that how a mother feels about their relationship with their partner, with their child, or the
relationship between children in their family, may have some bearing on how satisfied they
feel with their family overall. Existing research evidence suggests that these subsystem-
family functioning associations may be significant.
The couple subsystem is considered to be at the heart of the family system, with its
stability having implications for others in the family unit (Seligman & Darling 2007). Marital
(or partner) satisfaction has been found to be a predictor of family-level outcomes. Early
work by Trute (1990) explored child and parent predictors of family adjustment in 88
families of children with DD, reporting that overall family adjustment (as captured by the
Family Assessment Measure III; Skinner, Steinhauer, & Santa-Barbara, 1983) was associated
with specific aspects of marital adjustment (dyadic cohesion, and consensus). Trute suggested
that strengthening the couple subsystem could assist in maintaining a stable family
environment. Correlations between couple negativity and subsequent negative family
interactions (Kitzmann, 2000), and between maternal marital satisfaction and overall family
functioning (Feldman, Wentzel, Weinberger, & Munson, 1990) have also been found in
studies within the general population. It is therefore possible that satisfaction in the
marital/partner subsystem may have a bearing on how satisfied mothers of children with ID
feel about how their family functions overall.
The parenting subsystem and family functioning may also be related. The quality of
parent-child interactions influence child developmental outcomes (Guralnick, 2001), with
warmth and criticism in parent-child interactions found to be bidirectionally related to the
symptoms and emotional and behavioral outcomes of children with ASD (Hickey, Bolt,
Rodriguez & Hartley, 2020). Parent-child interactions can be affected when raising a child
with ID (Totsika, Hastings, Vagenas, & Emerson, 2014), with greater conflict and less
7
warmth in the parent-child relationship found to lead to later child behavioural and emotional
problems (Totsika et al., 2020), which may in turn be reflected in how a mother perceives the
functioning of their family. However due to a lack of empirical evidence, it is not clear
whether the parent-child relationship is associated with broader family-level outcomes such
as family functioning. Poorer family functioning (Herring et al., 2006; Jellett et al., 2014) and
family quality of life (Davis & Gavidia-Payne, 2009) has been found to be significantly
associated with the presence of child emotional and behavioral problems in families of
children with disabilities.
The sibling subsystem is an aspect of family functioning which requires further
exploration. As one of the key subsystems of a family unit (Seligman & Darling, 2007),
relations between siblings have the capacity to affect those at the individual and subsystem
level (Feinberg, Solmeyer, & McHale, 2012). Closeness to siblings is a consistent predictor
of an individual’s adjustment in later life (Vaillant & Mukamal, 2001) and conflictual sibling
interactions have been found to contribute to parental stress (McHale & Crouter, 1996 cited
in Feinberg et al., 2012). The outcomes for siblings of children with a brother or sister with
ID and/or ASD have been the focus of a number of empirical studies (Hayden, Hastings,
Totsika & Langley, 2019; Stoneman, 2005), however relationships between siblings have
received significantly less attention (Hastings, 2016). Associations between sibling
relationship quality and parents’ perceptions of family functioning are yet to be studied in the
disability field. It is interesting and pertinent to explore whether the sibling subsystem - a
subsystem of which a mother is not a part - has an influence on how they perceive their
family to be functioning.
The current study took a micro-level family systems approach (Cridland, Jones,
Magee, Caputi, 2014) to explore interactions within the family itself. The following research
question was investigated:
8
Is functioning in three family subsystems (marital/partner, parent-child,
sibling) associated with perceptions of overall family functioning in mothers
of children with ID?
Based on Family Systems Theory, we hypothesised that family subsystems would be
associated with latent construct of family functioning. We did not add specific hypotheses as
to the direction or relative magnitude of associations because of the lack of previous guiding
research.
9
Methods
Participants
Data from 467 mothers of children with ID from a UK cohort study (citation removed for
blind review) were analysed. Detail about the participating sample is provided in Table 1.
