child routines moderate daily hassles and children's psychological adjustment

This article was downloaded by: [The Aga Khan University]On: 22 October 2014, At: 06:46Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

Children's Health CarePublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/hchc20

Child Routines ModerateDaily Hassles and Children'sPsychological AdjustmentAlexis Bridley a & Sara Sytsma Jordan aa Department of Psychology , University of SouthernMississippi , Hattiesburg , MSAccepted author version posted online: 31 Jan2012.Published online: 16 May 2012.

To cite this article: Alexis Bridley & Sara Sytsma Jordan (2012) Child RoutinesModerate Daily Hassles and Children's Psychological Adjustment, Children's HealthCare, 41:2, 129-144, DOI: 10.1080/02739615.2012.657040

To link to this article: http://dx.doi.org/10.1080/02739615.2012.657040

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all theinformation (the “Content”) contained in the publications on our platform.However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness,or suitability for any purpose of the Content. Any opinions and viewsexpressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of theContent should not be relied upon and should be independently verified withprimary sources of information. Taylor and Francis shall not be liable for anylosses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly orindirectly in connection with, in relation to or arising out of the use of theContent.

http://www.tandfonline.com/loi/hchc20

http://www.tandfonline.com/action/showCitFormats?doi=10.1080/02739615.2012.657040

http://dx.doi.org/10.1080/02739615.2012.657040

This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan,sub-licensing, systematic supply, or distribution in any form to anyone isexpressly forbidden. Terms & Conditions of access and use can be found athttp://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014

http://www.tandfonline.com/page/terms-and-conditions

Children’s Health Care, 41:129–144, 2012

Copyright © Taylor & Francis Group, LLC

ISSN: 0273-9615 print/1532-6888 online

DOI: 10.1080/02739615.2012.657040

Child Routines Moderate Daily Hasslesand Children’s Psychological

Adjustment

Alexis Bridley and Sara Sytsma JordanDepartment of Psychology, University of Southern Mississippi,

Hattiesburg, MS

This study examined child routines as a moderator of the relation between chil-

dren’s daily hassles and internalizing and externalizing behavior problems. School

and community children .n D 131/ ages 8 through 12 reported on daily hassles,

and their primary caregivers reported on child routines and behavior problems.

Moderated multiple regression indicated significant main effects for child routines.

A significant interaction was found between children’s daily hassles and child

routines for the internalizing model, but not for the externalizing model. Children

reporting more daily hassles had fewer internalizing behaviors when they also had

more frequent child routines.

The National Institutes of Mental Health (2011) reported that an estimated5% of American children—or approximately 2.7 million children—suffer from

severe emotional or behavioral problems. One of many reported predecessors

of children’s internalizing and externalizing behavior problems is stress (Thoits,

1995). The majority of research on the relation between stressors and psycho-

logical functioning has evaluated stress via major life events, such as divorce,death in the family, job loss, and so forth; however, more recently, literature

supporting the impact of small, but chronic stressors, such as daily hassles,

has also provided evidence that these “lesser” stressors may also play a role in

development of children’s behavioral and emotional problems. The aim of this

Correspondence should be addressed to Alexis Bridley, Department of Psychology, University

of Southern Mississippi, 118 College Dr., 5025, Hattiesburg, MS 39404. E-mail: alexis.bridley@

gmail.com

129

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014

130 BRIDLEY AND JORDAN

study was to further evaluate the relation between daily hassles and children’s

emotional/behavioral problems by exploring a potential protective factor (child

routines) against children’s internalizing and externalizing behavior problems.Daily hassles have been defined as “experiences and conditions of daily living

that have been appraised as salient and harmful or threatening to the endorser’s

well-being” (Lazarus & Folkman, 1984, p. 376). More specifically, daily hassles

are “irritating, frustrating, distressing demands that to some degree characterize

everyday transactions with the environment” (Kanner, Feldman, Weinberger, &Ford, 1987, p. 3). It is theorized that similar to major life events, these minute,

yet irritating, situations build on one another and contribute to emotional and

behavioral impairment in adults and children.

Several studies have supported daily hassles as more powerful assessments of

stress than major life events in children and adults when predicting psychological

symptoms and dysfunctions (Burks & Martin, 1985; Chamberlain & Zika, 1990).Daily hassles have been identified as a significant predictor of psychological

well-being and distress for mothers of young children (Chamberlain & Zika,

1990). Although only a few studies, to date, have examined the impact of daily

hassles on children’s psychological adjustment, studies evaluating the larger

construct of “stress” have provided consistent evidence that children exposedto frequent stressors are at greater risk for both internalizing and externalizing

behavior problems (Creasey, Mitts, & Catanzaro, 1995; Kliewer & Kung, 1998;

Lazarus & Folkman, 1984).

