JFN, February

10.1177/1074840702239491
Haber et al. / Mother-Father
2003, Vol. 9 No.Perceptions
1 ARTICLE

Relationships Between Differences

in Mother-Father Perceptions and
Self-Concept and Depression
in Children With Epilepsy

Linda C. Haber, D.N.S., R.N., C.S.

Veterans Affairs Northern Indiana Health Care System
Joan K. Austin, D.N.S., R.N., F.A.A.N.
Indiana University School of Nursing
Gertrude R. Huster, M.H.S.
Kathleen A. Lane, M.S.
Susan M. Perkins, Ph.D.
Indiana University School of Medicine

The purpose of this study was to explore relationships between differences in

perceptions of mothers and fathers and self-concept and symptoms of depres-
sion, respectively, in 69 youth with epilepsy. Multiple regression was used to
test whether the absolute difference scores between mothers’ and fathers’ per-
ceptions of family adaptive resources, stigma, their children’s negative cop-
ing behaviors, and their attitudes toward epilepsy were predictors of child
self-concept and depression after adjusting for epilepsy severity, children’s
attitudes toward epilepsy, and children’s ratings of family adaptation. Only
the mother-father differences related to children’s negative coping behaviors
significantly predicted children’s self-concept and depressive symptoms.
Findings suggest that differences in perceptions related to children may be
more highly associated with the children’s outcomes than differences related
to family characteristics or the children’s illness.

Keywords: epilepsy, family research, quantitative, family adaptation.

JOURNAL OF FAMILY NURSING, 2003, 9(1), 59-78

DOI: 10.1177/1074840702239491
© 2003 Sage Publications
59
60 JFN, February 2003, Vol. 9 No. 1

Epilepsy, or recurring seizures, is one of the most common disorders

of childhood, affecting at least 1% of children and adolescents
(Hauser, 1994). As Hoare and Kerley (1992) noted, children with epi-
lepsy have a much higher rate of psychological disturbance than do
healthy children or children with other chronic illnesses. Children
with epilepsy have been found to be almost five times more likely to
have mental health problems than children from the general popula-
tion (McDermott, Mani, & Krishnaswami, 1995) and more than twice
as likely as children with other chronic physical conditions (Rutter,
Graham, & Yule, 1970).
Research predicting adjustment in children with epilepsy has been
based on complex models such as Austin’s (1996) revision of the dou-
ble ABCX model (McCubbin & Patterson, 1983). Although research
has made significant contributions to understanding family adapta-
tion to epilepsy, the effect of differences in perceptions among family
members has not been addressed. McCubbin et al. (1980) stated, “At
the family level, the source of perception is often unclear. One is com-
pelled to explore such questions as, ‘Do discrepancies in perception
among members need to be examined or considered, and when?’” (p.
862). Although more than 20 years have passed, there is no existing
theory that predicts how parental differences in perceptions about
children influence the children’s outcomes. This project is an effort to
determine if differences in parents’ perceptions should be included in
the double ABCX model as another factor affecting children’s adjust-
ment to epilepsy. The specific purpose of this study was to explore
how the relationships between mother-father differences in percep-
tions related to epilepsy, the family, and the children’s coping strate-
gies are related to the children’s self-concepts and depression.

This research was supported by Grant No. PHS R01 NS22416 from the
National Institute of Neurological Disorders and Stroke to Joan K. Austin,
D.N.S., R.N., F.A.A.N. We acknowledge assistance from D. Dunn, B. Hale, B.
Garg, and O. Markand as well as from the Epilepsy and Pediatric Neurology
Clinics at Riley Hospital at the Indiana University Medical Center and the
Medical Research Committee of Methodist Hospital in Indianapolis. We
thank A. McNelis for help with data collection, P. Dexter for editorial com-
ments, and J. Critchfield for editorial assistance. Address all correspondence
to Dr. Joan K. Austin, Indiana University School of Nursing, 1111 Middle Dr.,
NU492, Indianapolis, IN 46202-5107; e-mail: joausti@iupui.edu.
 Haber et al. / Mother-Father Perceptions 61