The majority were biological mothers (n=437, 93.6%) and lived with their spouse (n=397,
85%). Two hundred and twenty-four mothers (48%) were educated to university degree level
or higher, with 236 (50.5%) not in work at the time of the research. The majority of mothers
described their ethnicity as White (n= 431; 92.3%). Families had on average two children
living in the household (M=2.48, SD=0.71, Range= 1-7) and the majority of families had a
weekly household income below the UK median level at the time of the data collection
(n=268, 57.4%).
The children mothers reported on in the survey were all reported to have ID. Two-
hundred and thirty-nine (51.2%) children were reported to have a ‘mild/moderate’ ID, and
223 (47.8%) a ‘severe/profound’ ID. Just over half of the sample were also reported to have
ASD (n=243, 52%). Children were on average 9 years of age (SD=2.93, Range = 4-15 years)
and most were male: 293 (68.0%).
Parents were asked to answer questions about any sibling between the ages of 4 and
15 years of age. If there was more than one sibling in this age range, they were asked to select
the child closest in age to the child with ID. Two-hundred and thirty-four siblings were male
(50.1%) and 225 (48.2%) were female. The majority of siblings were the same gender: 228
(52.9%). Siblings of the child with ID were on average 9 years of age (SD=3.24, Range = 4-
15 years). The majority of siblings (n=342, 73.2%) were not considered to themselves have
“a longstanding illness, disability or infirmity”.
10
Table 1 Demographic profile of mothers (N=467) and their child with Intellectual Disability
and a sibling
Variables n (%)
Mother type
Biological
Adoptive
Step
Foster
437(93.6)
27(5.8)
1(0.2)
2(0.4)
Marital status
Married and living with spouse
Living with partner
397(85.0)
70(15.0)
Education level
University degree level or above
Below degree level
Missing
224(48.0)
221(47.3)
22(4.7)
Employment status
In work
Not in work
Missing
230(39.3)
236(50.5)
1(0.2)
Ethnic group
White
Mixed
Indian
Pakistani and Bangladeshi
431(92.3)
4(0.9)
4(0.9)
5(1.1)
11
Chinese
Black or Black British
Ethnic other
Missing
5(1.1)
5(1.1)
7(1.5)
6(1.3)
UK Median Weekly Household Income
Above median
Below median
181(38.8)
268(57.4)
ID severity
Mild/Moderate ID
Severe/Profound ID
Missing
239(51.2)
223(47.8)
5(1.1)
Child gender
Male
Female
Missing
320(68.5)
146(31.3)
1(0.2)
Sibling gender
Male
Female
Missing
234(50.1)
225(48.2)
8(1.7)
Sibling illness/disability
Yes
No
Missing
121(25.9)
342(73.2)
4(0.9)
Variables Mean (SD)
12
Child age 9.09 (2.93)
Sibling age 9.54 (3.24)
Number of all children in the household
Number of all people in the household
2.4(0.71)
3.63(0.92)
Note. SD: Standard Deviation
Measures
The Family APGAR scale (Smilkstein, 1978) was used to assess mothers’ perceptions of
family functioning. The Family APGAR was designed to capture five components of family
functioning: Adaptation, Partnership, Growth, Affection and Resolve. Sample items from the
measure include: “I am satisfied that I can turn to my family for help when something is
troubling me” (Adaptation), and “I am satisfied with the way my family expresses affection
and responds to my emotions, such as anger, sorrow and love” (Affection). Mothers were
asked to rate the 5 items on a Three-point scale: Almost Always =2, Some of the time =1,
Hardly ever=0. The measure is scored by summing the values for the items for a total score
that can range from 0 to 10. A higher score indicates a greater degree of satisfaction with
family functioning. Scores can be also be used to categorise families into dysfunctional (0-3),
moderately dysfunctional (4-7) and highly functional (8-10). The mean total score on the
Family APGAR for this sample was 5.71(SD=2.81, Range=0-10). The majority of scores fell
into the ‘moderately dysfunctional’ category (49.3%), followed by ‘highly functional’
(28.7%) and ‘dysfunctional’ (21.8%). The Family APGAR questionnaire has been used
previously in studies investigating family functioning in the general population (Gardner et
al., 2001) and has more recently been used to study family functioning where there is a child
with a disability (Rani et al., 2018). Internal consistency (Cronbach’s α) for the total Family
APGAR score in the present study was .87.
