Abstract
Background Maternal interactive behaviors theoretically affect developmental outcomes and mastery motivation in young children. However, these associations are inconsistent in the literature.
Objective The purposes of this study were: (1) to examine the differences in maternal behaviors between toddlers with motor delay (MD) and those with typical development (TD), (2) to investigate the correlation of maternal behaviors and developmental quotients (DQs) in toddlers with MD and TD, and (3) to examine the correlation of maternal behaviors and mastery motivation in toddlers with MD and TD.
Design This was a sex- and mental age–matched case-control study.
Methods Twenty-two mother-child dyads of toddlers with MD (ages 23–47 months) and 22 dyads of sex- and mental age–matched toddlers with TD (ages 15–29 months) were recruited. Maternal scores from the Nursing Child Assessment Teaching Scale, 2 indicators of motivation (persistence and mastery pleasure) from individualized mastery tasks and the Dimensions of Mastery Questionnaire, and DQs from the Comprehensive Developmental Inventory for Infants and Children were assessed.
Results Mothers of children in the MD group showed significantly lower cognitive growth fostering scores than mothers of children in the TD group. Maternal total scores were significantly correlated with whole DQs in both groups. In the MD group, maternal total scores correlated significantly with DMQ mastery pleasure but not with mastery task motivation.
Limitations The study design makes it impossible to know the causal relationships between maternal behaviors and children's DQs and motivation.
Conclusions Mothers of toddlers with MD exhibited less adequate interactive behaviors than mothers of toddlers with TD. Because higher-quality maternal behaviors correlated with higher DQs in the MD group, clinicians should encourage parents to participate in early intervention programs and model high-quality parenting behavior to enhance parents' and children's outcomes.
Quality of maternal interactive behaviors with their children has aroused research attention because mothers are the primary caregivers within the home environment, the most important social environment for infants and toddlers.1 Maternal behavior better predicts children's future adaptive behavior than a standardized cognitive developmental test,2 and it also affects children's development of mastery motivation.3 Maternal interactive behavior is mothers' behaviors observed in the mother-child interaction context.4 Four indicators are often used to represent maternal behavior: sensitivity to cues, response to child's distress, social-emotional growth fostering, and cognitive growth fostering behavior.5 Sensitivity to cues is the caregivers' ability to recognize and respond to the child's cues. Response to child's distress is the caregivers' ability to soothe a distressed child. Social-emotional behaviors are caregivers' abilities to provide learning experiences in interpersonal and affective domains. Cognitive growth fostering behaviors include providing scaffolding, appropriate assistance, adequate teaching behavior, and encouraging rather than controlling types of learning experiences.
Previous literature about maternal behaviors comparing toddlers with and without disabilities has varied. Some studies showed lower sensitivity to cues or lower responses to child's distress in mothers of children with disabilities than in mothers of children with typical development (TD) matched on chronological age,6–8 but some studies demonstrated no group differences.9,10 Although maternal social-emotional growth-fostering behavior showed no group differences in several studies,6–10 cognitive growth-fostering behavior was found to be lower in mothers of toddlers with disabilities than in mothers of toddlers with TD matched on chronological age or mental age.6–8,11–13 For preschoolers, the effects of child disability on maternal cognitive growth-fostering behavior were inconsistent.8,10,14 Maternal behavior during maternal-child interaction can be influenced by multiple factors, including maternal (ie, education, well-being, and personality), contextual (ie, social network, marital relations, and testing contexts), and child factors (ie, severity or type of disability, age, sex, temperament, and mastery motivation).9,15–21 Thus, the effect could be bidirectional: mothers affect their children, and children can affect their mothers.
Another important issue is whether maternal behavior is related to developmental outcomes. Vygotsky22 emphasized that young children learn to develop independent actions through experiences with their knowledgeable mothers. Previous studies also showed that the higher the quality of maternal behavior, the better the cognitive ability in toddlers with disabilities.23–27 Some studies showed that maternal cognitive growth-fostering behaviors were positively associated with motor ability in young children with physical disabilities.28,29 However, other studies showed no significant correlations in young children with Down syndrome or preterm infants.2,24 The somewhat inconsistent results might be due to different types of disabilities and different indicators of maternal behavior across the studies. Regarding children with TD, studies of maternal behaviors (ie, sensitivity to cues, responsiveness, and verbal stimulation promoting cognitive development) have demonstrated positive correlations with children's cognitive ability at 6 to 40 months of age30–33 and with children's motor abilities in infancy.34 In conclusion, research evidence suggests correlations between maternal interactive behavior and developmental outcomes in toddlers with and without motor delay (MD).
