Disclosure, family communication context, and child outcomes after infertility treatment
Martha A. Rueter,
a
PhD ,
Jennifer Connor,
b
PhD ,
Lauri
c
Pasch ,
Kayla Anderson,
a
MA ,
Ascan F. Koerner,
d
PhD ,
Mark
e
Damario
aFamily
Social Science, University of Minnesota, bCommunity Psychology, Counseling, and Family Therapy, St. Cloud State University,
c University of California, San Francisco, d Communication Studies, University of Minnesota, eObstetrics, Gynecology and Women’s Health, University of Minnesota
Background
Research Question &
Hypotheses
Research Question
Does family communication context moderate the association
between disclosure of ART conception and parent-child
relationship satisfaction, and does this interaction indirectly
relate to child adjustment?
Hypotheses
H1: Communication context moderates the association between
disclosure and parent-child satisfaction such that, in a restricted
communication context, disclosure of ART conception
negatively relates to parent-child satisfaction.
H2: In a restricted communication context, disclosure of ART
conception indirectly and negatively relates to child adjustment,
through is association with parent-child satisfaction.
Results
Participants
Families (n = 216) were recruited from a university reproductive endocrinology clinic in the Midwest. Eligible families
had at least one parent with at least one child born between 1998 – 2004, who was conceived via IVF, ICSI, or IUI.
Parents were mostly heterosexual (96.8%) and mostly White (95.8%), with median annual household incomes of
$100,000 – $150,000. Participating families included n = 312 children (Mage = 8.48 years, SD = 1.43).
Measures
Disclosure of conception method. Parents reported disclosure of conception method by responding “yes” or “no” to
the question, “Does your child know that s/he was conceived by ART?”
Communication context. Communication context was defined as a parent’s tendency to avoid talking about topics
s/he disapproves of or sees as inappropriate for discussion. Parents reported how much they agreed with two items
(1=disagree completely, 7=agree completely): (1) If I don't approve of it, I don't want to know about it and (2) I often
say things like “There are some things that just shouldn't be talked about”.
Parent-child relationship satisfaction. Measured using an adapted version of the Huston Marital Opinion
Questionnaire (Caughlin & Afifi, 2004; Huston & Vangelisti, 1991) which consists of 11 semantic differential-type
items beginning with “I would describe my relationship as . . .” and ending with two opposing options (e.g.,
rewarding vs. disappointing) scaled from 1 to 7.
Child behavioral adjustment. Parents reported children’s behavioral adjustment using the Child Behavior Checklist
(Achenbach & Rescorla, 2001). The child behavioral adjustment variable was created by summing two CBCL
subscales (rule-breaking behavior, aggressive behavior; α = .75).
Parent emotional state. Method bias from using parent self-report for all variables was addressed by controlling for
parents’ emotional state. Feelings of depression and anxiety were reported using the Internalizing subscale of the
Adult Self Report (Achenbach & Rescorla, 2003).
Child demographics. Parents reported the child’s age, sex (female = 1, male = 2), and donor status. Donor status was
coded as 1 for children conceived using donor egg, donor sperm, or both donor egg and donor sperm (n = 41).
Nondonor children (donor status = 0) were conceived using the intended parents’ gametes.
Figure 1. Association between disclosure and parent-child satisfaction
in a restricted compared to open communication context
7
Parent-child Relationship Satisfaction
Disclosure of assisted reproductive technology (ART) conception to
children may involve parents discussing personal, sensitive topics with
their children like parents’ infertility, sexual reproduction, and the child’s
conception occurring in a laboratory. Parents who conceived using donor
gametes have the added challenge of telling children about their genetic
origins (Scheib et al., 2003). Understandably, parents often report
uncertainty about raising these topics with children (Blake et al., 2010;
Daniels et al., 2011; Gross et al., 2004; Rauscher & Fine, 2012).
Most ART research does not consider family communication context
when examining disclosure outcomes. Yet, theory (Petronio, 2002) and
empirical findings (Caughlin & Afifi, 2004; Caughlin & Petronio, 2004;
Merrill & Afifi, 2012) suggest that a parent’s approach to discussing
personal information could moderate the effect of disclosure on parent
and child outcomes. E.g., some families allow an open flow of personal
information among family members. Others strictly control access to
private information, sharing infrequently in limited amounts. Available
research suggests that in this kind of restricted communication context
disclosure may negatively affect parent-child satisfaction and child
adjustment. (Caughlin, 2003; Caughlin and Afifi, 2004; Petronio, 2002).
Research also shows that relationship satisfaction is a proximal
outcome of disclosure (Collins and Miller, 1994) and parent-child
relationship satisfaction predicts child adjustment (Overbeek et al.,
2007). Therefore, we hypothesized that, among families with a restricted
communication context, disclosure of ART conception relates negatively
to parent-child relationship satisfaction and through this association, has
an indirect, negative effect on child adjustment.
Method
r = .18, p = .04
6.5
r = -.33, p = .02
6
5.5
Not Disclosed
Open communication context
Restricted communication context
Disclosed
Parents reported high parent-child satisfaction (M = 6.42, SD = .65) and
few child behavior (M = 3.03, SD = 4.33). Also, parent-child satisfaction
and behavior adjustment were correlated (r = -.53, t = 7.31, p < .001),
and disclosure was unrelated to parent-child satisfaction and child
behavioral adjustment in the full sample (Table, 1). We estimated the
hypothesized associations using structural equation modeling. Model
results supported the hypothesized moderator effect (b = -.18, 95% CI = .27 - -.09, b = -.24, t = -3.37, p = .001). As shown in Figure 1, in families
with open communication, disclosure positively related to parent-child
relationship satisfaction and negatively related to parent-child
satisfaction in families with restricted communication. The hypothesized
indirect effect was also supported (b = .59, 95% CI = .25 - .93, b = .12, t =
2.85, p = .004). This indirect effect means that in families with restricted
communication, disclosure negatively related to child adjustment,
through its association with parent-child satisfaction.
Table 1. Correlations among study variables
Measure
1. Communication Context
2. Child’s age
3. Child’s sex
4. Child’s donor status
5. Parent’s emotional state
6. Parent-child satisfaction
7. Disclosure status
8. Child behavioral adjustment
1
__
-.07
-.03
.02
-.02
-.18
-.08
-.02
2
3
4
__
.08
.03
-.01
.01
.21
.04
__
.01
-.04
-.01
.03
.04
__
-.00
-.01
.18
.08
5
6
7
__
-.32 __
.03 -.05 __
.34 -.53 .07
8
__
Conclusion
Using our full sample, this study’s findings replicate research showing
that disclosure of ART conception has little effect on family relationships
or child adjustment (Golombok et al., 2011; Lycett et al., 2004; Nachtigall
et al., 1997). Our results depart from earlier research by revealing
subgroups of families whose experience differs from the majority. In
doing so, our findings demonstrate the importance of considering family
context when determining outcomes of disclosure. Outcomes tend to be
positive in families with an open communication context. Outcome may
not be positive in families with a restricted communication context.
We interpret these findings not to mean that disclosure should be
encouraged in some families, those with open contexts, and avoided in
families that prefer a restricted context. Rather, we argue that parents
who have strong reservations about discussing private information may
benefit from additional support because when disclosure of ART
conception occurs in a restricted communication context, topic
avoidance may bring to light an unwillingness to discuss the child’s
conception, leading to accumulating frustration that erodes family
relationships (Petronio, 2002).