13
Two single item measures were used to assess aspects of the mothers’ relationship
with their spouse or partner. The first item was a global measure of relationship happiness.
Mothers were asked to select “the number which best describes how happy or unhappy you
are with your relationship, all things considered” on a scale of 1 (very unhappy) to 7 (very
happy). The modal score for this measure was 6. The second item asked mothers to rate “how
often do you and your [husband/wife/partner] disagree over issues related to your child?” on
a scale of 1 (never) to 6 (more than once a day). The modal score for this measure was 2 (less
than once a week). Both these items have been used in UK population-representative cohort
studies such as the Millennium Cohort Study (Johnson, 2012).
The Child-Parent Relationship Scale Short Form (CPRS-SF) was used to measure the
quality of the mother-child relationship. The CPRS-SF is adapted from the Student-Teacher
Relationship Scale (STRS; Pianta, 1992) and is a 15 item scale asking parents to rate their
relationship with their child. Items are measured on a scale of 1 (definitely does not apply) to
5 (definitely applies). Item scores are summed to provide scores for two dimensions:
closeness, and conflict. Seven items are summed for closeness, and eight items for conflict.
Higher scores indicate greater closeness or conflict in the parent-child relationship. The mean
score for closeness was 25.91(SD=5.26, Range=7-35) and conflict 24.52(SD=7.41, Range=8-
40). The measure has been used in studies of parents of children with ID (Totsika et al.,
2014). Sample items include “I share an affectionate relationship with this child” (Closeness),
and “This child and I always seem to be struggling with each other” (Conflict). Internal
consistency (Cronbach’s α) in the present study was .76 for Closeness, and .85 for Conflict.
A shortened version of the Sibling Relationship Questionnaire – revised (SRQ brief
parent-version; Furman & Buhrmester, 1985) was used to assess mothers’ perceptions of
sibling relationship quality. The SRQ brief version is a 39-item questionnaire which measures
16 aspects of sibling relationship across four broad domains: warmth/closeness, relative
14
status/power, conflict, and rivalry. In the present study, participants completed 10 items that
captured dimensions of warmth/closeness, and conflict. Mothers completed the three two-
item subscales of the Warmth factor (Intimacy, Companionship, Affection), and two scales of
the Conflict factor (Quarrelling and Antagonism). Mothers were asked to read the 10 items
and rate how much they applied to the relationship between their child with ID and the
sibling on a Five-point scale from 1 (hardly at all) to 5 (extremely much). The mean score
for warmth was 17.68(SD=4.98, Range=6-30) and conflict was 11.11(SD=4.53, Range=4-
20). The brief parent-version of the SRQ has been used before to assess the relationship
quality of children with ASD and their siblings (Petalas et al., 2012). Sample items include
“How much do the sibling and the child love each other?” (Affection), and “How much do
the sibling and the child disagree and quarrel with each other?” (Quarrelling). Scores for
Warmth and Conflict were derived by calculating a weighted mean score from 1-5 for each of
these two relationship domains. Internal consistency (Cronbach’s α) in the present study was
.85 for Warmth and .84 for Conflict.
Procedure
The data used for the present analysis were part of a large survey of caregivers of children
with ID aged 4 to 15 years in the UK [citation removed for blind review]. Following ethical
approval from a National Health Service research ethics committee, information about the
study was distributed via a number of charity organizations who support families of children
with ID. Recruitment took place mostly online through social media and locally through
advertising via local parent support groups. A primary caregiver was asked to complete an
online or paper survey. A total of 1192 primary parental caregivers took part in the study. The
present research focuses on the data from all 467 mothers who reported being married and
15
living with their spouse, or living with a partner; and who provided data on a sibling in the
household (including reporting on sibling relationship quality with the child with ID), and
also reported on their relationship with their child with ID.
