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Observed and perceived parental overprotection in relation to psychosocial adjustment in preadolescents with a physical disability: The mediational role of behavioral autonomy
Abstract
The purpose of this study was to tes a mediational model of associations between parental overprotectiveness (OP), behavioral autonomy. and psychosocial adjustment in 68 families with 8- and 9-year-old preadolescents with spipa bifida and a demographically matched sample of 68 families with able-bodied children. Measures included questionnaire and observational assessments of parental OP; parent and child reports of behavioral autonomy; and parent, child, and teacher reports of preadolescent adjustment. On the basis of both questionnaire and observational measures of OP, mothers and fathers of children with spina bifida were significantly more overprotective than their counterparts in the able-bodied sample, although this group difference was partially mediated by children's cognitive ability. Across samples, mothers were more likely to be overprotective than fathers. Both questionnaire and observational measures of parental OP were associated with lower levels of preadolescent decision-making autonomy as well as with parents being less willing to grant autonomy to their offspring in the future. For the questionnaire measure of OP, and only for the spina bifida sample. the mediational model was supported such that parental OP was associated with less behavioral autonomy, which was, in turn, associated with more externalizing problems. Findings are discussed in relation to the literature on parenting, autonomy development, and pediatric psychology.
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“In addition, youth with chronic illnesses face a host of barriers and adversities, including social isolation, inability to engage in normal activities, parental attitudes, and behaviors (e.g., overprotection), etc. [30,31].”
From Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness (2022) · cites this paper as [31]
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“Additional analyses were conducted to determine whether shared variance across child and mother reports, as opposed to unique variance associated with either child or mother reports, best accounted for the data (Holmbeck et al., 2002).”
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“In a study of children with spina bifida, parental overprotectiveness was linked to lower levels of child autonomy that in turn predicted greater externalizing problems (Holmbeck et al., 2002).”
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“…a few studies, mostly conducted on pediatric populations, have employed parent or child reports of current overprotection, the use of observational methods is rare, and the measurement of overprotection relies on the subjective judgments of the observers (see Holmbeck et al., 2002, for a review).”
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“Using multimethod measurement, including teacher-rated and child performance-based measures of behavioral regulation, strengthens findings when different measurements are in the same direction (Holmbeck et al., 2002).”
Mediator and Moderator Effects in Developmental and Behavioral Pediatric Research
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“In support of their hypothesis, Holmbeck and colleagues found that group status significantly predicted parental overprotection, as measured by self-report questionnaires and observer ratings, so they proceeded to test condition 2 (the relationship between the predictor and the mediator).(6) As expected, the second re…”
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“In a review of the literature, Holmbeck et al. (2002) characterized parental overprotectiveness as a tendency for infantilization, toward excessive physical and social contact with a child, extreme fear associated with the fulfilling of parental functions, unwarranted control, intrusiveness, and…”
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Self-citationA Developmental Perspective on Adolescent Health and Illness: An Introduction to the Special Issues
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“Recent findings suggest that excessive parental control during this period of development is linked with lower levels of autonomy, which are, in turn, associated with higher levels of problem behaviors (Holmbeck et al., 2002).”
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“behavior in children with spina bifida [26].”
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“Recent studies indeed suggest that parents of children with a chronic illness report more OP than parents of children without a chronic illness, and that such OP is related to adjustment difficulties in their children (Holmbeck et al., 2002).”
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“Holmbeck et al. (2002) suggested that parental OP entailed excessive anxiety in parenting roles, infantilization, excessive physical and social contact.”
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Zukerman, J., Devine, K. A., & Holmbeck, G. N. (2010) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsq075 · Cited by 123
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“Children with a disability tend to be overprotected compared with their able-bodied peers (Holmbeck et al., 2002; Sanders, 2006) so that parents may limit their child’s IT use as a safeguard.”
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“…observed by parents of adolescents with MMH may also be related to research findings in the areas of family stress (Coakley, Holmbeck, Friedman, Greenley, & Thill, 2002), interpersonal attachment (Holmbeck & Faier-Routman, 1995), and diminished autonomy in this population (Holmbeck et al., 2002).”
