Similarity between Parent’s and Children’s Coping with Childhood Cancer
Ellen K. Williams
Thesis completed in partial fulfillment
of the requirements of the
Honors Program in the Psychological Sciences
Under the Direction of Prof. Bruce E. Compas
Vanderbilt University
2 April 2012
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Abstract
Objective. Childhood cancer diagnoses and treatment presents challenges and
sources of stress for both children and their parents in related domains. It is important
to understand how parents and children cope with the child’s cancer. The current study
will examine the degree of similarity in ways of coping in a sample of children with
newly diagnosed cancer and their parents. Methods. Children and adolescents (5 to 17years-old; N = 334) and their parents were recruited near the time of a child’s diagnosis
or relapse of cancer. Children, mothers, and fathers completed measures on coping at
home or in the hospital/clinic. Results. Mother’s coping was significantly related to
children’s coping with 6 of the 9 significant correlations (r’s ranged from -.24 to .31, p <
.05 or p < .01). There was no significant relationship between father’s and children’s
coping. Linear multiple regression analyses indicated that there was a unique effect of
secondary control between mothers and children. Conclusions. There is a relationship
between mother’s coping and children’s coping, which suggests that there may be
benefit in teaching parents coping strategies in interventions to improve children’s
coping with cancer.
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
Introduction
Over 12,000 children and their parents are faced with significant stress
associated with a cancer diagnosis and treatment annually in the U.S, with cancer also
being the second highest cause of death for children (Jemal, Siegel, Xu, & Ward, 2010).
Parents and children are faced with a variety of different stressors caused by cancer,
including disruptions in daily/role functioning, physical effects of treatment,
uncertainty about the disease and treatment, and the fear and threat of death
(Rodriguez, Dunn, Zuckerman, Vannatta, Gerhardt, & Compas, 2012). With these high
levels of stress, it is important to understand how parents and their children cope with
the child’s cancer. Theories of the socialization of coping propose three alternative
models for how children’s adaptations to stressors are affecting the family, including
coaching, modeling, and family context (Kliewer, Sandler, & Wolchik, 1994). These
models suggest that parent’s coping with the child’s cancer will affect how the child
copes with cancer, but there is a lack of research about this relationship. However,
previous research has not examined the relations between the ways that children and
parents cope with the stress associated with a child’s cancer. The current study will
examine the degree of similarity in ways of coping in a sample of children with newly
diagnosed cancer and their parents.
Children with Cancer
Childhood cancer diagnoses and treatment presents challenges and sources of
stress for both children and their parents (Kupst & Bingen, 2006). A recent study by
Rodriguez et al. (2012) examined stressors faced by children and their mothers and
fathers in several domains. For children, stressors include daily/role functioning
3
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(missing school or falling behind in school work, not being able to do the things that
children used to do, frequent hospital or clinic visits, concerns about family and
friends), physical effects of treatment (feeling sick from treatments, changes in
appearance, pain and soreness from medical procedures), and uncertainty about cancer
(not understanding medical professionals, confusion about cancer, and concerns about
the future). Daily/role functioning stressors were most frequently rated as stressful
from self-reports from children, whereas parents rated children’s physical effects
stressors as more stressful than role functioning stressors. Parents cancer-related
stressors included daily/role functioning (paying bills and family expenses, concerns
about job, having less time and energy for other family members, cancer
communication (talking with child about cancer, talking with family and friends about
cancer, understanding information about cancer and medical treatment, arguing with
child about taking medicines and other treatment), and cancer caregiving (not being
able to help child feel better, the effects of child’s treatment, not knowing if child’s
cancer will get better). Caregiving stressors were rated as somewhat or very stressful
by 88% of mothers and 74% of fathers and levels of this type of stress were associated
with higher levels of emotional distress.
The high levels of stress related to cancer both for parents and children indicate
that it is important to understand how parents and children cope with this stress.