In the pediatric literature, daily stressors have also been implicated as a

contributing factor in the exacerbation of a number of pediatric chronic illnesses.More specifically, stress significantly predicts an increase in frequency and

intensity of pain episodes in both pediatric rheumatic disease and pediatric

sickle cell disease (Stone, Broderick, Porter, & Kaell, 1997; von Weiss et al.,

2002). Stress also predicts fatigue and stiffness in pediatric rheumatic patients

(Schanberg et al., 2000). Similar to the adult literature, daily stress is also

related to an increase in somatic complaints, especially in children with recurrentabdominal pain (Walker, Garber, Smith, Van Slyke, & Clarr, 2001). As evident

from both the child clinical and pediatric literatures, stress can greatly impact a

child’s emotional, behavioral, and physical well-being. Therefore, it is important

that children’s stress and factors that mitigate stress continue to be explored.

Although children exposed to a variety of stressful situations are at riskfor developing psychological problems, not all do. Researchers have identified

several social and family factors that may protect against the deleterious impact

of daily hassles on children’s psychological adjustment (Kliewer & Kung, 1998;

Von Weiss et al., 2002). For example, Von Weiss et al. found fewer daily

hassles and higher social support predicted fewer adjustment problems (bothinternalizing and externalizing) for children diagnosed with pediatric rheumatic

disease. In addition, Kliewer and Kung reported a significant relation between

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014

CHILD ROUTINES AND ADJUSTMENT 131

daily hassles and internalizing behavior problems and externalizing problems.

Family cohesion, family conflict, and family routines all moderated the relation

between daily hassles and internalizing behavior problems. Family cohesion,family conflict, adaptability, and family routines moderated the relation between

daily hassles and externalizing behavior problems. Specifically, high levels of

family cohesion and family routines mitigated the relation between daily hassles

and both internalizing and externalizing problems, whereas high levels of family

conflict were associated with more internalizing and externalizing problems. Fi-nally, high levels of family adaptability were associated with fewer externalizing

behaviors among children with more daily hassles.

Lanza and Drabick (2011) evaluated family routines (perceived and reported

by the child) as a moderator of hyperactivity/impulsivity symptoms and oppo-

sitional defiant disorder (ODD) from both the parent and teacher perspective.

Results indicated that children reporting high levels of routines and high levelsof teacher-reported hyperactivity/impulsivity symptoms were rated significantly

lower on the teacher ODD rating scale than those children reporting low levels

of routines. Results of the parent model were not significant. These findings are

consistent with previous literature, and suggest that routines may protect against

development of disruptive behavior disorders, even among children exhibitinghigh levels of hyperactive and impulsive behavior.

Researchers theorize that routines may also function as a protective fac-

tor against maladjustment among families experiencing stress associated with

chronic illness (Fiese & Wamboldt, 2000). It has been suggested that families

who already have regular routines in place may be better equipped to manage theadditional demands of a chronic illness, resulting not only in improved medical

regimen adherence, but also less psychological distress (Fiese & Wamboldt,

2000; Pierce & Jordan, 2012). Markson and Fiese (2000) examined family ritual

meaning and family ritual routine as protective factors against the development of

anxiety in children with asthma and comparison peers. Mother’s report of family

ritual meaning emerged as a protective factor against anxiety among childrenwith high health-life stress. Moreover, a recent longitudinal study of adjustment

among youth affected by maternal HIV/AIDS found that families with more

frequent family routines had youth with lower levels of a variety of internaliz-

ing and externalizing behaviors including depression, anxiety, aggression, and

conduct problems, over time (Murphy, Williams, Herbeck, & Payne, 2009).Taken together, these findings support a moderating role for family routines in

development of child and adolescent internalizing and externalizing behaviors.

Similar to family rituals and routines, child routines may also function as a

potential “buffer” for children’s behavioral problems. Child routines have been

defined as “observable, repetitive behaviors which directly involve the child andat least one adult acting in an interactive or supervisory role, and which occur

with predictable regularity in the daily and/or weekly life of the child” (Sytsma,

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014


Kelley, & Wymer, 2001, p. 243). It is important to distinguish individual child

routines from family routines because routines of individual children in families

may differ just as child adjustment may differ across children within a family(Jordan, 2003). It has been previously theorized that child routines may function

as a setting event for children’s compliance, with children being more likely to

comply with directives if they have a history of completing that activity in a

routine manner, such as at a regular time, place, and in a typical sequence

(Sytsma et al., 2001). Thus, it is expected that child routines will buffer theeffects of hassles on development of behavioral problems similar to that of

family rituals and routines by providing predictability and consistency in the

environment.