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Rose, B. M., & Holmbeck, G. N. (2007) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsm042 · Cited by 110
“Refer to Holmbeck et al. (1997, 2002) for complete demographic information, including ethnicity, socioeconomic status, and family structure.”
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“Other researchers have aptly pointed out that clinicians may often overlook or diminish the importance of overprotection and perceptions of vulnerability in parents of children with chronic illness (Holmbeck et al., 2002; Thomasgard, Metz, Edelbrock, & Shonkoff, 1995).”
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“children with chronic illnesses, and developmental outcomes, such as less behavioral autonomy in the future (e.g., Cappelli, McGrath, & MacDonald, 1989; Holmbeck et al., 2002).”
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“…Although discrepancies have been a useful concept for understanding autonomy and parent– child relationships, research on discrepancies has been hampered by limitations in the methods commonly used to understand discrepancies between adolescent and parent reports (see Holmbeck et al., 2002).”
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“These control and submissive behaviors reflect authoritative parenting and represent a middle ground between permissive parenting (Baumrind, 1978) characterized by a lack of guidance (seen as 1–1, or 1–8 behaviors in the model) and submission (seen as 2–1, and 2–8 behaviors in the model), and authoritarian parenting s…”
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Trajectories of autonomy development across the adolescent transition in children with spina bifida.
Friedman, D., Holmbeck, G. N., DeLucia, C., Jandasek, B. N., & Zebracki, K. (2009) · Rehabilitation Psychology · doi:10.1037/a0014279 · Cited by 80
“Significant moderation in the model suggests subgroups of children with spina bifida who, in particular, may need additional help in managing the adolescent transition and attaining the developmental competency of emotional and behavioral autonomy (Lerner & Galambos, 1998; Silverberg & Gondoli, 1996; Steinberg & Morri…”
MethodInfluentialSelf-citationAkré, C., & Surı́s, J.-C. (2014) · Health Education Research · doi:10.1093/her/cyu040 · Cited by 78
“For this specific population of adolescents, the struggle for autonomy is accentuated by the limits implied by their CI, the specific treatments needed [3] and frequently overprotective parents [5, 6].”
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Sleddens, E. F. C., O’Connor, T. M., Watson, K. B., Hughes, S. O., Power, T. G., Thijs, C. T., de Vries, N. K., & Kremers, S. (2014) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/1479-5868-11-15 · Cited by 78
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Stallwood, L. (2005) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2005.04.003 · Cited by 72
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“cifically, Holmbeck and colleagues [5] found that higher levels of parental overprotective behavior were significantly related to less autonomy as well as more externalizing behavior problems in children with spina bifida.”
Hoff, A. L., Mullins, L. L., Gillaspy, S. R., Page, M. C., Pelt, J. C. V., & Chaney, J. M. (2005) · Families Systems & Health · doi:10.1037/1091-7527.23.3.329 · Cited by 73
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“The PBI was selected because it has demonstrated reliability and validity, including convergence of reports among siblings and relations with observations of parenting behavior (e.g., Holmbeck et al., 2002; Parker et al., 1979; Parker, 1983).”
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“Although bereaved parent overprotection and anxiety has not been specifically examined in the literature, these have been associated with a range of negative psychological sequelae in children, including externalising problems (Holmbeck et al., 2002), anorexia nervosa (Shoebridge and Gowers, 2000), as well as anxiety…”
BackgroundA framework for the youth with type 1 diabetes during the emerging adulthood transition
Hanna, K. M. (2012) · Nursing Outlook · doi:10.1016/j.outlook.2011.10.005 · Cited by 61
“Most writings have been on parental involvement and suggest that variations exist, with over-involvement an adaptive response for good management of chronic conditions, but not a way to foster development of self-responsibility.(58) Thus, supportive behaviors are conceptualized as: (1) those with the goal of maintaini…”
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“Although for a long time parental overprotection has only been studied at younger ages or in case of psychological or physical disability (Holmbeck et al. 2002; Parker 1983), societal changes (e.g., delayed onset of adulthood) have instigated an interest in studying overprotection in other…”
BackgroundThe perils of overprotective parenting: fathers' perspectives explored
BRUSSONI, M. J., & Olsen, L. L. (2012) · Child Care Health and Development · doi:10.1111/j.1365-2214.2011.01361.x · Cited by 58
“…as the process by which parents attempt to help children achieve a positive outcome but results in a constraining and detrimental effect on children’s mental health, including increased psychological problems and reduced selfconfidence (Anderson & Coyne 1991; Holmbeck et al. 2002; Sanders 2006).”