Understanding how parents and children cope with childhood cancer, and how their
coping relates to each other has important implications for interventions as well as
greater understanding of possible mechanisms in the development of coping during
childhood and adolescence.
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Coping
There is considerable debate and discussion surrounding how coping is defined,
although a consensus is emerging. As defined by Compas, Jaser, Dunn, and Rodriguez
(2012), “coping can be viewed as a collection of purposeful, volitional efforts that are
directed at the regulation of aspects of the self and the environment under stress.”
Eisenberg, Fabes, and Guthrie (1997) describe coping as “involving regulatory
processes in a subset of contexts— those involving stress” (p. 42). Skinner and
Wellborn (1994) define coping as “an organizational construct, which describes how
people regulate their own behavior, emotion, and motivational orientation under
conditions of psychological distress” which includes how people “mobilize, guide,
manage, energize, and direct behavior, emotion, and orientation, or how they fail to do
so” under stressful conditions (abstract, p. 113). Compas, Connor-Smith, Saltzman,
Thomsen, and Wadsworth (2001) define coping as, “conscious and volitional efforts to
regulate emotion, cognition, behavior, physiology, and the environment in response to
stressful events or circumstances” (p. 89). These definitions all focus on how coping
involves the regulation of psychological and behavioral processes. The emerging
definition of coping allows coping to be researched more completely and its importance
to be understood.
There is also debate on how coping should be measured. Compas et al. (2012)
state that, “in their comprehensive review of over 400 subtypes of coping that have
appeared in research on coping, Skinner, Edge, Altman, and Sherwood (2003) identified
only four frameworks for classifying subtypes of coping that have been empirically
tested and validated (Ayers, Sandler, West, & Roosa, 1996; Connor-Smith, Compas,
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
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Wadsworth, Thomsen, & Saltzman, 2000; Tobin, Holroyd, Reynolds, & Wigal, 1989;
Walker, Smith, Garber, & Van Slyke, 1997).” Of those that have been empirically tested
and validated, only Connor-Smith et al. (2000) and Walker et al. (1997) have been used
for children and adolescents coping with illness (Connor-Smith et al. 2000, Walker et
al., 1997). Compas et al. (2012) identified multiple common factors between these
frameworks, including factors identifying different types of coping. Each framework
had a dimension of active or primary control coping, which includes a direct effort to
change the source of stress or one’s response to the stressor. The frameworks also had
a dimension related to accommodative or secondary control coping, which includes
adapting to stress through “reappraisal, positive thinking, acceptance, or distraction”
(Compas et al., 2012, p. 461). The third factor of coping presented is passive, avoidant,
or disengagement coping, which includes avoidance of the source of stress (Compas et
al., 2012). These frameworks have been widely used to study coping with a variety of
different stressors.
The framework developed by Conner-Smith et al. (2000) divides coping into
three specific factors with common techniques that are used within the factor, and has
previously been used to study children with illnesses. The factors are primary control
coping (problem solving, emotional expression, emotional regulation), secondary
control coping (cognitive restructuring, positive thinking, acceptance, distraction), and
disengagement coping (wishful thinking, avoidance, denial) (Connor-Smith et al., 2000).
The type of coping technique used by children and adolescents is related to
psychological and physiological processes, including anxiety, depression, aggression,
and positive mood. For example, the use of secondary control coping in response to
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
stressors associated with parental depression was associated with lower internalizing
and externalizing symptoms (Langrock, Compas, Keller, Merchant, & Copeland, 2002).
In addition, secondary control coping was related to a decrease in anxious/depressed
symptoms and aggressive behavior in response to parental depression and
interparental conflict (Fear et al., 2009). Increased levels of observed positive mood
and lower levels of affective problems were also associated with the use of secondary
control coping (Jaser, Champion, Dharamsi, Riesing, & Compas, 2011). The results also
suggested that positive mood created a resilient affect, showing the importance of
primary and secondary control coping in increasing positive affect and decreasing
affective problems. In a recent study by Compas, Desjardins, Gerhardt, Vannatta,
Young-Saleme, Rodriguez, Dunn, and Snyder (2013), secondary control coping was
found to have the most consistent association with emotional distress and was related
to lower levels of anxiety and depression for children with cancer.