Child routines have been evaluated as a potential moderator in only one pub-

lished study. Greening, Stoppelbein, Konishi, Sytsma Jordan, and Moll (2007)

tested child routines as a moderator of the relation between emotional/behavioralproblems and adherence in children and adolescents diagnosed with insulin-

dependent diabetes mellitus. Although the moderation model was not supported,

previous studies demonstrating family cohesion and family routines as moder-

ators of stress and children’s behavior problems suggest further investigation

of child routines is warranted. To the extent that child routines increase theconsistency and predictability of daily events, they also may decrease the impact

of daily hassles on the development of internalizing and externalizing problems.

To date, no known studies have examined child routines as a potential pro-

tective factor against development of internalizing behavior problems, despite

evidence of significant correlations between the child routines and internalizingbehavior problems (Jordan, 2003). Therefore, the aim of this study was to

broaden the child stress literature by exploring the role of child routines as a

potential moderator of the relation between daily hassles and children’s psycho-

logical adjustment. It was predicted that children reporting a higher frequency

of daily hassles, but more daily routines (i.e., more consistency), would report

less internalizing and externalizing problems than children reporting a higherfrequency of daily hassles, but fewer child routines.

METHOD

Participants

Participants included 131 children ages 8 to 12 years (M D 9:44, SD D 1:22)

and their parent/guardian. Of the children, 56.8% were girls; 59.8% were White,

35.6% were Black, and 3% were mixed or “other” ethnicity. Initially, participantswere recruited from local schools in Mississippi; however, due to low rates

of participation from both students and school officials, participants were also

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014


recruited via undergraduate students. Of the students recruited through school

districts, 54.7% were enrolled in public schools and 45.3% in private schools. In

addition, 9.1% of the 131 participants reported previous psychological treatmentfor the child participant.

Measures

Demographic form. Parents/guardians were asked to provide information

about both themselves and the target child. Information about the parent/guardianincluded age, gender, race, marital status, educational background, occupation,

education, and household income. Information obtained about the child included

age, birth date, gender, race, grade, classroom teacher, and previous psycholog-

ical treatment.

Daily hassles. The Children’s Hassles Scale (CHS; Kanner, Coyne, Schae-

fer, & Lazarus, 1981) is a 43-item, child self-report questionnaire assessing the

occurrence and severity of daily hassles. Items are evaluated on a 3-point Likert

scale ranging from 0 (happened but it did not bother me), 1 (happened and

bothered me sort of bad), to 2 (happened and bothered me very bad)—childrenalso had the option of choosing “did not happen to me.” These responses yield

number of events that occurred, number of neutral events that occurred, number

of negative events that occurred, and sum of the negative events’ ratings of

bother. For this study, the sum of the negative events’ ratings of bother was used

to evaluate children’s daily hassles. Psychometric evaluations have demonstratedacceptable internal consistency, as well as construct validity (Varni, Rubenfield,

Talbot, & Setoguchi, 1989; Zuckerman, Oliver, Hollingsworth, & Austrin, 1986).

Coefficient alpha for this study was .90.

Child routines. The Child Routines Questionnaire (CRQ; Sytsma et al.,2001) is a 39-item, parent report measure (formerly named the Child Routines

Inventory), which assesses the occurrence of common child routines of children

aged 5 through 12. Items are evaluated on a 5-point Likert scale ranging from

0 (never) to 4 (nearly always), with higher scores reflecting more frequent

routines. The CRQ is divided into four factors: daily living routines, household

responsibilities, discipline routines, and homework routines, in addition to a

total routine score. The CRQ has demonstrated good psychometric properties

with good internal consistency (˛ D .79–.83 for subscales, and ˛ D :90 for

the total score), good test–retest reliability (r D .75–.85 for subscales, and

r D :86 for the total score), and adequate construct validity, strongly correlatingwith measures of family routines, child behavior problems, parenting stress, and

maternal depression (Sytsma et al., 2001; Sytsma-Jordan, Kelley, & Henderson,

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014


2002). For the purpose of this study, the CRQ total score was used to assess

child routines as a moderator .˛ D :93/.

Child behavior. The Child Behavior Checklist (CBCL) 6–18 (Achenbach

& Rescorla, 2001) is an empirically derived, parent report, broadband measure of

child adjustment for children aged 6 to 18 that is widely used in clinical research.

The scale yields a total problems score, two broadband scales (Internalizing

Problems and Externalizing Problems), and eight narrowband scales. The CBCLconsists of 113 items rated on a 3-point Likert scale ranging from 0 (not true) to 2

(very/often true), with higher scores reflecting poorer adjustment. Psychometric

evaluations have revealed high internal consistency ranging from .76 to .93

among both subscales and composite scores, high test-retest reliability, r D :90

for total scores, and good criterion-related and construct validity (Achenbach &Rescorla, 2001). For this study, Internalizing and Externalizing Problems were

used as criterion variables, and coefficient alphas were .87 and .90, respectively.

Procedure

Following university institutional review board approval, participants were re-

cruited through two different methods: local school districts and undergraduatesstudents.