Approach to Statistical Analysis
A series of Structural Equation Models (SEM) were fitted in AMOS 24®. In comparison to
other statistical analysis techniques such as regression, SEM is capable of testing more
sophisticated theory (Schumacker & Lomax, 2012). It can test how variables define
constructs, simultaneously test how constructs are related to each other, and explicitly take
into account measurement error when analysing data (Schumacker & Lomax, 2012). The data
was normally distributed so models were estimated using Maximum Likelihood (ML), a
consistent and unbiased approach to parameter estimation commonly employed in SEM
(Hair, Black, Babin, Anderson, & Tatham, 2006). Full Information Maximum Likelihood
(FIML) was used to account for missing values across all the measures used in the sample
(total n=42), as it can be used on an incomplete dataset to produce estimates which allow for
the fit of a model to an entire sample (Little, Jorgensen, Lang & Moore, 2013).
The analysis was conducted in four stages. First, a Confirmatory Factor Analysis
(CFA) was fitted to assess the construct validity of a latent variable of family functioning,
using the five items of the Family APGAR scale. Model fit was assessed using a number of
goodness of fit indexes including the Tucker Lewis Index (TLI), Comparative Fit Index
(CFI), and the Root Mean Square Error of Approximation (RMSEA).Hu and Bentler (1999)
recommend a CFI and TLI value >.95, and an RMSEA of <.06 to .08 indicate good fit
between the model and observed data (Hu & Bentler, 1999; Schreiber, Nora, Stage, Barlow,
& King, 2006).
16
With limited existing theory to guide the entry of observed relationship indicators into
the structural model, a correlation matrix of six observed relationship indicators (that
represented measurements of parental relationship satisfaction, parental disagreement, parent-
child conflict, parent-child closeness, sibling warmth, and sibling conflict) was conducted to
determine which subsystem indicators would be entered into the structural models and their
order of entry based on the strength of their association with family functioning. The
correlation matrix showed that all of the six subsystem relationship indicators were
significantly correlated with the latent construct of family functioning (r= -.12 to .45) (Table
2). Each indicator was entered into the model sequentially, with paths drawn from each of the
exogenous variables to the endogenous variable of family functioning. Where an entered
variable did not have a significant path it was not retained in the next model. Models with
significant paths were then examined by a nested model comparison (Chi-Square difference
test) to ascertain which one was most parsimonious (Preacher, 2006).
Finally, as recommended by Pohlmann (2004), a within-sample replication was
performed to gauge factor stability. We randomly divided the sample into two groups (Group
1 n=233, Group 2 n=234) and fitted the final structural model to both halves of the dataset.
Results
Measurement Model
The measurement model for the five Family APGAR items showed good fit to the data χ2 (5)
=16.696, p=.005, CFI = .98, TLI = .96, RMSEA = .07 (90% CI .03 -.11). All factor loadings
were significant (p <.05) and ranged from .71 to .80 (Figure 1). Standardized factor loadings
showed that Affection (APGAR4, Figure 1) had the strongest loading on family functioning
(β = 0.80).
17
Table 2 Correlation matrix
1. Family functioning 1 2 3 4 5 6 7 8 9 10 11 12
2. Adaptation .76*** -
3. Partnership .78*** .62** -
4. Growth .77*** .60** .59** -
5. Affection .80*** .56** .63** .62** -
6. Resolve .71*** .53** .52** .54** .60** -
7. Relsat .45*** .34** .40** .37** .40** 35** -
8. Disagree -.34*** -.24** -.30* -.28** -.31** -.26** -.39** -
9. CPConflict -.24*** -.19** -.19** -.18** -.18** -.25* -.09 .36** -
10. CPClose .20*** .13** .15** .16** .15** .22** .09* -.17** -.29** -
11 .SRQConflict -.12** -.05 -.14** -.07 -.13** -.12** -.08 .30** .44** .11* -
12 .SRQWarmth .24*** .15** .20** .17** .20** .27** .10* -.16** -.27** .42** -.03 -
Note. Adaptation, Family APGAR item 1; Partnership, Family APGAR item 2; Growth, Family APGAR item 3; Affection, Family APGAR item 4; Resolve, Family APGAR item 5; Relsat,
Global measure of relationship satisfaction; Disagree, How often couples disagree over issues related to their child; CPConflict, Child-Parent Relationship Scale-Short Form Conflict Factor;
CPClose, Child-Parent Relationship Scale-Short Form Closeness Factor; SRQConflict, Sibling Relationship Questionnaire Short version Conflict Factor; SRQWarmth, Sibling Relationship
Questionnaire Short version Warmth Factor
* p < .05, ** p < .01, *** p < .001
18
Figure 1. Confirmatory factor analysis of the latent construct of family functioning
Figure 1. APGAR 1, Adaptation; APGAR2, Partnership; APGAR3, Growth; APGAR4,
Affection; APGAR5, Resolve.