BACKGROUND

Perception, a central component of the double ABCX model, refers

to how individuals perceive their situations. The approach taken by
the authors is that all self-report data are measures of respondents’
perceptions in relation to the information submitted even if the data
being requested are objective (such as annual income) and even if the
variables are not labeled as perceptions in theoretical models.
The importance of obtaining perceptions from more than one fam-
ily member has been emphasized by a number of scholars (Ferketich
& Mercer, 1992; Holmbeck, Coakley, Hommeyer, Shapera, &
Westhoven, 2002; Thompson & Gustafon, 1996). Draper and Marcos
(1990) extensively discussed and offered recommendations for
approaches to the conceptual and methodological problems that arise
when multiple perceptions are obtained. Schumm, Barnes, Bollman,
Jurich, and Milliken (1985) identified the sources of variance in family
data as true individual variance, random error variance, shared vari-
ance in dyads, and family variance.
When perceptions are obtained from more than one family mem-
ber, differences are often found. Differences are described by Barnes
(1989) as an integral part of family life, and Draper and Marcos (1990)
emphasized the importance of individual differences and characteris-
tics in understanding family problems. As Draper and Marcos (1990)
noted,

The process of coming together may not erase or neutralize existing

individual differences. In some cases, family formation may even exac-
erbate individual differences. Some elements of family process can be
understood only by knowing both the shared commitment of the fam-
ily and the idiosyncracies of individual members. (p. 15)

Larsen and Olson (1990), Thomson (1990), and others provided sup-
port for viewing differences in perceptions of family members as an
important concept. This study is consistent with the view that differ-
ences between mothers and fathers are important factors that should
be studied in their own right.
Although research using multiple informants is increasing, the
focus is seldom on mother-father differences. In Achenbach,
McConaughy, and Howell’s (1987) meta-analysis of the degree of con-
sistency between different informants’ reports of the behavioral and/
or emotional problems of children, only 22 out of the 119 studies com-
62 JFN, February 2003, Vol. 9 No. 1

pared mother and father reports. There is a large body of research

comparing perceptions of a parent (usually the mother) with those of
the child or adolescent (see, e.g., Bleil, Ramesh, Miller, & Wood, 2000;
Hodges, Gordon, & Lennon, 1990; Holmbeck & O’Donnell, 1991;
Paikoff, Carlton-Ford, & Brooks-Gunn, 1993; Perrin, Ayoub, &
Willett, 1993). There are also a substantial number of studies compar-
ing mother and teacher reports, such as those by Kinard (1995) and
Marmorstein and Hubbard (1995).
Even when information is obtained from both parents, data on the
extent of mother-father agreement may not be reported. For example,
although Cantwell, Lewinsohn, Rohde, and Seeley (1997) obtained
reports from both parents for 36.6% of the 281 adolescents in their
sample, disagreement between parents was not discussed. In
Holmbeck et al.’s (2002) study of conflict and cohesion, self-report
data from mothers and fathers were analyzed separately. Theunissen
et al. (1998) avoided the issue of differences between parents entirely
by using data from only one caretaker (either mother or father) for
95% of their sample and by having mothers and fathers complete the
parent form together for the remaining 5% of the sample.
Researchers studying mother-father differences have examined
the amount of agreement between mother and father reports (e.g.,
Eiser, Havermans, Pancer, & Eiser, 1992) and the extent to which fac-
tors such as age and gender of children and psychiatric status of
mothers may influence mother-father differences in perception (e.g.,
Tarullo, Richardson, Radke-Yarrow, & Martinez, 1995). In a meta-
analysis of 60 studies, Duhig, Renk, Epstein, and Phares (2000) exam-
ined both correspondence and discrepancies between mother and
father ratings on their children’s internalizing, externalizing, and
total behavior problems. Moderator variables of age, gender, and eth-
nicity of the children and parental socioeconomic status also were
included. The study by Barnes (1989) was the only report found that
examined the effects of discrepancy. To our knowledge, there have
been no reports of studies that addressed the relationships between
mother-father differences and childhood adjustment to epilepsy.
Specific research questions were as follows:

1. How are differences between mothers’ and fathers’ perceptions in

relation to the epilepsy (attitudes and stigma), family (adaptation and
adaptive resources), and children’s coping behaviors respectively
related to children’s self-concepts?
 Haber et al. / Mother-Father Perceptions 63

2. How are differences between mothers’ and fathers’ perceptions in

relation to the epilepsy (attitudes and stigma), family (adaptation and
adaptive resources), and children’s coping behaviors respectively
related to the children’s depression?