In contrast to secondary coping techniques, disengagement coping has been
found to be associated with lower levels of positive mood and higher levels of affective
problems (Jaser et al., 2011). Disengagement coping is also associated with higher
behavioral emotional responses and higher levels of depressive symptoms (ConnorSmith et al., 2000; Fear et al., 2009). The use of primary control coping is associated
with higher positive mood, but it may be a more effective form of coping when the
individual perceives or has some degree of control over the problem or stressor (Jaser
et al., 2011).
Development and Socialization of Coping
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Zimmer-Gembeck and Skinner (2011) reviewed and critiqued research on the
development of coping across childhood and adolescence. Zimmer-Gembeck and
Skinner identified what coping techniques were most commonly used for each age
group. They noted that research suggests that young children primarily seek support
from adults or use active behavioral forms of coping to get what they want, overcome
obstacles, distract themselves, or withdraw from stressful situations. In middle
childhood, Zimmer-Gembeck and Skinner note that children become more self- reliant
and their coping strategies become more differentiated and complex. For adolescents,
“instrumental action is supplemented by planful problem-solving, which is among the
most common strategies adolescents report using when they encounter challenges.
Distraction tactics also become more diverse; compared to children, adolescents more
often draw upon both behavioural and cognitive strategies” (Zimmer-Gembeck &
Skinner, 2011, p. 12). However, these patterns of the development of coping do not
explain how children learn how to cope, or explain the effect parent’s coping abilities
has on children.
One model of how children learn to cope is the socialization of coping. The
socialization of coping proposes three alternative models for how children’s
adaptations to stressors affect the family, including coaching, modeling, and family
context (Kliewer et al., 1994). Coaching is the parent’s direct instruction or assistance
on how to appraise stressful events and deal with problems. Modeling is the parents’
own response to stressful situations and how these affect children’s appraisals of
stressful events, and includes watching and imitating parental responses. Family
context is how the parents provide and shape the family environment, including
8
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stability, family cohesion, the parent-child relationship, acceptance and warmth, and
authoritative parenting styles (Kliewer et al., 1994). In a more recent study, Kliewer,
Parrish, Taylor, Jackson, Walker, and Shivy (2006), examined the influences of the
caregiver for the socialization of coping with regard to community violence. The study
presented different models and their implications with models predicting problemfocused coping, avoidance-distraction coping, proactive actions coping, aggressive
coping, and arousal reduction coping. Modeling, coaching, and family context each
contributed to the reports of coping by children, with problem-focused coping having
the strongest associations with changes in adjustment. For example, in the model
predicting problem-focused coping, more educated caregivers who encouraged active
coping were more likely to support problem-focused coping (Kliewer et al., 2006). Also
for the model predicting proactive coping, encouragement to proactively avoid
situations created feelings for the child that they were loved, valued, and accepted by
their caregiver (Kliewer et al., 2006).
Coping with Cancer
Childhood cancer is stressful for the entire family, and parents and children face
stress in similar domains, including daily/role functioning, communication about
cancer, and fear about the future. Parents are also involved in their child’s cancer
treatment, so they are aware of the stress in their child’s life. Children with cancer and
their parents provide a potentially interesting sample to study coping because of the
similarities in the source of stress. Since parents and children are facing similar stress
from cancer, this provides an opportunity for children to observe how their parents
cope as well as be coached by their parents for how they should cope with cancer.
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
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Modeling, coaching, and family context all potentially influence how children learn to
cope with cancer, so the children with cancer and their parents provide a unique
sample to see how parents’ and children’s coping are related and to see if parents and
children cope similarly to childhood cancer. However, as noted above, these potentially
important processes have not been examined in previous research on children coping
with cancer.