Structural Model
Model 5 (including partner relationship satisfaction, partner disagreement, child-parent
conflict, and sibling relationship warmth) accounted for the most variance in family
functioning (32%) and was the most parsimonious (p=.002) when compared to model 2
(Table 3).
19
Table 3 Structural models predicting family functioning
Structural models χ2(df) CFI TLI RMSEA Total
variance
explained
(R2)
All paths
sig
(p<.05)
Nested
Chi-square
comparison
1 – Relsat
2 – Relsat, Disagree
3 – Relsat, Disagree, CPConflict
4 – Relsat, Disagree, CPConflict, CPClose
5 – Relsat, Disagree, CPConflict, SRQWarmth
6 – Relsat, Disagree, CPConflict, SRQWarmth,
SRQConflict
17.997(9)
20.060(13)
28.424(17)
33.546(21)
37.925(21)
45.422 (25)
.99
.99
.99
.99
.98
.98
.98
.99
.98
.98
.97
.97
.04
.03
.03
.03
.04
.04
.24
.27
.30
.31
.32
.32
yes
yes
yes
no
yes
no
3 vs 2
5 vs 2*
Note. * p < .05
20
Standardized regression weights (Figure 2) showed that partner relationship
satisfaction (β = .40, p < .001) had the strongest positive association with family functioning,
followed by sibling relationship warmth (β = .15, p < .001). Disagreement between parents
over issues related to the child (β = -.15, p= .003) and conflict in the child-parent relationship
(β = -.13, p= .006) had a negative association with family functioning. The model showed
good fit to the data χ2 (21) =37.925, p=.019, CFI = .98, TLI = .97, RMSEA = .04, 90% CI .01
-.06), and was accepted as the final structural model. Given that mothers of children with ID
are more likely to experience mental health problems (Emerson, 2003; Singer, 2006), we
conducted a sensitivity analyses with the Kessler 6 (K6; Kessler et al., 2003), a screening tool
for mental illness used in the general population, as a covariate in the model. The path
coefficients did not change significantly as a result.
Figure 2. Final structural model predicting family functioning
Figure 2. Standardized estimates. Relationship satisfaction, Global measure of relationship
satisfaction; Disagree over issues, How often couples disagree over issues related to their
child; Child-parent conflict, Child-Parent Relationship Scale-Short Form Conflict Factor;
Sibling relationship warmth, Sibling Relationship Questionnaire Short version Warmth
Factor
21
Within-sample replication
Model fit for Group 1 was extremely good (χ2 (21) =17.025, p=.710, CFI = 1.00, TLI = 1.01,
RMSEA = .00, 90% CI .00 -.04) (Table 4). Model fit for Group 2 (χ2 (21) =44.006, p=.001,
CFI = .96, TLI = .91, RMSEA = .07, 90% CI .04 -.10) was reasonable (Table 4). The model
fit for Group 1 is likely to be a result of low statistical power failing to detect discrepancies
between the observed and specified model. The directions of the paths in both the random
groups were the same as within the overall sample (Table 5). Lastly, it is also worth noting
that for Group 2 that the strength of sibling warmth is very weak.