METHOD

Sample

The current sample is a subsample of families who participated in a

larger study of family adaptation to childhood epilepsy (Austin,
Huster, Dunn, & Risinger, 1996). In the larger study, the double ABCX
model served as a source theory for the selection of variables. Data
were collected twice in the larger study, approximately 4 years apart
(Time 1 and Time 2), from 136 families. The participation rate was 98%
of those invited to participate. At Time 2, 117 provided usable data (7
were lost to follow-up, 3 were dropped from the study because the
children developed other conditions, 3 chose not to participate, and 6
had incomplete data). There were 75 mother-father pairs at Time 1
and 69 mother-father pairs at Time 2 with complete data. To be
included in the study at Time 1, the children must have been ages 8
through 12 years, had epilepsy for at least 1 year, been on antiepileptic
medication for at least 1 year, and had an IQ of at least 70. The children
were treated for seizures on an outpatient basis either by physicians at
clinics in two large hospitals (in Indiana) or by private physicians. The
sample used in this study included only those families in which data
were complete for the children and both parents at Time 2. Time 2 data
were used because they contained information on child depression. A
total of 69 families were used in this analysis: 32 boys and 37 girls with
an average age of 14.4 years.
The severity of each child’s seizure condition was rated on a scale
of 0 to 10 by a pediatric neurologist based on seizure type, seizure fre-
quency, and amount of antiepileptic medication. (See Austin et al.,
1996, for more information on severity ratings.) At Time 2, 46.4% (n =
32) of the children had inactive conditions (i.e., no medication and no
seizures). Another 27.5% (n = 19) were classified as having low-severity
conditions because their seizures were well controlled by medication.
The final 26.1% (n = 18) were classified as having high-severity condi-
tions because they continued to have regular seizures despite some-
times being on two medications. Although these data were collected
64 JFN, February 2003, Vol. 9 No. 1

more than 7 years ago, the treatment of epilepsy has not substantially
changed.
Parents were currently married in all but one of the families. In this
family, the parents had divorced after 2 years of marriage. They were
included because they shared custody and both were involved in
parenting the child. Couples who remained married had been mar-
ried an average of 15.2 years. The parents ranged in age from 28 to 50
years, and most were educated at the high school level or higher. Of
the families, 3 (4.3%) earned less than $10,000 annually, 5 (7.2%)
earned between $10,000 and $20,000, 24 (34.8%) earned between
$20,000 and $40,000, 9 (13.0%) earned between $40,000 and $50,000,
and 28 (40.6%) earned at least $50,000. Of the 69 families, 65 were Cau-
casian, 3 were African American, and 1 was Hispanic.

Procedure

Approval was obtained from the review boards at the university

and at the clinical settings where participants were selected prior to
initiating the study. Once it was determined from medical records
that participants met the criteria, parents in the outpatient clinic or the
physician’s office were approached about the study and asked for
permission to approach their children. Only those families providing
consent were included in the study. Interviews and self-report ques-
tionnaires were completed independently by mothers, fathers, and
children. Data collection took place either before or after regularly
scheduled appointments with physicians or in the home to accommo-
date family schedules. Each parent and child was given a small incen-
tive of $10.

Instruments

All multiple-item scales were explored for internal consistency

reliability using Cronbach’s alpha. Results reported here are for the
Time 2 epilepsy sample in the larger study.

Self-concept. Self-concept was measured using the Piers-Harris

Children’s Self-Concept Scale (Piers, 1984). The Children’s Self-Concept
Scale is an 80-item scale that measures children’s perceptions of them-
selves. Children responded with “yes” or “no” to each item. Data
were coded so that a higher score indicates a more positive self-
concept. This instrument provides subscale scores on behavior,
 Haber et al. / Mother-Father Perceptions 65

happiness-satisfaction, intellectual and school status, physical appear-

ance, anxiety, and popularity as well as a total score. Recent research
shows the scale to have good reliability in a chronic illness sample
(McNelis et al., 2000). In this study, the total score was used in data anal-
ysis. Internal consistency reliability was .95 for the total scale.

Child Depression Inventory. The Child Depression Inventory

(Kovacs, 1980-1981), a 27-item scale, was used to measure overt
symptoms of depression. Children responded to each item with a rat-
ing of 0 to 2 in the direction of increasing psychopathology. Scores
greater than 12 suggest a risk of clinical depression. Recent research
showed the scale to have good reliability in a chronic illness sample
(McNelis et al., 2000). In this study, the internal consistency reliability
for the total scale was .88.