School recruitment. Approval was obtained from local school boards,

superintendents, and principals depending on the authorization process required

by the district. Study information and consent forms were sent home for allchildren in the third through sixth grade. Eligible children (i.e., those aged 8–12)

returning a signed consent form within 1 week were asked to sign an assent form,

and were then administered the CHS during class time. Participating students

were provided a parent packet, which consisted of a letter and instructions, a

demographic form, the CRQ, and the CBCL. Parents were instructed to completeand return the packet to the child’s teacher by the end of that week.

Undergraduate recruitment. Participants were also obtained through the

assistance of undergraduate students, who were provided extra credit points or

course credit for recruiting study participants. Undergraduates were obtainedthrough an online human subject recruitment program (SONA) (Sona Systems

Ltd., Tallinn, Estonia). Undergraduates who agreed to assist in enrolling parents

and children into the study attended a training session, and were given verbal

instructions from the primary investigator on participant eligibility, informed

consent, and measure completion, which he or she was directed to provide tothe participating parent and child. Undergraduates were required to accurately

repeat the directions back to the primary investigator prior to being given a packet

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014


containing separate sets of forms for the parent (instruction letter, consent form,

demographic form, CRQ, and CBCL) and the child (child assent and CHS). All

participating parent’s/guardian’s names were entered into a drawing for two $50gift certificates to Walmart.

RESULTS

Preliminary Analyses

Due to the dual recruitment method, independent-sample t tests were performed

to determine if there was a significant difference on demographic and othervariables of interest between participants recruited through the two different

methods. There was a significant difference between recruitment methods on

participant race when dichotomized into White and Black, �2(1, N D 132/ D

11:31; p < :01; and on internalizing behavior problems, t(129) D 3.28, p D

:001. Children recruited through the schools were more likely to be White than

Black, and reported more internalizing behavior problems. Participant race wasnot significantly related to dependent measures (internalizing and externalizing

problems), and, therefore, was not controlled in subsequent analyses. Descriptive

statistics for study variables are provided in Table 1.

Bivariate correlations between demographic variables and dependent variables

revealed significant relations between total family income (with 8 differentranges treated as a continuous variable) and Externalizing Problems, as well as

children’s previous psychological help and both Internalizing and Externalizing

Problems (see Table 2). Previous psychological help was not controlled so as

to not place undue restriction on the inherent variability within the sample;

however, total family income was controlled in the externalizing model.

Main Analyses

Moderated multiple regressions were performed to determine if child routines

moderate the relation between children’s daily hassles and both internalizing

TABLE 1

Descriptive Statistics for Primary Variables

Variable M SD Minimum Maximum 25% 50% 75% Skewness

Child routines 113.99 19.58 37 143 102 118 128.00 �1.50

Daily hassles 28.57 15.52 0 71 14 29 40.00 0.18

Internalizing 49.52 9.09 33 75 43 48 53.25 0.73

Externalizing 48.98 8.97 33 68 44 47 56.00 0.37

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014

TA

BLE

2

Corr

ela

tions

Betw

een

Dem

ogra

phic

Variable

sand

Exte

rnaliz

ing

and

Inte

rnaliz

ing

Behavio

rs

Va

ria

ble

12

34

56

78

91

01

11

2

1.

Ex

tern

aliz

ing

—

2.

Inte

rnal

izin

g.5

9*

*—

3.

Ch

ild

age

.00

.04

—

4.

Ch

ild

gen

der

�.1

5�

.09

.06

—

5.

Ch

ild

race

.03

�.0

4�

.04

�.0

5—

6.

Hel

p�

.27

**

�.2

5*

*�

.12

.04

.03

—

7.

Par

ent

age

�.0

5.0

3.1

2.0

4�

.17

.03

—

8.

Par

ent

gen

der

.00

�.1

0�

.08

.06

�.2

5*

*.1

2.0

1—

9.

Inco

me

�.2

1*

�.1

8.0

7.0

3�

.34

**

.05

.23

*�

.03

—

10

.R

ecru

itm

ent

�.0

5�

.28

**

�.1

1�

.09

.18

*.1

2�

.09

�.0

2�

.07

—

11

.C

hil

dro

uti

nes

�.1

7*

�.2

9*

*�

.12

.10

.02

.04

�.0

1.0

8.1

2�

.10

—

12

.D

aily

has

sles

�.0

1�

.02

�.0

7.0

8.0

1�

.04

.02

�.1

2.0

6�

.02

�.0

8—

No

te.

ND

131

.G

end

er:

0D

mal

e,1

Dfe

mal

e;ra

ce:

0D

Wh

ite,

1D

no

n-W

hit

e;H

elp

Dp

rev

iou

str

eatm

ent

for

beh

avio

rp

rob

lem

s(0

Dn

o,

1D

yes

);re

cru

itm

ent:

0D

sch

oo

l,1

Du

nd

erg

rad

uat

es.