22
Table 4 Within-sample structural models predicting family functioning
Structural models χ2(df) CFI TLI RMSEA Total variance
explained
(R2)
All paths sig
(p<.05)
1 – Overall sample
2 – Random Group 1
3 – Random Group 2
37.925(21)
17.025(21)
44.006(21)
.98
1.00
.96
.97
1.01
.91
.04
.00
.07
.32
.31
.34
yes
no
no
Table 5 Within-sample associations between family functioning and relationship variables
Structural models Relsat
β
Disagree
β
CPConflict
β
SRQWarmth
β
1 – Overall sample
2 – Random Group 1 (N=233)
3 – Random Group 2 (N=234)
.40***
.39***
.41***
-.15**
-.10
-.19**
-.13**
-.11
-.15*
.15***
.22***
.07
23
Discussion
We explored whether dimensions of dyadic relationships in the family were related to overall
family functioning. The latent factor structure of family functioning among families of
children with ID was initially tested in a CFA, where the five observed Family APGAR
variables (Adaption, Partnership, Growth, Affection, and Resolve) loaded onto a latent
construct of family functioning. Good model fit suggested that family functioning is a valid
construct that can be described using the Family APGAR items in this sample of mothers of
children with ID. Given that the Family APGAR is a relatively new measure to be used in the
ID field, further validation work is needed to fully establish its psychometric properties.
However, the data suggest that it might be a useful measure for research which explores
family functioning in families of children with ID.
The final structural model showed that functioning in the three family subsystems
(marital/partner, parental, sibling) was associated with perceptions of overall functioning,
thus supporting our original hypothesis. Four dimensions: partner relationship satisfaction,
sibling warmth, partner disagreement, and child-parent conflict were all associated with
maternal perceptions of family functioning, accounting for 32% of the variance in the family
functioning latent construct. These findings appear to support the idea that subsystem
functioning and broader family functioning are somehow linked: how mothers felt about
relationships in all of three subsystems was related to how they perceived their family to be
functioning overall. Family systems theories pertain that families are comprised of
subsystems (Cox & Paley, 1997; Minichin, 1985) that are interconnected and operate within a
larger family system (Cridland et al,. 2014; Smith-Acuña, 2010), however they say less about
the relationship between these two hierarchical levels. Our findings seem to suggest an
interdependence between subsystems and the broader-level construct of family functioning,
however further empirical research to explore these theoretical ideas is warranted.
24
Interestingly, our findings show that both of the variables capturing aspects of the
marital/partner relationship were predictive of family functioning, with the perceived quality
of the relationship between the mother and their spouse or partner the strongest predictor of
perceived family functioning. Family systems theories pertain that the marital/partner
relationship is at the heart of the family unit (Seligman & Darling, 2007), and our findings
appear to support this and furthermore indicate that subsystems may be hierarchical in nature.
There is existing empirical evidence reporting associations between marital quality and
family functioning in the general population (Feldman, Wentzel, Weinberger, & Munson,
1990; Froyen, Skibbe, Bowles, Blow & Gerde, 2013; Kitzmann, 2000; Henderson, Sayger &
Horne, 2003). Work by Shek (1999; 2001) showed that marital satisfaction was related to
parental perceptions of family functioning over time, and that compared to individual
measures of well-being, dyadic measures (including marital satisfaction and adjustment) had
a stronger influence on perceived family functioning for parents. Given that mothers have
already been found to be more likely to experience spillover between marital and parental
subsystems (Hartley et al., 2016), these findings also indicate the potential for spillover
between the marital dyad and broader family system. Intervention which bolsters
spousal/partner relationship satisfaction and provides strategies which aim to reduce
disagreement between parents about their child with ID, could be beneficial for family
functioning.