Attitude toward epilepsy. Children completed the 13-item Child Atti-

tude Toward Illness Scale (Austin & Huberty, 1993) to provide a mea-
sure of their attitudes toward having a seizure condition. Children
responded to the items on 5-point scales, and a total score was used in
data analyses. Recent research has supported the reliability and valid-
ity of the Child Attitude Toward Illness Scale (Heimlich, Westbrook,
Austin, Cramer, & Devinsky, 2000). Internal consistency reliability
was .84 in this study.
Parents completed a semantic differential attitude scale that was
developed for the larger study to measure parents’ positive and nega-
tive feelings associated with their children’s seizure condition. The
scale, which contains six items with bipolar adjectives reflecting the
evaluative domain (Osgood, Suci, & Tannenbaum, 1957), had an
internal consistency reliability of .77 in this sample. The total score
was used in data analyses.

Stigma. The 5-item stigma scale used in this study was based on the
adult stigma scale developed by Ryan, Kempler, and Emlen (1980).
Parents rated their perceptions of stigma surrounding their children’s
seizure condition on 7-point scales from 1 (very unlikely) to 7 (very
likely). A total score was used in data analyses. Internal consistency
reliability for this scale was .76.

Family adaptation. Parents completed the original version

(Smilkstein, 1978) and children completed the revised version (Aus-
tin & Huberty, 1989) of the Family Adaptation-Partnership-Growth-
66 JFN, February 2003, Vol. 9 No. 1

Affection-Resolve to obtain a measure of perceptions related to family

adaptation. These 5-item questionnaires measure each family mem-
ber’s satisfaction with five aspects of family function (adaptation,
partnership, growth, affection, and resolve) using 5-point response
scales ranging from 0 (strongly disagree) to 4 (strongly agree). The total
score was used in the analyses. Both the original scale (Smilkstein,
Ashworth, & Montano, 1982) and the revised scale (Austin &
Huberty, 1989) have demonstrated adequate reliability and validity
in previous research and in this sample. The internal consistency reli-
ability was .88 for both the original and revised versions.

Family adaptive resources. Mastery and Health is a 20-item subscale

of the Family Inventory of Resources for Management (McCubbin &
Comeau, 1991). Parents rated “how well the statement describes our
family situation” on 4-point scales from 0 (not at all) to 3 (very well).
The Mastery and Health subscale reflects a sense of mastery over fam-
ily events, mutuality, and physical and emotional health. Internal
consistency reliability for this subscale was .90.

Child coping. The Coping Health Inventory for Children (CHIC,

Austin, Patterson, & Huberty, 1991) was completed by each parent to
measure perceptions of the child’s coping. This 45-item scale mea-
sured parents’ perceptions of the extent to which the two coping pat-
terns, positive coping and negative coping, were used by their chil-
dren. Because in preliminary analysis these two coping scales were
found to be highly correlated and also because negative coping has
been more highly correlated with child adjustment outcomes in pre-
vious research, the negative coping scores were used in this study. The
negative coping subscale items address irritability and viewing one-
self as less worthy than other children because of the health condition.
Each parent described how often their child demonstrated the
maladaptive coping behaviors from 1 (never) to 5 (almost always).
Strong reliability (test-retest reliability and internal consistency) and
validity have been found for these subscales in past research (Austin
et al., 1991; McNelis et al., 2000). Internal consistency reliability for the
negative coping scale was .83.

Data Analyses

Descriptive statistics were calculated for all variables. For continu-

ous variables, these included means, ranges, and standard devia-
 Haber et al. / Mother-Father Perceptions 67