*p

<:0

5.

**p

<:0

1.

136

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014


TABLE 3

Moderated Multiple Regression: Child Routines Questionnaire and Internalizing

as Dependent Variable

Results From Final Model

Variable B SE B ˇ �R2

Step 1 .03

Daily hassles �.01 .06 �.02

Child routines �.10* .05 �.17*

Step 2 .03*

Daily Hassles � Child Routines �.01* .00 �.18*

Note. N D 130.

*p < :05.

and externalizing behavior problems (Holmbeck, 2002). Daily hassles and childroutines were centered for ease of interpretation of interactions and to minimize

multicollinearity between the main effects and interaction terms (Aiken & West,

1991; Holmbeck, 1997). Two interaction terms were calculated by multiplying

the children’s daily hassles total by each of the centered moderators.

Although child race was significantly related to internalizing problems basedon recruitment method, when regression models were separately analyzed based

on recruitment method, results were nonsignificant. Therefore, to conserve power,

participants were consolidated into one group. No control variables were entered

for the internalizing model; however, total family income was entered as a

control for the externalizing model. As shown in Table 3, the full sampledemonstrated a significant main effect for child routines and a significant inter-

action between children’s daily hassles and child routines for the internalizing

model, �F.1; 127/ D 4:183, p < :05 (R2D :061). However, post hoc tests of

simple slopes indicated neither the high routines group slope—t(127) D �1:66,

p D :099—nor the low routines group slope—t(127) D 0:993, p D :323—was

significantly different than zero (see Figure 1; Holmbeck, 2002). In addition,results failed to support child routines as a moderator of children’s daily hassles

and externalizing behavior problems; however, there was a significant main effect

of child routines and children’s externalizing behavior problems (see Table 4).

DISCUSSION

The results of the study support child routines as a moderator of children’s dailyhassles and internalizing behavior problems. One potential explanation for this

model is child routines reduce behavior problems by providing children with

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014


FIGURE 1 Children’s daily hassles and internalizing behavior problems, with child

routines as a moderator.

consistent and predictable lifestyles. More specifically, if a child is prone toexperiencing symptoms of depression or anxiety, child routines may alleviate

these symptoms by providing the child with predictability and consistency of

their day (Ivanova & Israel, 2006). For example, a highly anxious child who

does not have a consistent routine may worry that he or she will not have

time to complete his or her homework, whereas a child who has a consistentroutine knows the daily allotted time to complete homework, thus reducing

the homework-related anxiety. Previous findings also suggest that stability in

events and activities during childhood are associated with lower levels of re-

TABLE 4

Moderated Multiple Regression: Child Routines Questionnaire and Externalizing

as Dependent Variable

Results From Final Model

Variable B SE B ˇ �R2

Step 1 .04*

Total income �.87* .37 �.21*

Step 2 .04

Daily hassles �.03 .06 �.05

Child routines �.11* .05 �.19*

Step 3 .01

Daily Hassles � Child Routines �.00 .00 �.09

Note. N D 130.

*p < :05.

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014


ported depressive symptoms during college (Ivanova & Israel, 2005). Therefore,

child routines may also help buffer against symptoms of childhood depres-

sion by providing greater stability of events and activities (Ivanova & Israel,2006).

Psychosocial adjustment in children with chronic diseases is also impacted

by daily stress, which may be more magnified due to the daily hassles of disease

management. Positive family qualities (i.e., family cohesion) have been shown

to predict fewer behavioral symptoms, whereas negative or problematic familyqualities (i.e., conflict) predict higher levels of behavioral symptoms in children

diagnosed with a chronic disease (Drotar, 1997). Developing daily routines for

the child may reduce behavioral symptoms associated with disease management

by providing a consistent and specific time in which disease-specific behav-

iors occur, thus reducing the likelihood of family conflict, increasing medical

adherence and better overall disease management. For example, a child withtype 1 diabetes, who needs to routinely check his or her blood sugar, may

couple blood sugar checks with meals, thus consistently adhering to the medical

regimen while simultaneously developing a predictable and consistent schedule.

The routine would indirectly reduce family conflict, which frequently occurs

over disease-specific behaviors (e.g., blood sugar checking; Cohen, Lumley,Naar-King, Partridge, Cakan, 2004).