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“However, more intrusive forms of involvement may undermine adolescents’ confidence in their own ability to manage illness (Holmbeck et al., 2002), especially for those adolescents who already feel competent in their abilities (Pomerantz et al., 2007).”
InfluentialThe Experience of Self-Management in Adolescent Women with Spina Bifida
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“Parental overprotectiveness, which has been found to be elevated in parents of children with spina bifida [35] and which was found to be bivariately (but not multivariately) associated with self-worth in children with CP [10], would send the wrong message to children that they are not able on their own to stand up to…”
BackgroundThe Adolescent Research Participant: Strategies for Productive and Ethical Interviewing
Mack, R., Giarelli, E., & Bernhardt, B. A. (2009) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2008.07.009 · Cited by 56
“There is some evidence that children with chronic conditions may experience overprotectiveness by their parents and caregivers (Holmbeck et al, 2002), and this can be an additional burden (Suris, 2003).”
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Family Functioning in Children and Adolescents with Spina Bifida
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“On the other hand, group differences on these variables appear to be mediated by child cognitive ability, such that children with spina bifida tend to have lower IQs, and children with lower IQs tend to have parents who are more controlling.(29) Severity of illness was related to parental and family adjustment in seve…”
BackgroundSelf-citationA systematic review of parenting interventions for child chronic health conditions
Mitchell, A. E., Morawska, A., & Mihelic, M. (2019) · Journal of Child Health Care · doi:10.1177/1367493519882850 · Cited by 54
“For example, parents can be reluctant to discipline their child (Holmbeck et al., 2002), tend to be more inconsistent in their discipline (Walker et al.”
BackgroundModifiable Parent Factors Associated with Child and Adolescent School Refusal: A Systematic Review
Chockalingam, M., Skinner, K., Melvin, G. A., & Yap, M. B. H. (2022) · Child Psychiatry & Human Development · doi:10.1007/s10578-022-01358-z · Cited by 59
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“The focus on autonomy is also consistent with adolescent developmental literature in which autonomy is viewed as an important aspect of development for adolescents in general (Steinberg, 1990), but especially for those with chronic conditions (Holmbeck et al., 2002).”
BackgroundPsihogios, A. M., Kolbuck, V. D., & Holmbeck, G. N. (2015) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsv044 · Cited by 52
Self-citationParent–Child Relationships in Diverse Contexts
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Clinical adolescent psychology: What it is, and what it needs to be.
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Differences/Disorders of Sex Development: Medical Conditions at the Intersection of Sex and Gender
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“Our results suggest that collaborative coping is not perceived as effective when adolescents appraise the stressful event as their own, potentially because such involvement may be perceived as intrusive and overprotective (Holmbeck et al., 2002).”
BackgroundParental Protection of Extremely Low Birth Weight Children at Age 8 Years
Wightman, A., Schluchter, M., Drotar, D., Andreias, L., Taylor, H., Klein, N. K., Wilson-Costello, D., & Hack, M. (2007) · Journal of Developmental and Behavioral Pediatrics · doi:10.1097/dbp.0b013e3180330915 · Cited by 48
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“Independent of culture or intellectual ability (Holmbeck et al., 2002), early adolescence is a period of disequilibrium in the family context, where the child is on a merge toward an autonomous stage of life, often questioning parental rules and routines, pushing for more symmetrical relationship…”
BackgroundSystematic review of the link between maternal anxiety and overprotection
Jones, L. B., Hall, B., & Kiel, E. J. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.08.065 · Cited by 49
Parent-child interactions during the initial weeks following brain injury in young children.