tions. Descriptive statistics for categorical variables included the

number and percentage in each category. Attitudes toward the epi-
lepsy and perceptions of family adaptation, family adaptive
resources, stigma, and negative coping were scored separately for
mothers and fathers. Intraclass correlation coefficients were used to
compare the agreement between mothers’ and fathers’ ratings of
these factors. Paired t tests also were conducted on each of these
scores to test whether, on average, mothers scored higher or lower
than fathers. In addition, the absolute value of the difference (absolute
difference score) between each mother’s score and each father’s score
was computed for each of these scales to measure the difference
within the family. The two outcomes were the child’s self-concept and
child’s depression inventory scores. The independent variables were
child’s attitude toward epilepsy, child’s perception of family adapta-
tion, illness severity, and the absolute values of the mother-father dif-
ference related to family adaptation, family adaptive resources,
stigma, attitudes toward epilepsy, and child’s negative coping. Illness
severity was grouped into inactive, low-, and high-severity levels.
Pearson correlation coefficients between each of the outcomes and the
respective absolute difference scores, child’s attitude toward epilepsy
and child’s perception of family adaptation, and Spearman correla-
tion coefficients between each of the outcomes and illness severity
were calculated to identify associations. Stepwise linear regression
was used for model selection using p = 0.15 for entry and p = 0.10 for
exit. Potential predictor variables for entry included the absolute dif-
ference scores for family adaptation, family adaptive resources,
stigma, attitude toward epilepsy, negative coping, child’s age and
gender, and family’s socioeconomic status, which along with the
forced variables of child’s attitude, child’s perception of family adap-
tation, and illness severity categories, account for 12 degrees of free-
dom. Illness severity, child’s attitude, and child’s perception of family
adaptation variables were forced because they were found to be asso-
ciated with either depression or internalizing problems in the larger
study (Austin et al., 1996; Dunn, Austin, & Huster, 1999). This is
greater than the recommended 10 observations per variable. How-
ever, no more than five variables (using 6 degrees of freedom) ever
entered the models at once. We also fit models that included all 12 pre-
dictor variables. However, the results from these models paralleled
those of the stepwise results (for example, child’s age and gender and
family’s socioeconomic status were not significant in the larger mod-
els, and there were no substantive differences with respect to the
68 JFN, February 2003, Vol. 9 No. 1

Table 1: Relationship Between Mother-Father Scores

Absolute
Mother Father Difference
Intraclass
a
Variable Correlation M SD M SD M SD

Family adaptation 0.47 15.04 3.39 14.09 3.66 2.78 2.39

Family adaptive resources 0.37 38.35 8.54 39.40 8.83 7.73 5.96
Stigma 0.29 17.09 6.56 16.99 5.79 5.43 4.97
Attitude toward epilepsy 0.40 3.33 0.88 3.46 0.60 0.63 0.52
Child’s negative coping 0.54 1.78 0.56 1.79 0.49 0.39 0.32

a. All intraclass correlations were significant at p < 0.05.

direction, magnitude, and significance of the variables of interest), so

we report only the results from the stepwise procedure. Transforma-
tions of variables were also looked at based on results from the
descriptive statistics. The aptness of the resulting regression models
was examined through residual diagnostics, including linearity of
regression function and normality and constancy of variance of the
error terms.

RESULTS

Both outcome variables showed wide variation. For self-concept,

the scores ranged from 24 to 78, with an average score of 60.1 ± 13.2
(mean ± standard deviation). The depression scores ranged from 0 to
31, with an average of 7.65 ± 7.43. A total of 16 children (23.2%) scored
12 or higher on the Child Depression Inventory, indicating risk for
clinical depression.
The descriptive statistics for the absolute difference scores, the
mothers’ scores, the fathers’ scores, and the intraclass (i.e., within
family) correlation coefficients are presented in Table 1. Intraclass cor-
relation coefficients were all significant, ranging from 0.29 through
0.54, indicating only slight to moderate agreement between parents’
perceptions. Paired t tests were not significant, indicating that moth-
ers’ ratings were not consistently higher or lower than fathers’ for
these scores. However, all of the absolute difference scores were
greater than 0, indicating there was difference in parents’ perceptions
of these factors.
 Haber et al. / Mother-Father Perceptions 69

Table 2: Final Regression Model for Child’s Self-Concept

Cumulative
2
Variable Beta t Score p Value Adjusted R

Child attitude 7.37 3.31 0.0015

Child Family APGAR 1.13 3.61 0.0006
Illness severity of inactive compared
with high 7.57 2.35 0.0222
Illness severity of low compared to high 4.77 1.36 0.1777 0.37
Difference in negative coping –11.30 –2.96 0.0044 0.44

Note: APGAR = Adaptation-Partnership-Growth-Affection-Resolve.