Findings from this study are also consistent with previous literature supporting

family routines as a moderator of daily hassles and internalizing problems in

inner-city youth (Kliewer & Kung, 1998). This study indicates that children

reporting a higher frequency of daily hassles and a higher frequency of dailyroutines report significantly less parent-reported internalizing behavior problems

than children reporting a higher frequency of daily hassles and a lower frequency

of daily routines; however, when the two slopes were further analyzed, results

indicated that neither slope was significantly different from zero. Therefore,

although child routines significantly moderated the relation between daily hassles

and internalizing problems, the effect was not robust.One explanation for the lack of significant slopes is the sensitivity of the

outcome measure coupled with a community sample. As a broadband measure

of psychopathology, the CBCL is most sensitive in the clinical range, and

may not adequately detect the impact of minute differences among children’s

reported daily hassles, particularly among non-clinical children. Although suchdifferences may cause individuals to experience different levels of distress, they

may not rise to the level of psychopathology that would be best captured by

this instrument. This study’s range of reported internalizing and externalizing

behavior problems is not representative of the population. More specifically,

there were no cases of clinically significant externalizing behavior problems.t � 70/ reported in this study, and very few cases of clinically significant

internalizing behavior problems reported given that the 75th percentile is well

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014


below the clinical range (see Table 1). Therefore, future studies should evaluate

internalizing and externalizing behavior problems using more sensitive instru-

ments, including narrowband scales, to better capture non-clinical responses,and use more diverse samples (i.e., include more clinical cases) to study these

relations.

The results of this study did not support the hypothesis that child routines

moderate the relation between children’s daily hassles and externalizing behavior

problems. This finding was not consistent with Kliewer and Kung’s (1998)findings with family routines moderating the relation between children’s daily

hassles and externalizing behavior problems among inner-city youth. It is unclear

whether these differences stem from the composition of the samples (inner city

vs. suburban), type of routine (family vs. child), or measurement of the outcome

variable (multi- vs. single informant). Yet, findings are consistent with other

single informant studies examining child routines as a moderator (Greeninget al., 2007; Jordan, 2003).

Although prior literature suggests daily hassles is a better construct for

evaluating stress than major life events due to the aversiveness and chronicity

of everyday events, this suggestion may only be true for individuals who are

experiencing significant amounts of stress (Chamberlain & Zika, 1990). Consis-tent with previous literature, it is predicted that the evaluation of daily hassles

better represents an individual’s adjustment and response to a significant stressor

(e.g., chronic illness) than solely evaluating major life events (DeLongis, Coyne,

Dakof, Folkman, & Lazarus, 1982; Kanner et al., 1987; Lazarus & Folkman,

1984). Lack of significant findings in this study may also be explained bythe shifted distribution of children’s reported daily hassles (see Table 1). The

possible range of reported daily hassles is 0 to 129; however, the range for this

study was 0 to 71. Given the restricted range, as well as the reported means and

quartiles, this study did not appear to capture a sample of children reporting

significant amounts of daily hassles. Thus, the shifted distribution of children’s

daily hassles responses limits findings related to those children reporting higheramounts of daily hassles.

Limitations and Directions for Future Research

These findings should be interpreted in light of several limitations. First, partic-ipants were recruited through two sources (i.e., local schools and via undergrad-

uates) with different racial compositions and level of internalizing problems.

More White than Black participants were recruited through local schools due

to a generally higher response rate for White participants, whereas race was

equally distributed in the undergraduate sample. Race was unrelated to thedependent variables; thus, it is unlikely these racial differences impacted these

findings. Also, children recruited through local schools reported higher levels of

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014


internalizing behavior problems than children recruited through undergraduates.

When separately analyzed based on recruitment method, neither of the modera-

tion models were significant. However, when the samples were combined, childroutines emerged as a significant moderator. Thus, the separate analyses may

have been underpowered due to small sample size.

A second potential limitation is the difference in measure administration

for children depending on the recruitment method. Children recruited through

local schools were orally presented the questions to reduce the amount oftime children were removed from the classroom, whereas children recruited

through undergraduate students completed their measures outside the laboratory.

Therefore, it is unknown if the children recruited through undergraduate students

were provided the same help as children recruited through local schools. In

an effort to reduce differences in measure administration, parents of children

recruited through undergraduate students were given detailed instructions aboutadministration. No significant difference was observed in mean daily hassles

across the administration methods. Thus, it does not appear that measure ad-

ministration affected children’s response patterns.

The study is also limited by its cross-sectional design and reliance on a single

method of data collection (questionnaires). As a result, directionality and causalrelations cannot be concluded. Future, longitudinal studies using larger sample

sizes with uniform recruitment and administration methods are recommended.

Implications for Clinical Practice

This study provides tentative information on potential points of intervention to

reduce internalizing problems among children who report experiencing a large

number of daily hassles. By providing a consistent and predictable schedule

for children, caregivers may help to reduce internalizing behavior problems.