Hypotheses
Modeling, coaching, and family context are impacted by how the parent
themselves cope with stress. With a parent modeling and coaching certain coping
techniques, we hypothesize that children will cope similarly to their parents. For
example, mothers’ primary, secondary, and disengagement coping will be positively
correlated with children’s primary, secondary, and disengagement coping respectively.
We also hypothesize that children will cope more similarly to their parents as children
move from childhood into adolescence.
Method
Participants
Participants were 483 parents, including 317 mothers and 166 fathers of 334
children with cancer. Within this group of mothers and fathers, there were 153 couple
dyads (i.e., data were collected from both the mother and the father of the child).
Participants were recruited from pediatric cancer registries at two hospitals in the
Midwestern and Southern United States. Eligibility criteria included children who (a)
were ages 5–17 years old; (b) had a new diagnosis or relapse/recurrence of initial
cancer diagnosis (i.e., child’s treatment progressed to maintenance phase or further and
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
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initial diagnosis recurred) within the previous 6 months; (c) were actively receiving
treatment through the oncology division; and (d) had no preexisting developmental
disability.
Parents consented to participate in the study between 0 and 6 months after their
child’s diagnosis or relapse (M = 1.4 months, SD = 1.2) and returned questionnaires
between 0 and 9 months after their child’s diagnosis (M = 2.4, SD = 2.1). Families of
children with new diagnoses comprised 88.9% of the sample; there were no significant
differences in enrollment or completion time based on the child’s first-time diagnosis
versus relapse status. Reports were obtained from all of these parents about their
children’s coping and emotional distress, and child self-reports were obtained from 116
adolescents (ages 10-17 years old) who were old enough to complete the self-report
measures used in this study. This subset of children was on average 13.5 years old (SD
= 2.5), and 54.3% (n = 63) were female.
For all families included in the study (see Table 1), children were on average
10.6 years old (SD = 3.9), and 51.8% (n = 170) were male. Children had diagnoses of
leukemia (37%; n = 120), lymphoma (26%; n = 84), brain tumor (8% n = 26), and other
solid tumors (e.g., osteosarcoma, Wilm’s tumor; 30%; n = 98). Thirty-seven children
(11%) were recruited into the study following a relapse of their original cancer. For the
subgroup of children who were old enough and provided self-report data, children
were on average 13.4 years old (SD = 2.4); 48% (n = 76) male; 90% (n = 141)
White/Caucasian, 8% (n = 12) Black/African-American, and 2% (n = 4) other. They had
diagnoses of leukemia (33% n = 51, lymphoma (34%; n = 53), brain tumor (5%; n = 7),
and other solid tumor (29%; n = 46). Sixteen (10%) were children with relapsed
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
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disease.
Mothers were on average 37.5 years old (SD = 7.1), and fathers were 39.5 years
old (SD = 7.7). Race and ethnicity of the parents was 86.5% (n = 418) White/Caucasian,
8.9% (n = 43) Black/African-American, 0.8% (n = 4) Asian-American, 0.2% (n = 1)
American Indian/Native Alaskan, and 3.3% (n = 16) other. The families represented a
variety of annual income levels: 27.7% (n = 91) earned $25,000 or less, 28% (n = 92)
earned $25,001-$50,000, 14.3% (n = 47) earned $50,001-$75,000, 11.6% (n = 38)
earned $75,001-$100,000, and 14.9% (n = 49) earned over $100,000.
Measures
Demographic and Medical Data. Parents provided demographic information
including age, education level, race, family income, and marital status. Participants gave
permission for the research staff to access medical data, where the child’s
diagnosis/relapse status was extracted.