Wade, S. L., Taylor, H. G., Walz, N. C., Salisbury, S. R., Stancin, T., Bernard, L. A., Oberjohn, K. S., & Yeates, K. O. (2008) · Rehabilitation Psychology · doi:10.1037/0090-5550.53.2.180 · Cited by 48
“Existing research suggests that changes in parenting behaviors and parent–child interactions may be brought about by parental distress resulting from the child’s condition (Quittner, Opipari, Regoli, & Jacobsen, 1992), by parental perceptions of the child (Holmbeck et al., 2002; Stern, Karraker, Sopko, & Norman, 2000)…”
BackgroundResultInfluentialCallus, A., Bonello, I., Mifsud, C., & Fenech, R. (2019) · Disability & Society · doi:10.1080/09687599.2018.1547186 · Cited by 48
Luyckx, K., Goossens, E., Missotten, L. C., & Moons, P. (2011) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e3182331e99 · Cited by 47
Transition in young adults with spina bifida: a qualitative study
Ridosh, M. M., Braun, P., Roux, G. M., Bellin, M. H., & Sawin, K. J. (2011) · Child Care Health and Development · doi:10.1111/j.1365-2214.2011.01329.x · Cited by 46
Huang, I., Brinkman, T. M., Mullins, L. L., Pui, C., Robison, L. L., Hudson, M. M., & Krull, K. R. (2018) · Psycho-Oncology · doi:10.1002/pon.4769 · Cited by 46
“When caring for children with cancer, parents may adopt a protective or indulgent strategy in response to perceived health vulnerability.(12) In fact, after a diagnosis of leukemia, 30% to 40% of parents used preventive‐focused parenting strategy with pessimistic communication and restraints on the child's activities.”
BackgroundEfficacy of digital health interventions in youth with chronic medical conditions: A meta-analysis
Domhardt, M., Schröder, A., Geirhos, A., Steubl, L., & Baumeister, H. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100373 · Cited by 45
“, 2012), reduced quality of life (QoL; Holmbeck et al., 2002) or symptoms of depression (Pinquart and Shen, 2011) and anxiety (Cobham et al.”
BackgroundA Camp-based Intervention Targeting Independence Among Individuals with Spina Bifida
O’Mahar, K. M., Holmbeck, G. N., Jandasek, B. N., & Zukerman, J. M. (2009) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsp125 · Cited by 45
Self-citationMother Child Appraised Involvement in Coping with Diabetes Stressors and Emotional Adjustment
Berg, C. A., Wiebe, D. J., Beveridge, R. M., Palmer, D. L., Korbel, C., Upchurch, R., Swinyard, M. T., Lindsay, R., & DONALDSON, D. L. (2007) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsm043 · Cited by 45
“However, overinvolvement or intrusive involvement in the form of control may be increasingly detrimental with age (Anderson & Coyne, 1991; Holmbeck et al., 2002; Wiebe et al., 2005), as it is more likely to communicate a message of incompetence and inefficacy (Pomerantz & Eaton, 2000).”
BackgroundParenting behaviors and the well-being of children with a chronic physical condition.
Crandell, J., Sandelowski, M., Leeman, J., Havill, N. L., & Knafl, K. A. (2017) · Families Systems & Health · doi:10.1037/fsh0000305 · Cited by 44
The Experience of Parenting an Adolescent with Spina Bifida
Sawin, K. J., Bellin, M. H., Roux, G. M., Buran, C. F., Brei, T. J., & Fastenau, P. S. (2003) · Rehabilitation Nursing · doi:10.1002/j.2048-7940.2003.tb02057.x · Cited by 44
“However, even in these close, positive relationships, adolescents with SB reported overprotectiveness, which may delay adolescent development (Blum et al., 1991; Holmbeck et al., 2002).”