Child perceptions of family adaptation, child attitude toward epi-

lepsy, and the absolute difference scores between mothers’ and
fathers’ perceptions of children’s negative coping behaviors were all
highly correlated (p < 0.05) with the outcomes. The illness severity
score was highly correlated with self-concept (p < 0.01) and margin-
ally correlated (p = 0.07) with child depression symptoms. The abso-
lute difference between parents’ scores on family mastery was mar-
ginally associated (p = 0.07) with child depression, whereas the
difference between parents’ attitudes toward epilepsy was margin-
ally associated (p = 0.06) with self-concept.
The descriptive statistics revealed high variance on both child
depression and absolute differences. Appropriate transformations
were made, and the models were run as previously described. The
results were comparable to running the models on untransformed
data. For ease of interpretation, the results on the untransformed data
are shown as follows.
The stepwise regression model for predicting child’s self-concept
examined the absolute difference scores for family adaptation, family
adaptive resources, stigma, attitudes toward epilepsy, and negative
coping along with the child’s attitude toward epilepsy, perceptions of
family adaptation, and illness severity. However, mother-father dif-
ferences related to family adaptation, family adaptive resources,
stigma, and attitude did not reach the entry p value of 0.15. The final
regression model for predicting child’s self-concept is shown in
Table 2 (adjusted R2 = 0.44, F = 11.784, p = 0.0001). The addition of the
absolute difference in negative coping increased the adjusted R2 from
0.37 to 0.44. These results indicate that the greater the mother-father
absolute difference is in rating their children’s negative coping, the
poorer the child’s self-concept is.
70 JFN, February 2003, Vol. 9 No. 1

Table 3: Final Regression Model for Child’s Level of Depression

Cumulative
2
Variable Beta t Score p Value Adjusted R

Child attitude –4.30 –3.31 0.0016

Child Family APGAR –0.65 –3.57 0.0007
Illness severity of inactive compared
with high –1.76 –0.94 0.3536
Illness severity of low compared to high –0.82 –0.40 0.6882 0.31
Difference in negative coping 7.26 3.26 0.0018 0.40

Note: APGAR = Adaptation-Partnership-Growth-Affection-Resolve.

Similarly, the stepwise regression model for predicting child’s

level of depression symptoms examined the absolute difference
scores for family adaptation, family adaptive resources, stigma, atti-
tudes toward epilepsy, and negative coping along with the child’s
attitudes toward epilepsy, perceptions of family adaptation, and ill-
ness severity. However, mother-father absolute differences related to
family adaptation, family adaptive resources, stigma, and attitude
did not meet the entry p value of 0.15. The final regression model for
predicting child’s level of depression is shown in Table 3 (adjusted
R2 = 0.40, F = 10.133, p = 0.0001). The addition of the absolute differ-
ence in negative coping increased the adjusted R2 from 0.31 to 0.40.
These results indicate that the greater the mother-father absolute dif-
ference is in rating their child’s negative coping, the greater is the
child’s level of depressive symptoms.
For both models, the residuals showed that the regression model
was linear. They also showed that the error terms were normally dis-
tributed with constant variance. Thus, our models appear to be
appropriate to use.

DISCUSSION

The major finding of this study is that not all mother-father differ-
ences are related to self-concept or depression in children with epi-
lepsy. Differences in perceptions related to the children are more
strongly associated with the children’s depressive symptoms and
self-concepts than are differences related to family characteristics
(adaptation and family adaptive resources) or to the children’s illness
(attitude and stigma). Our results demonstrate that the greater the
 Haber et al. / Mother-Father Perceptions 71

mother and father differences are in rating their child’s negative cop-
ing, the lower is the child’s self-concept and the higher is the child’s
level of depressive symptoms. Possible reasons for these relation-
ships warrant close examination.
As described previously, negative coping is parents’ perceptions of
their children’s coping. Parents were asked to describe how often
their children made statements or demonstrated specific behaviors.
In 8 out of 10 items on the Coping subscale related to children viewing
themselves as less worthy than other children due to health condi-
tions, parents rate whether their children make statements reflecting
feelings or beliefs. For the Coping subscale that reflects irritability, 12
out of the 13 items are behaviors parents could observe. So, for both
subscales, parents’ reports would be based on what they have heard
the children say, what they have observed about the children’s behav-
iors, or what the other parents have told them about the children’s
speech or behavior.
Parents’ ratings may be accurate reflections of what they experi-
ence even when mothers and fathers have different perceptions. Dif-
ferences between parents’ reports could indicate they do not have
access to the same data about their children’s coping. For example, (a)
the child may be more likely to talk with one parent than with the
other, (b) one parent may have more opportunity to observe the child
than does the other parent, and/or (c) the parent who has observed or
talked with the child may have not communicated the information to
the other parent. Another source of difference in reports may be that
parents interpret the information differently due to their individual
characteristics, including psychological functioning (Duhig et al.,
2000). For example, a parent who views his or her child’s behavior as
reflecting on his or her competence or worth as a parent may deny
problems. If that parent’s spouse is better able to face real problems in
the child, differences between parents’ perceptions will occur.
Mother-father differences in perceptions of their child may be
highly related to how they treat the child. Differences in parenting
styles are common, with one parent being less strict, more sympa-
thetic, and so forth than the other parent. Mother-father differences in
perceptions would naturally occur if the child is more disruptive
when the parent who is primarily responsible for disciplining the
child is absent (Duhig et al., 2000). Differences may reflect other
aspects of family dynamics such as interaction patterns, coalitions,
and triangles within the family (Bowen, 1978; Kerr & Bowen, 1988; see
Innes, 1996; Knudson-Martin, 1994, for more recent research on
72 JFN, February 2003, Vol. 9 No. 1