Children’s coping. The Responses to Stress Questionnaire-Pediatric Cancer
version (RSQ-PC; Connor-Smith et al., 2000; Miller et al., 2009; Rodriguez et al., 2012)
was used to obtain adolescents’ self-reports and mothers’ and fathers’ reports of their
children’s coping with cancer. The RSQ-PC Version includes a list of 12 cancer-related
stressors (e.g., missing school, frequent hospital or clinic visits, changes in personal
appearance), and 57 items reflecting voluntary (coping) and involuntary (automatic)
stress responses of children/adolescents in response to cancer-related stressors. For
the purpose of this study, only the three voluntary coping scales are reported. The
coping scales include: primary control coping (i.e., problem solving, emotional
modulation, emotional expression), secondary control coping (i.e., acceptance, cognitive
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
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restructuring, positive thinking, distraction), and disengagement coping (i.e., avoidance,
denial, wishful thinking). To control for response bias and individual differences in base
rates of item endorsement, proportion scores were calculated by dividing the total
score for each factor by the total score for the entire RSQ (Osowiecki & Compas, 1998,
1999; Vitaliano, Maiuro, Russo, & Becker, 1987). In the current sample, internal
consistencies of children’s self-reports (ages 10-17) were: primary control  = 0.81,
secondary control  = 0.84, and disengagement  = 0.82. Internal consistencies for
mother and father parent reports, respectively, were: primary control  = 0.66/0.74,
secondary control  = 0.87/0.85, and disengagement  = 0.71/0.69. The factor
structure of the RSQ has been supported in confirmatory factor analytic studies with
children and adolescents from a wide range of ethnic and cultural backgrounds coping
with a wide range of stressors (e.g., Benson et al., 2011; Compas et al., 2006; ConnorSmith et al., 2000; Connor-Smith & Calvete, 2004; Wadsworth, Reickmann, Benson, &
Compas, 2004; Yao et al., 2011).
Parents’ Coping. Participants completed a version of the Response to Stress
Questionnaire (RSQ; Connor-Smith et al., 2000) that is designed to assess coping
responses to stressors related to having a child with cancer. The RSQ includes 57 items
on which participants indicate on a 4-point scale how much they use various coping
methods, from 0 (not at all) to 4 (a lot), in response to stressful aspects of their child’s
cancer (e.g., “Not knowing if my child’s cancer will get better,” “Understanding
information about cancer and medical treatments”). Factor analyses of the RSQ have
identified five factors: primary control engagement coping (problem solving, emotional
expression, emotional modulation), secondary control engagement coping (cognitive
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
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restructuring, positive thinking, acceptance, distraction), disengagement coping
(avoidance, denial, wishful thinking); two additional scales that reflect involuntary
stress responses were not used in the current analyses. The RSQ has been shown to
have good psychometric properties (Connor-Smith et al., 2000). Internal consistencies
for this sample for each of the factors of interest ranged from  = .75 to  = .79 for
mothers and from  = .74 to  = .76 for fathers. Proportion scores were created by
dividing the total score for each factor by the total score for the RSQ (Connor-Smith et
al., 2000) and were used in the current analyses to control for response bias. Means and
standard deviations were calculated for mothers’ and fathers’ Primary Control Coping,
Secondary Control Coping, and Disengagement Coping ratio scores, and for mothers’
and fathers’ depressive, anxiety, and PTSS symptoms.
Procedure
Parents were identified from cancer registries at the two hospitals in the
Southern and Midwestern United States and approached in the outpatient
hematology/oncology clinics or in inpatient rooms by a member of the research team.
The staff member introduced the study, explained that the goals of the study were to
help medical personnel and future families of children and youth with cancer better
understand how families coped with the stress of a cancer diagnosis and treatment, and
assessed parents’ interest in participating. Variation in the time at which parents were
first approached by the research team occurred based on the timing of communication
of the diagnosis from the medical team, parents’ availability to hear about the study,
and parents’ needing time to consider the study before consenting. After providing
informed consent during a visit to the hospital, parents were given questionnaire
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
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packets that they completed in the hospital, outpatient clinic, or took home and
returned at a subsequent visit. In the case that only one parent was present and
another parent or caregiver was involved, consent forms and questionnaires were sent
home for the other caregiver to consider. Parents consented to participate in the study
between 0 and 6 months after their child’s diagnosis or relapse (M = 1.4 months, SD =
1.2) and returned questionnaires between 0 and 9 months after their child’s diagnosis
(M = 2.4, SD = 2.1). Families of children with new diagnoses comprised 88.9% of the
sample; there were no significant differences enrollment or completion time based on
the child’s first-time diagnosis versus relapse status. Families were compensated $50
when at least one parent completed the measures. The Institutional Review Boards at
both sites approved the study protocol.