BackgroundResultInfluentialDevine, K. A., Wasserman, R. M., Gershenson, L., Holmbeck, G. N., & Essner, B. S. (2010) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsq093 · Cited by 44
Self-citationEllis, D. A., Templin, T., Naar‐King, S., & Frey, M. A. (2008) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsn044 · Cited by 44
Aging Families and the Demographics of Family Financial Support of Adults With Disabilities
Fujiura, G. T. (2009) · Journal of Disability Policy Studies · doi:10.1177/1044207309350560 · Cited by 42
“, 2007), psychosocial adaptation (Holmbeck et al., 2002), family composition (Mitchell, 2007), quality of life (Jiyeon, Turnbull, & Turnbull, 2002), among other topics.”
BackgroundBerg, C. A., Schindler, I., & Maharajh, S. (2008) · Journal of Family Psychology · doi:10.1037/a0013641 · Cited by 42
“The adolescent’s view of the decreased need for collaboration as a cognitive tool may affect views of the interpersonal enjoyment of collaboration, as collaboration may increasingly be viewed as intrusive (Holmbeck et al., 2002).”
BackgroundParental perspectives and challenges in inclusive education in Singapore
Wong, M. E., Poon, K. K., Kaur, S., & Ng, Z. J. (2014) · Asia Pacific Journal of Education · doi:10.1080/02188791.2013.878309 · Cited by 42
Parental child-rearing attitudes are associated with functional constipation in childhood
Dijk, M. D. V.-V., de Vries, G., Last, B. F., Benninga, M. A., & Grootenhuis, M. A. (2014) · Archives of Disease in Childhood · doi:10.1136/archdischild-2014-305941 · Cited by 42
Morawska, A., Mitchell, A. E., Burgess, S., & Fraser, J. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.06.001 · Cited by 42
“Parent and family factors impact on illness onset (Mrazek et al., 1999), and disease course (Rohan et al., 2014), and parents of chronically ill children engage in different parenting practices compared to parents of healthy children (Holmbeck et al., 2002; Pinquart, 2013).”
BackgroundFedele, D. A., Mullins, L. L., Wolfe-Christensen, C. B., & Carpentier, M. Y. (2011) · Journal of Pediatric Hematology/Oncology · doi:10.1097/mph.0b013e3182025221 · Cited by 42
“Taken together, these finding are consistent with earlier research indicating that maternal and child adjustment are linked(23) and cross-sectional research showing relationships between parental overprotection, perceived child vulnerability, parenting stress, and subsequent childadjustment outcomes.(5,8,9,14,18) Furt…”
BackgroundResultInfluentialPsihogios, A. M., & Holmbeck, G. N. (2013) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jst047 · Cited by 41
Self-citationPetegem, S. V., Sznitman, G. A., Darwiche, J., & Zimmermann, G. (2021) · Family Process · doi:10.1111/famp.12709 · Cited by 41
Vera, J., Granero, R., & Ezpeleta, L. (2011) · Child Psychiatry & Human Development · doi:10.1007/s10578-011-0272-z · Cited by 41
Beato, A. F., Pereira, A. I., Barros, L., & Muris, P. (2015) · Journal of Child and Family Studies · doi:10.1007/s10826-015-0337-x · Cited by 39
“2013) and is characterized by excessive parental shielding (Holmbeck et al. 2002) and constant supervision of the child (Thomasgard and Metz 1993).”
Interactions With Parents and Friends Among Chronically Ill Children: Examining Social Networks
Herzer, M., Umfress, K., Aljadeff, G., Ghai, K., & Zakowski, S. G. (2009) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e3181c21c82 · Cited by 39
Stepansky, M. A., Roache, C. R., Holmbeck, G. N., & Schultz, K. (2009) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsp054 · Cited by 39
“higher levels of intrusive parenting (Holmbeck et al., 2002).”