Our findings also show a relationship between the sibling subsystem and the broader
family subsystem, with perceived warmth between the child with ID and their sibling a
significant predictor of how mothers perceived family functioning. This is an important
finding given the lack of empirical work exploring the relationship between the sibling
subsystem and the wider family system in the disability field. In the general population,
sibling relationship quality has been found to be related to the quality of relationships in
25
parental and spousal/partner subsystems (Dunn, Deater-Deckard, Pickering & Golding, 1999)
and overall family functioning (MacKinnon, 1989). What is unclear at this point is why
sibling warmth but not conflict was associated with family functioning. It could be the case
that aspects of the ‘warmth’ factor (intimacy, companionship, and affection) are more
pertinent to mothers when one of the children has a disability. Mothers may expect conflict
between siblings and so it has little bearing on how they perceive their family to be
functioning, however sibling relationships with little warmth and closeness may have more
bearing on aspects of family functioning captured in the Family APGAR measure, such as the
way that family members express affection and respond to emotions, and the way that the
family share time together. There is the potential for positive, preventative intervention which
promotes warm sibling interactions. Further investigation is needed to help us understand the
role of sibling relationships in the functioning of families of children with ID, particularly as
siblings age, given the pivotal and long-lasting nature of their relationship (Dunn, 2000) and
the likelihood that siblings may one day need to provide care or support to their sibling with
ID
Conflict in the parent-child relationship was also found to be negatively associated
with mother’s perceptions of family functioning. According to FST, conflict in any family
subsystem has the potential to reverberate throughout a family, affecting other subsystems
and members, and the maintenance of subsystem boundaries (Seligman & Darling, 2007).
The quality of the parent-child relationship has been found to be associated with parental
views of family functioning over time in the general population (Shek, 1999), and parents of
children with ID have been found to report a more negative parent-child relationship
compared to parents of typically developing children (Totsika et al., 2014). This finding may
be explained by previous evidence of an association between the increased behavioral and
emotional problems in children with ID and poorer family functioning (Herring et al., 2006;
26
Jellett et al., 2015). While our study did not focus on behavioral and emotional problems per
se, child behavioral and emotional problems have been found to be associated with parent-
child conflict (Totsika et al., 2014) and so one might theorize that this may then influence
how mothers feel about the functioning of their family - a pathway that could be examined
using longitudinal research designs. Programmes which target parent-child relationships have
been found to benefit parents of children with Special Educational Needs (Lindsay, 2019) and
have the potential to positively impact on family-level outcomes. This study has provided an
initial insight into the associations between dimensions of subsystem functioning and
maternal perceptions of family functioning. As the data were cross-sectional, future
replication is needed with longitudinal data to allow exploration of causal pathways and
understand why certain relationship dimensions were more strongly associated with family
functioning than others.
It is important to note a number of other study limitations, namely that our findings
only capture global perceptions of family functioning and not necessarily how the family is
actually functioning on a day to day basis. Diary studies may be a way of overcoming this
limitation (Lickenbrock, Ekas, & Whitman, 2011). We also acknowledge that there is an
issue of self-report bias as all measures were mother-reported and are therefore likely to be
highly correlated (Podsakoff, MacKenzie, Lee & Podsakoff, 2003). When exploring
relationship quality, the perspective of one individual should be interpreted with caution. For
example, when assessing partner relationship quality, both partners should be reporting on
their relationship (Sim, Cordier, Vaz & Falkmer, 2016). There is also evidence that parental
perceptions of sibling relationships do not always align with siblings’ reports of their
relationship with their sibling (Rossiter & Sharpe, 2001; Hastings & Petalas, 2014).
Therefore, we need to solicit the views of other family members such as fathers and siblings
in order to be truly systematic in our approach (Gardner et al., 2012). We should also look to
27
understand family functioning in other family structures (Gardner et al., 2012). The current
study focused on the experiences of mothers who are currently living a with a partner and
with at least two children, so the findings cannot be extended to other family types. Future
research should look to further investigate other pertinent covariates (such as maternal
depression), and consider taking a ‘macro-level’ family systems approach that explores the
way in which systems, such as families, interact with other systems, such as communities
(Cridland et al., 2014; Seligman & Darling, 2007). It could be that family functioning is
affected by factors outside of the family unit, such as interactions with services, which is
particularly pertinent to families raising a child with a disability.
The functioning of families of children with ID is emerging as an important field of
study. Our research, underpinned by family systems approaches, demonstrates the
interconnectedness of family subsystems and broader family functioning, and signifies the
potential for systemic family intervention which aims to improve functioning at the
individual, subsystem, and unit level. However, further research is needed to understand the
direction of these associations to establish where support should be targeted and what is
needed at different points of the family lifecycle.
28
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