The relation between maternal behavior and children's motivation is also an important issue. Mastery motivation is defined as a multifaceted, psychological force that stimulates the child's attempt to master tasks that are at least moderately challenging for him or her.35 This construct can be measured by: (1) persistence, or the duration of task-directed behavior; and (2) mastery pleasure indexed by positive affect during or immediately after task-directed behavior.36 Several studies have shown that higher cognitive growth-fostering behaviors of mothers were related to higher motivation of their children with developmental delays.10,14,37–40 On the contrary, Young and Hauser-Cram41 found that maternal response to child's distress but not cognitive growth fostering behavior was positively correlated with persistence of preschoolers with delays. These somewhat inconsistent results regarding association between maternal behaviors and children's motivation might be due to different maternal and child motivation measures used in the studies. Motivation outcomes may vary when measured by observation in mastery tasks or by questionnaires with maternal ratings.42
A previous study showed that, even when controlling for sex, activity level, and developmental quotients (DQs) of children with TD, total scores of the Home Observation for Measuring Environment Inventory (HOME) at 6 months but not 2 years of age were positively correlated with children's persistence at 3 years of age.43 A variety of cognitive-oriented activities, positive affect, and nondirective behaviors in the social environment were facilitators of motivation in toddlers aged 12 or 20 months.44–46 There were, however, no conclusive results in previous studies for toddlers with TD at 24 to 36 months of age. Although Kelley et al47 found that maternal evaluative feedback and control style at 24 months could predict children's persistence at 36 months, Gilmore et al14 found that, for 2- to 3-year-olds, maternal directiveness was not significantly correlated with a concurrent measure of children's object mastery motivation. In addition to maternal behavior, there are likely other variables that are part of the equation that affects mastery motivation and the DQ, such as child temperament, socioeconomic status (SES), parental education, and quality of home environment in children with and without MD.17,43–47
The purposes of this study were: (1) to examine differences in 4 indicators of maternal behavior between mothers of toddlers with and without MD, (2) to investigate correlations between maternal behavior and DQs in toddlers with and without MD, and (3) to examine correlations between maternal behavior and children's motivation in the 2 groups. We hypothesized that: (1) there would be significantly lower cognitive growth fostering behaviors in mothers of toddlers with MD than in mothers of toddlers with TD, who were matched pairs based on their children's mental age and sex; (2) maternal behavior would be significantly correlated to developmental outcomes in toddlers with and without MD; and (3) there would be significant correlations between maternal behavior and motivation in toddlers with and without MD.
Method
Design and Setting
We conducted a sex- and mental age–matched case-control design study at a university laboratory in Taiwan.
Participants
To calculate the sample size, we used the study by Kolobe,29 which investigated correlations (Pearson r) between maternal behavior measured by the Nursing Child Assessment Teaching Scale and developmental outcomes in children with MD. The correlation coefficients between maternal behavior and developmental outcomes were about .55.29 When we set the correlation coefficient as .50, α level as .05, and power as .80, the estimated sample size was 22 for each group.48 Thus, a convenience sample of 22 Taiwanese children with MD was recruited from hospitals and clinics in the greater Taipei area.
The inclusion criteria for children with MD were: (1) aged from 24 to 48 months; (2) medical doctor's diagnosis related to motor delay, including impaired sensorimotor function with nonprogressive disorders of the central nervous system or impaired neuromotor development; (3) motor DQ less than 85 (1 SD below the mean of the norm) measured by the diagnostic test of the Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT)49; (4) cognitive and fine motor developmental age of 15 months or above in order to have the skills to perform the mastery tasks used in this study; (5) mothers as the primary caregiver of the children for at least 4 hours daily; and (6) mothers' educational level was at least junior high school, and there was adequate reading ability to fill out the questionnaire. The exclusion criteria were: (1) unstable health condition, such as progressive epilepsy, frequent hospitalization, or receiving a surgical operation in the previous 6 months; (2) visual or auditory impairment; and (3) diagnosis of autism spectrum disorder or attention deficit hyperactivity disorder.
For each child with MD, a mental age– and sex-matched child with TD was recruited from advertisements or well-baby clinics in a medical center. For each pair, the child with TD had a chronological age within 2 months of the mental age of the sex-matched child with MD. Inclusion criteria for children with TD were: (1) the whole CDIIT DQ was 85 or above,49 (2) mothers as the primary caregiver for at least 4 hours daily, and (3) mothers' educational level was at least junior high school.
Measures
Nursing Child Assessment Teaching Scale.