Self-citationKaugars, A. S., Zebracki, K., Kichler, J., Fitzgerald, C., Greenley, R. N., Alemzadeh, R., & Holmbeck, G. N. (2010) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsq106 · Cited by 38
Self-citationHanna, K. M., DiMeglio, L. A., & Fortenberry, J. D. (2005) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsi036 · Cited by 38
“This is important for adolescents because overprotective parents inhibit their development of general autonomy (Holmbeck et al., 2002) and diabetes management autonomy (Anderson Downloaded from https://academic.oup.com/jpepsy/article-abstract/30/3/257/893621 by guest on 27 July 2018 & Coyne, 1991).”
BackgroundPeeters, M. A. C., Hilberink, S. R., & van Staa, A. (2014) · Journal of Pediatric Rehabilitation Medicine · doi:10.3233/prm-140272 · Cited by 37
Parental perceptions of child vulnerability in a community-based sample
Houtzager, B. A., Möller, E. L., Maurice‐Stam, H., Last, B. F., & Grootenhuis, M. A. (2014) · Journal of Child Health Care · doi:10.1177/1367493514530954 · Cited by 36
“…children such as psychosomatic complaints, separation anxiety, impaired peer relationships and school underachievement and can lead to overprotective behaviour in parents, possibly resulting in lowered autonomy in the child (Green and Solnit, 1964; Holmbeck et al., 2002; Thomasgard and Metz, 1995).”
Building a transitional care checklist in rheumatology: A Delphi-like survey
Akré, C., Surı́s, J.-C., Bélot, A., Couret, M., Dang, T.-T., Duquesne, A., Fonjallaz, B., Georgin‐Lavialle, S., Larbre, J.-P., Mattar, J., et al. (2017) · Joint Bone Spine · doi:10.1016/j.jbspin.2017.09.003 · Cited by 36
Trajectories of family processes across the adolescent transition in youth with spina bifida.
Jandasek, B. N., Holmbeck, G. N., DeLucia, C., Zebracki, K., & Friedman, D. (2009) · Journal of Family Psychology · doi:10.1037/a0016116 · Cited by 35
Self-citationChronic Anterior Uveitis in Children: Psychosocial Challenges for Patients and Their Families
Parker, D. M., Angeles‐Han, S. T., Stanton, A. L., & Holland, G. N. (2018) · American Journal of Ophthalmology · doi:10.1016/j.ajo.2018.03.028 · Cited by 35
Kirk, K., Fedele, D. A., Wolfe-Christensen, C. B., Phillips, T. M., Mazur, T., Mullins, L. L., Chernausek, S. D., & Wisniewski, A. B. (2010) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2010.10.005 · Cited by 35
Metadata
- Authors
- Holmbeck, G. N., Johnson, S. Z., Wills, K. E., McKernon, W., Rose, B., Erklin, S., & Kemper, T.
- Affiliations
- Loyola University Chicago (US)
- ORCID
- Holmbeck, Grayson N.
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2002
- Volume
- 70
- Issue
- 1
- Pages
- 96-110
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W2135416944
- Cited by
- 353
- References
- 103
- Citations by year
- 2026: 9 · 2025: 5 · 2024: 11 · 2023: 20 · 2022: 16 · 2021: 18 · 2020: 12 · 2019: 20 · 2018: 17 · 2017: 19 · 2016: 15 · 2015: 19 · 2014: 27 · 2013: 15 · 2012: 20
- FWCI
- 10.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Developmental and Educational Psychology › Psychosocial Factors Impacting Youth
- Keywords
- parental overprotection, behavioral autonomy, psychosocial adjustment, preadolescents, spina bifida, physical disability, externalizing problems, cognitive ability, gender differences in parenting, mediation, decision-making autonomy, parenting
- MeSH terms
- Adaptation, Psychological, Child, Female, Humans, Male, Parent-Child Relations, Social Adjustment, Spinal Dysraphism, Parenting, Observation, Children with Disabilities, Disabled Children, Personal Autonomy
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