Statistical Analyses
Pearson correlation coefficients and linear regression analyses were conducted
to evaluate associations between mothers’ coping, fathers’ coping, and children’s
coping.
Results
No significant differences were found between sites for age of child, type of
tumor, time since diagnosis, and coping ratio scores. Therefore, all analyses included
combined data from both sites.
Descriptive statistics
Means and standard deviations are presented in Table 2 for mothers’ and
fathers’ reports of coping on the RSQ and children’s self report on coping on the RSQ.
Mothers’, fathers’, and children’s reports of coping are reported as proportion scores to
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
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control for response bias and individual differences in base rates of item endorsement.
The proportion scores were calculated by dividing the total score for each factor by the
total score for the entire RSQ. The proportion scores were normally distributed, with
no skewness towards zero.
Correlational analyses
Bivariate correlations of mothers’, fathers’, and children’s’ self-report of coping
are presented in Table 3. As hypothesized, mother’s coping was significantly related to
children’s coping. For the nine correlation values between mother’s coping and
children’s coping, 6 of the 9 correlations were significant (r’s ranged from -.24 to .31, p
< .05 or p < .01). Specifically, mothers’ secondary coping was significantly associated
with children’s secondary coping (r = .31, p < .01). In addition, mothers’ disengagement
coping was significantly correlated with children’s disengagement coping (r = .19, p <
.05). However, fathers’ coping had no significant associations with children’s coping.
The correlations did fit the same trend as mothers’ coping and children’s coping.
Disengagement coping was negatively associated with primary and secondary coping
(r’s ranged from -.22 to .25), but these correlations were not significant, perhaps due to
the smaller sample of fathers in the study and the relatively lower statistical power
than in the sample of mothers and children.
Correlations between mothers’ and fathers’ coping and children’s coping while
accounting for age is presented in Table 4. Children who had completed the self-report
of the RSQ were split into a younger and older group based on the median of 169
months or 14.1 years. There is no difference in the magnitude of the correlations for
younger and older children based on Fisher’s z tests with z’s ranging from 0 to 1.31
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
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with no significant differences. Younger children had 3 of the 9 correlations between
mother’s coping and children’s coping as being significant, with the greatest of those
being between mother’s secondary control coping and children’s secondary control
coping (r = .36, p < .01). For the older children, only 1 of the 9 correlations between
mother’s coping and children’s coping was significant; the correlation between
mother’s secondary control coping and children’s disengagement coping (r = -.29, p <
.05). These correlations do not support the hypothesis that with age, children’s coping
will become more similar to their parents, but the sample is limited by the child self
report only being able to be given to children between the ages of 10 and 17.
Regression Analyses
There were multiple significant relationships between mothers’ self report of
coping and children’s self report of coping; 6 of 9 correlations were significant with all
types of coping having significant associations with children’s coping. Linear multiple
regression analyses were conducted to examine the associations of all three types of
mother’s coping when entered together in models predicting children’s coping. Since
there were no significant correlations for father’s self report of coping and children’s
self report of coping, linear multiple regressions were only conducted for children and
mothers. For the model predicting child report of secondary control coping, the overall
equation was significant, F (3, 107) = 4.06, p < .01, adjusted R2 = .37. Mother’s
secondary control coping ( = .23, p < .05) was a significant predictor of child selfreported secondary control coping; primary control and disengagement coping were
not significant predictors for children’s secondary control coping, and there were no
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
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significant predictors of mother’s coping for children’s primary and disengagement
coping.