For example, if an anxious child has an erratic school pickup schedule, that

child may become increasingly anxious if his or her parent is running 10 minlate, wondering if he or she was supposed to take the bus home; however, an

anxious child with a consistent school pickup schedule would know that his or

her parent is coming, and is probably running late. Similarly, providing children

with a predictable and stable environment may also help reduce exacerbation of

depression symptoms.Child routines are also identifiable practices that can aid in the development

and implementation of health interventions for pediatric patients. By developing

disease-specific routines, families will be able to identify when medical supplies

are low (i.e., syringes for diabetes) or when prescriptions need refills prior to

running out. In addition, developing daily routines may also be helpful in provid-ing consistency with medical regimens, thus improving medical adherence (i.e.,

taking medication at the same time everyday, checking blood sugar before meals,

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014


etc.; Pierce & Jordan, 2012). Better medical adherence has been consistently

related to less medical complications, as well as reduced disease-related family

conflicts, thus reducing the stress in the home (Drotar, 1997; Fiese & Wamboldt,2000; Kliewer & Kung, 1998).

To greater or lesser degrees, families tend to engage in daily routines to help

minimize the demands of multiple responsibilities (home, work, and kids). It is

important that clinicians identify these routines and use them as a guide when

developing and implementing behavioral management techniques for childrenpresenting with internalizing or externalizing problems. By coupling interven-

tions with already consistent behaviors, clinicians will also increase the likeli-

hood of successful implementations of interventions.

ACKNOWLEDGMENTS

Portions of this study were originally conducted by Alexis Bridley as a Master’s

thesis, in partial fulfillment of requirements for a doctoral degree in ClinicalPsychology. Further information regarding child routines, daily hassles, and

children’s psychological adjustment is available upon request.

REFERENCES

Achenbach, T. M., & Rescorla, L. A. (2001). Manual for ASEBA school-age forms & profiles.

Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.

Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions.

Newbury Park, CA: Sage.

Burks, N., & Martin, B. (1985). Everyday problems and life change events: Ongoing versus acute

sources of stress. Journal of Human Stress, 11, 27–35. doi:10.1080/0097840X.1985.9936735

Chamberlain, K., & Zika, S. (1990). The minor events approach to stress: Support for the use of daily

hassles. British Journal of Psychology, 81, 469–481. doi:10.1111/j.2044-8295.1990.ab tb02373.x

Cohen, D., Lumley, M., Naar-King, S., Partridge, T., & Cakan, N. (2004). Child behavior problems

and family functioning as predictors of adherence and glycemic control in economically disad-

vantaged children with type I diabetes: A prospective study. Journal of Pediatric Psychology, 29,

171–184. doi:10.1093/jpepsy/jsh019

Creasey, G., Mitts, N., & Catanzaro, S. (1995). Associations among daily hassles, coping, and

behavior problems in nonreferred kindergartners. Journal of Clinical Child Psychology, 24, 311–

319. doi:10.1207/s15374424jccp2403_8

DeLongis, A., Coyne, J. C., Dakof, G., Folkman, S., & Lazarus, R. (1982). Relationship of daily

hassles, uplifts, and major life events to health status. Health Psychology, 1, 119–136. doi:10.

1037/0278-6133.1.2.119

Drotar, D. (1997). Relating parent and family functioning to the psychological adjustment of children

with chronic health conditions: What have we learned? What do we need to know? Journal of

Pediatric Psychology, 22, 149–165. doi:10.1093/jpepsy/22.2.149

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014


Fiese, B. H., & Wamboldt, F. S. (2000). Family routines, rituals, and asthma management: A

proposal for family-based strategies to increase treatment adherence. Families, Systems & Health,

18, 405–418. doi:10.1037/h0091864

Greening, L., Stoppelbein, L., Konishi, C., Sytsma Jordan, S., & Moll, G. (2007). Child routines and

youths’ adherence to treatment for type 1 diabetes. Journal of Pediatric Psychology, 32, 437–447.

doi:10.1093/jpepsy/jsl029

Holmbeck, G. N. (1997). Toward terminological, conceptual, and statistical clarity in the study of

mediators and moderators: Examples from the child-clinical and pediatric psychology literatures.

Journal of Consulting and Clinical Psychology, 65, 599–610. doi:10.1037/0022-006X.65.4.599

Holmbeck, G. N. (2002). Post-hoc probing of significant moderational and mediational effects in

studies of pediatric populations. Journal of Pediatric Psychology, 27, 87–96. doi:10.1093/jpepsy/

27.1.87

Ivanova, M., & Israel, A. (2005). Family stability as a protective factor against the influence of

pessimistic attributional style on depression. Cognitive Therapy and Research, 29, 243–251. doi:

10.1007/s10608-005-3167-0

Ivanova, M., & Israel, A. (2006). Family stability as a protective factor against psychopathology

for urban children receiving psychological services. Journal of Clinical Child and Adolescent

Psychology, 35, 564–570. doi:10.1207/s15374424jccp3504_7

Jordan, S. S. (2003). Further validation of the Child Routines Inventory (CRI): Relationship to

parenting practices, maternal distress and child externalizing behavior (Dissertation No. AAT