Bowen’s family systems theory). In such families, the child’s relation-

ship with one parent may be very different from his or her relation-
ship with the other parent. In fact, Barnes (1989) used differences as
indicators of coalitions within the family. In some families, the parent-
child coalition may be much stronger than the marital coalition.
According to family system theory, strong cross-generational coali-
tions may be detrimental to the well-being of family members and to
the unit as a whole (Christensen & Margolin, 1988). More specifically,
Cox, Paley, Payne, and Burchinal (1999) suggested that the most dam-
aging aspects of such coalitions is that the parental behavior in parent-
child interactions is likely to be in response to the parent’s, not the
child’s, needs.
In Kodadek and Haylor’s (1990) interpretive research with families
with blind children, discrepancy between parents was one character-
istic of different family response styles. Kodadek and Haylor found
that (a) parents in realistically accepting families generally agreed on
parenting approaches; (b) mothers in the devoted-parent families
were the dominant parent, and the marital relationship was second-
ary to the parent-child relationship; (c) in families in which children
were expected to be perfect, fathers were the dominant parents and
the marital relationships were strained; and (d) in the overwhelmed
families, parents had separate and different approaches to parenting,
and marital relationships were not strong.
Knafl and Deatrick (1990) used data from a grounded theory study
of 62 families with chronically ill children to develop a theory of fam-
ily management style. Family management style refers to how fami-
lies as a unit respond to children’s chronic illness. One component of
the model is individual family members’ definitions of the situation.
These researchers present a case example in which members have
shared definitions of the situation and another case in which mem-
bers disagree about the impact of the illness on their family.
Eiser et al. (1992) studied 194 married couples who were parents of
children with a chronic condition (diabetes, asthma, cardiac disease,
epilepsy, and leukemia). These authors found no mother-father dif-
ferences in perceptions of their children’s frustration and/or hostility
and withdrawal (the measures of child functioning that are closest to
negative coping). Nonetheless, they speculated that differences
between parents’ perceptions of their children might help families
balance the limitations of chronic illness with the need for the children
to lead full and normal lives. Our findings do not support such a posi-
tive view of the effects of mother-father differences.
 Haber et al. / Mother-Father Perceptions 73

As Duhig et al. (2000) acknowledged, major discrepancies between

particular mothers and fathers may be clinically meaningful. Results
of this study (that the greater the mother-father differences in rating
their children’s negative coping, the lower are children’s self-con-
cepts and the higher the children’s levels of depressive symptoms)
may be especially relevant in those clinical situations in which chil-
dren with epilepsy have poor self-concepts and depressive symp-
toms. Given the high percentage of emotional problems in children
with epilepsy, nurses working with these children should routinely
assess their self-concepts and levels of depressive symptoms. If data
on either measure indicate the children are having problems, one area
to explore is parents’ differences in perception of negative coping.
Mother-father differences in rating children’s negative coping (one
parent viewing the child as having more problems than does the other
parent) may result in parental disagreement about whether counsel-
ing is indicated. A parent who does not view the child’s coping as
problematic, for example, is unlikely to participate in family counsel-
ing or to support individual therapy for the child. How nurses
respond in situations such as these depends on their skills in interven-
ing in the family system to induce change. The goal would be to
widen both parents’ knowledge about their children’s behaviors and
emotional lives. Specific interventions might include nurses (a) point-
ing out that it is natural for each parent to have his or her own percep-
tions, (b) encouraging parents to share with clinicians and each other
how they developed their perceptions, and (c) suggesting that par-
ents create opportunities to observe their children in settings unfamil-
iar to them.
If there is a high level of disagreement in mother-father perceptions
of children’s coping, nurse clinicians could assess the strength of par-
ent-child coalitions relative to the strength of their marriages. As
noted previously, the children’s well-being could be at risk when par-
ents have closer relationships with their children than with their
spouses. Instead of trying to directly reduce the intensity of the close
parent-child relationships, the clinicians’ goal would be to create a
better balance in the families by strengthening the couples’ marriages
and the children’s relationships with the other parents.
Theoretically, our current findings provide support for the impor-
tance of mother-father differences as a concept and demonstrate that
adding mother-father differences in perceptions as another factor to
the double ABCX model is warranted. The participant population
should be expanded to determine if results found in this study are
74 JFN, February 2003, Vol. 9 No. 1