Discussion
The diagnosis and treatment of cancer present both parents and children with
challenges and sources of stress related to the disease, its treatment, disruptions in
daily life, and fears about the future. Understanding how parents and children cope
with the stress of cancer and how coping relates is important for providing
interventions to enhance effective adaptation to cancer. Previous research provides
models of how parents might influence children’s coping and how children learn to
cope, for example, through modeling and coaching from the theory of the socialization
of coping (Kliewer et al., 1994). The current study examined how parents and children
coping are related, and there has been no research that has looked at how parents and
children cope with a child having cancer.
The current study is one of the first to use a control-based model to study
children’s and parent’s coping with cancer by examining primary control, secondary
control, and disengagement coping. To determine how parents’ and children’s coping
relates, correlations and linear regressions were preformed. Mothers’ and children’s
coping were significantly related, with 6 of 9 correlations being significant (r’s ranged
from -.24 to .31, p < .05 or p < .01). There were no significant relationships between
fathers’ coping and children’s. However, the correlations for fathers were a similar
magnitude as mothers. The fewer number of fathers created a lack of power that could
have hidden potential relationships. One of the weaknesses of the study was the small
number of fathers.
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In the linear multiple regression analyses for mothers’ coping predicting
children’s coping, there was a significant relationship between mothers’ secondary
control coping and children’s secondary control coping. This demonstrates a unique
effect of secondary control coping between mothers and children. Previous research
suggests that secondary control coping has a significant relationship with distress and
symptoms of anxiety and depression (Compas, Desjardins et al., 2013). The
relationship between mothers’ and children’s secondary control coping has
implications for the importance of secondary control coping in interventions. Since
there is a relationship between mothers’ coping and children’s coping, it may be
important to ensure that interventions teach coping strategies not only to children, but
also to their parents.
Our study had several limitations that need to be addressed in future research.
First, this study was cross-sectional, and it will be important to examine the association
between parents’ and children’s coping using prospective longitudinal designs. Second,
our sample was limited by the age at which children can use a self-report of coping and
fill out the RSQ. To include children under the age of 10, future research should ensure
that there is another informant to report on young children’s coping. Third, our sample
was somewhat limited with regard to ethnic and racial diversity; future studies of
children’s coping with cancer with more diverse samples are needed.
The findings from this study have implications for future research. The current
study looked at how parents’ and children’s coping relates, but it does not study how
children learn to cope. There are opportunities for future research to study how
children learn to cope with cancer and other stress and the influence parent’s coping
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
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has on that learning. Future research should also examine the relationship of fathers’
coping and children’s coping. The trends in correlations found in this study suggest
that there could be significant relationships that could be studied in the future. Future
research should also examine the effect that both parents have on children together. If
both parents use and promote one coping strategy, there could be a different effect on
the child. Since parents coping strategies are related to each other, the effect that both
parents have on children should be examined further (Compas, Bemis, Gerhardt,
Vannatta, Dunn, & Rodriguez, 2013).
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
21
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25
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
Table 1. Demographic characteristics of Mothers, Fathers, and Children.
Age
Years of Education
Race
White
African-American
Asian-American
AmericanIndian/Native Alaskan
Other
Annual Family Income
< $25,000
$25,001 – $50,000
$50,001 – $75,000
$75,001 – $100,000
> $100,000
Marital Status
Married/Living with
Someone
Single, Divorced,
Separated,
Or Widowed
Mothers
Fathers
Children
(n = 317)
(n = 166)
(n=334)
M
37.5
16.0
SD
7.1
3.9
M
39.5
16.0
SD
7.7
4.3
M
10.5
5.4
SD
4.0
3.9
N
%
N
%
N
%
269
31
3
1
84.9
9.8
0.9
0.3
149
12
1
0
89.8
7.2
0.6
0
281
32
1
1
84.1
9.6
0.3
0.3
12
3.8
4
2.4
19
5.7
87
88
48
36
49
28.2
28.6
15.6
11.7
15.9
34
41
35
25
31
20.5
24.7
21.1
15.1
18.7
-
-
237
75.2
154
92.8
-
-
78
24.7
12
7.2
-
-
26
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
27
Table 2. Means and standard deviations for measures of coping in mothers, fathers, and
children.