3098074). Retrieved from http://etd.lsu.edu/doc/available/etd-0612103-213510

Kanner, A. D., Coyne, J. C., Schaefer, C., & Lazarus, R. S. (1981). Comparison of two modes

of stress measurement: Daily hassles and uplifts versus major life events. Journal of Behavioral

Medicine, 4, 1–39. doi:10.1007/BF00844845

Kanner, A. D., Feldman, S. S., Weinberger, D. A., & Ford, M. E. (1987). Uplifts, hassles, and

adaptational outcomes in early adolescents. Journal of Early Adolescence, 7, 3. doi:10.1177/

0272431687074002

Kliewer, W., & Kung, E. (1998). Family moderatos of the relation between hassles and behavior

problems in inner-city youth. Journal of Child Clinical Psychology, 27, 278–292. doi:10.1207/

s15374424jccp2703_5

Lanza, H. I., & Drabkick, D. A. G. (2011). Family routine moderates the relation between child

impulsivity and oppositional defiant disorder symptoms. Journal of Abnormal Child Psychology,

39, 83–94. doi:10.1007/s10802-010-9447-5

Lazarus, R. S., & Folkman, S. (1984). Stress appraisal, and coping. New York, NY: Springer.

Markson, S., & Fiese, B. H. (2000). Family rituals as a protective factor for children with asthma.

Journal of Pediatric Psychology, 25, 471–480. doi:10.1093/jpepsy/25.7.471

Murphy, D. A., Williams, W. D., Herbeck, D. M., & Payne, D. L. (2009). Family routines and

parental monitoring as protective factors among early and middle adolescents affected by maternal

HIV/AIDS. Child Development, 80, 1676–1691. doi:10.1111/j.1467-8624.2009.01361.X

National Institutes of Mental Health. (2011). American children: Key national indicators of well-

being 2011. Bethesda, MD: Retrieved from http://www.childstats.gov/pdf/ac2011/ac_11.pdf

Pierce, J., & Jordan, S. (2012). Development and evaluation of the pediatric diabetes routines

questionnaire. Children’s Health Care, 41(1), 56–77.

Schanberg L. E., Sanstorm, M. J., Starr, K., Gill, K. M., Lefebure, J. C., Keefe, F. J., : : : Tennen,

H. (2000). The relationship of daily mood and stressful events to symptoms in juvenile rheumatic

disease. Arthritis Care & Research, 13, 33–41. doi:10.1002/1529-0131(200002)13:1<33::AID-

ART6>3.0.CO;2-5

Stone, A. A., Broderick, J. E., Porter, L. S., & Kaell, A. T. (1997). The experience of rheumatoid

arthritis pain and fatigue: Examining momentary reports and correlates over one week. Arthritis

& Rheumatism, 10, 185–193. doi:10.1002/art.1790100306

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014


Sytsma, S., Kelley, M., & Wymer, J. (2001). Development and initial validation of the Child Routines

Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 241–251. doi:10.1023/A:

1012727419873

Sytsma-Jordan, S., Kelley, M. L., & Henderson, M. (2002, November). Children’s routines, parenting

stress, and maternal depression in parent–child dyads referred to a multidisciplinary ADHD clinic

and nonreferred controls. Poster presented at the 36th annual meeting of the Association for

Advancement of Behavior Therapy, Reno, NV.

Thoits, P. A. (1995). Stress, coping, and social support processes: Where are we? What next? Journal

of Health and Social Behavior, 35, 53–79. doi:10.2307/2626957

Varni, J. W., Rubenfield, L. A., Talbot, D., & Setoguchi, Y. (1989). Determinants of self-esteem

in children with congenital/acquired limb deficiencies. Journal of Developmental and Behavioral

Medicine, 10, 13–16. doi:10.1097/00004703-198902000-00003

Von Weiss, R. T., Rapoff, M. A., Varni, J. W., Lindsley, C. B., Olson, N. Y., Madson, K. L., &

Bernstein, B. H. (2002). Daily hassles and social support as predictors of adjustment in children

with pediatric rheumatic disease. Journal of Pediatric Psychology, 27, 155–165. doi:10.193/jpepsy/

27.2.155

Walker, L. S., Garber, J., Smith, C. A., Van Slyke, D. A., & Clarr, R. L. (2001). The relation of daily

stressors to somatic and emotional symptoms in children with and without recurrent abdominal

pain. Journal of Consulting and Clinical Psychology, 69, 85–91. doi:10.1037/0022-006X.69.1.85

Zukerman, L. A., Oliver, J. M., Hollingsworth, H. H., & Austrin, H. (1986). A comparison of life

events scoring methods as predictors of psychological symptomatology. Journal of Human Stress,

12, 64–70. doi:10.1080/0097840X.1986.9936769

Dow

nloa

ded

by [

The

Aga

Kha

n U

nive

rsity

] at

06:

46 2

2 O

ctob

er 2

014

child routines moderate daily hassles and children's psychological adjustment

Documents