true for general population families, for ethnic minority families, for
families of children with other chronic conditions, and for families of
children with epilepsy who live in other locations or who have had a
more recent epilepsy diagnosis. Further research is needed to more
fully understand the family dynamics in situations in which mother-
father differences in perception are associated with negative effects
on children’s well-being. For example, Cummings and Wilson’s
(1999) research on how marital conflict can be constructive or destruc-
tive from children’s perspectives implies that perhaps it may not be
mother-father differences per se but how these differences are han-
dled that have negative effects on children’s well-being. As Kazak,
Simms, and Rourke (2002) noted, managing conflict within the family
is a daily task. Therefore, future research should be designed to exam-
ine how mother-father differences are resolved.

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Linda C. Haber, D.N.S., R.N., C.S., is a clinical specialist at Veterans Affairs North-
ern Indiana Health Care System in Marion. Her research and clinical interests are in
the area of marriage and family dynamics. Recent publications include “Family The-
ory and Research” in Encyclopedia of Nursing Research (1998), New York:
Springer.

Joan K. Austin, D.N.S., R.N., F.A.A.N., is a distinguished professor in the School of

Nursing at Indiana University. Her program of research, which is funded by the
National Institute of Neurological Disorders and Stroke and the National Institute of
Nursing Research, focuses on child and family adaptation to childhood epilepsy.
Recent publications include “Informant Agreement of Behavior Ratings in Adoles-
cents With Epilepsy” (with T. J. Huberty, J. K. Harezlak, D. W. Dunn, & W. T.
Ambrosius) in Epilepsy & Behavior (2000) and “Behavior Problems in Children
Prior to First Recognized Seizures” (with J. K. Harezlak, D. W. Dunn, G. F. Huster,
D. F. Rose, & W. T. Ambrosius) in Pediatrics (2001).

Gertrude R. Huster, M.H.S., was a biostatistician in the Department of Medicine at

the Indiana University School of Medicine from 1992 to 1999. Her research focus was
in collaboration with Joan Austin evaluating children with epilepsy to determine fac-
tors affecting child adaptation (behavior, self-concept, and depression). Recent publi-
cations include “Symptoms of Depression in Adolescents With Epilepsy” (with
D. W. Dunn & J. K. Austin) in the Journal of the American Academy Child Ado-
lescent Psychiatry (1999) and “Childhood Epilepsy and Asthma: Changes in
Behavior Problems Related to Gender and Change in Condition Severity” (with J. K.
Austin & D. W. Dunn) in Epilepsia (2000).

Kathleen A. Lane, M.S., is a biostatistician at the Indiana University School of Medi-

cine. She has been a biostatistician for 5 years and has worked on numerous studies in
the fields of Alzheimer’s disease, osteoarthritis, radiology, nursing, and others.
78 JFN, February 2003, Vol. 9 No. 1

Recent publications include “Social Support and Health-Related Quality of Life in

Chronic Heart Failure Patients” (with S. J. Bennett et al.) in Quality of Life
Research (2001) and “Effect of Alignment of the Medial Tibial Plateau and X-Ray
Beam on Apparent Progression of Osteoarthritis in the Standing Anteroposterior
Knee Radiograph” (with S. A. Mazzuca et al.) in Arthritis & Rheumatism (2001).

Susan M. Perkins, Ph.D., is an assistant professor in the Indiana University School of

Medicine in Indianapolis. Her research interests are in the areas of biostatistics, health
services research, dermatological research, quality-of-life research, and epilepsy
research. Recent publications include “Using a Computer Reminder System to
Increase Preventive Care for Hospitalized Patients: A Randomized Controlled Trial”
(with P. R. Dexter et al.) in the New England Journal of Medicine (2001) and
“Assessing Rater Agreement Using Marginal Association Models” (with M. P.
Becker) in Statistics in Medicine (2002).