Mothers on self
(n = 110)
Coping
Primary Control
Secondary Control
Disengagement
Fathers on self
(n = 55)
Children on self
(n = 116)
M
SD
M
SD
M
SD
.20
.27
.12
.04
.05
.03
.19
.27
.13
.04
.06
.03
.18
.29
.15
.04
.06
.03
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
28
Table 3. Correlations among mother, father and child self-reports of own coping.
1
1. Primary
control coping
Child’s
Self
Report
Mother’s
Self
Report
Father’s
Self
Report
2. Secondary
control coping
3.
Disengagement
coping
4. Primary
control coping
2
3
4
5
6
7
8
9
--.33**
---
-.56**
-.43**
---
.16
.26**
-.15
--
.22*
.31**
-.28*
.46**
--
-.14
-.24*
.19*
-.69**
-.62**
--
.21
.25
-.03
.44**
.39*
-.46**
--
.13
.16
-.08
.29**
.31**
-.30*
.36**
--
-.22
-.18
.16
-.38**
-.17
.30*
-.58**
-.55**
5. Secondary
control coping
6.
Disengagement
coping
7. Primary
control coping
8. Secondary
control coping
9.
Disengagement
coping
Note. Sample sizes: n = 116 children; n = 110 mothers; n = 55 fathers. Cross-informant
correlations are in gray.
--
29
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
Table 4. Correlations among mother, father and child self-reports of children’s coping
separated by age: Old above the diagonal, young below the diagonal.
Child’s
Self
Report
Mother’s
Self
Report
Father’s
Self
Report
1
2
3
4
5
6
7
8
9
1. Primary
control coping
---
.34**
-.57**
.19
.17
-.04
.12
-.02
-.25
2. Secondary
control coping
.32*
---
-.48**
.24
.26
-.18
.20
-.02
-.19
3.
Disengagement
coping
-.55**
-.36**
---
-.25
-.29*
.13
-.18
-.24
.31
4. Primary
control coping
.13
.24
-.05
--
.45**
-.64**
.46*
.12
-.36
5. Secondary
control coping
.27*
.36**
-.18
.47**
--
-.58**
.25
.22
-.23
6.
Disengagement
coping
-.23
-.23*
.22
-.73**
-.66**
--
-.37
-.20
.24
7. Primary
control coping
.26
.32
.01
.43*
.47*
-.54**
--
.21
-.60**
8. Secondary
control coping
.24
.34
.01
.39*
.38
-.38*
.46*
--
-.49**
9.
Disengagement
coping
-.22
-.23
.10
-.38*
-.10
.38*
-.57**
-.58**
--
Note. Sample sizes: Old n = 58 children; n = 52 mothers; n = 27 fathers. Young n = 58
children; n = 58 mothers; n = 28 fathers Cross-informant correlations are in gray.
SIMILARITY BETWEEN PARENT’S AND CHILDREN’S COPING WITH CHILDHOOD CANCER
30
Table 5. Regressions of Child’s Coping with Mother’s Primary, Secondary, and
Disengagement Coping
Child’s Primary Control
Coping
Child’s Secondary Control
Coping
Child’s Disengagement
Coping
Mothers’ Reports of Coping
Primary Control
 = .11
Secondary Control  = .20
Disengagement
 = .06
F (3,106) = 1.94; R2 = .15
Primary Control
 = .19
Secondary Control  = .23*
Disengagement
 = .05
F (3,107) = 4.06*; R2 = .37
Primary Control
 = -.02
Secondary Control  = -.17
Disengagement
 = .08
F (3,107) = 2.08; R2 = .11