The Nursing Child Assessment Teaching Scale (NCATS) is used to measure mother-child interaction for children from birth to 36 months of age. In a standardized context, a certificated observer scored the presence or absence of 73 behaviors on a “yes/no” scale while the mother was teaching a task, which was just beyond the child's developmental capability. The NCATS is organized into 6 subscales: 4 subscales describe maternal behavior (sensitivity to cues, response to child's distress, social-emotional growth fostering, and cognitive growth fostering), and 2 subscales describe child behavior (clarity of cues and responsiveness to parents). The child behavior subscales were not used for this report. The 4 maternal subscales were summed to obtain the maternal total score.5 Higher maternal total scores indicate higher quality of maternal interactive behavior in a teaching context. Maternal total scores for children with TD had acceptable test-retest reliability (r=.86).5 Support for the validity of NCATS has been shown by its discrimination between mothers of preterm infants and those of full-term infants.5 In addition, the NCATS maternal total score at 12 months of age was a significant predictor of children's cognition and language developmental outcomes at 18 months.50
Comprehensive Developmental Inventory for Infants and Toddlers.
The CDIIT is a diagnostic developmental test with 5 developmental domains (cognition, language, motor, social, and self-help). Developmental ages and DQs in all domains can be obtained based on norms with 3,703 Taiwanese children aged 3 to 72 months.51 The mean DQ for each domain is 100, with a standard deviation of 15. According to the CDIIT manual, a DQ of 85 or above is within normal limits, 70 to 84 is borderline; 55 to 69 is mild delay, 40 to 54 is moderate delay, and 39 or below indicates severely delayed performance.52 The CDIIT has acceptable psychometric properties, including test-retest reliability, construct validity, and concurrent validity.49,51–54
Dimensions of Mastery Questionnaire.
The Dimensions of Mastery Questionnaire (DMQ) is used to rate caregivers' perceptions of children's behavior on 2 indicators of motivation: total persistence and mastery pleasure. The DMQ contains 45 items, each rated on a 5-point Likert scale from 1 (“not typical at all”) to 5 (“very typical”).55,56 Our team translated the DMQ into Chinese for children aged 1.5 to 5 years. A back translation by 2 bilingual people who were unfamiliar with the DMQ was approved by Morgan (the DMQ developer) after adjustments were made based on a pilot test.57 Morgan et al57 compared results from English and Chinese parents and reported evidence for reliability and validity in both English and Chinese versions of the DMQ. The total persistence score included 4 types of items: object-oriented persistence items (eg, tries to complete tasks involving objects or toys such as puzzles even if they are hard), gross motor persistence items (eg, tries to do well in physical activities even when they are hard), social persistence with adults' items (eg, tries to get adults to understand), and social persistence with children's items (eg, tries to get included when children play). The mastery pleasure items included, for example, smiles broadly after finishing something. The score for each of these 2 scales was obtained by averaging item scores that ranged from 1 to 5. A higher score indicates higher mastery motivation. Both the English and Chinese versions of the DMQ have acceptable internal consistency (α>.7).56,57 Validity of the DMQ also was demonstrated by distinct differences in motivation between infants at low and high risk for motor delay42,56 and by factor analyses.57 Furthermore, the DMQ showed moderate stability in children with TD aged 2 to 3 years.43
Individualized structured mastery tasks.
Two sets of individualized structured mastery tasks, developed by Morgan et al,58 were modified somewhat to observe object-oriented motivation for children aged 15 to 48 months.42 Two types of tasks were used: 6 puzzles and 3 cause-effect toys with difficulty levels that varied from easy for children with TD at age 15 months to difficult for children with TD at 3.5 years of age. One specific puzzle and one cause-effect toy were identified during testing as moderately challenging (ie, not too easy and not too difficult) for each child.58 The moderate difficulty level for each mastery task was estimated initially by the child's mental age according to CDIIT results and was determined by the child's performance during the tasks. The criterion for moderate challenge was that the child successfully completed at least one part of the task but did not finish all parts of the task within the first 2 minutes.58 Once a moderately challenging task was identified, the examiner continued with that task for up to 4 minutes.
The child's behavior during the structured mastery tasks was coded in 5-second intervals for 2 indicators: task persistence and task pleasure. Persistence was calculated as the number of 5-second intervals (0–48) in which the child showed mostly task-directed behavior (ie, trying to fit a puzzle piece). Mastery pleasure was calculated from the number of 5-second intervals in which the child showed positive facial expressions, vocalizations, or gestures during or immediately after task-directed behavior. Task persistence and mastery pleasure were summary scores combining the scores from the moderately challenging puzzle and cause-effect toy. The structured mastery tasks had acceptable psychometric properties, including interrater reliability (kappa=.80–.89) in this study as well as in the literature.40,42,58
Procedure
Mothers and children were invited to the laboratory for a 90-minute session. After a warm-up period (with interesting toys other than the testing materials), the mother-child teaching interaction observation was conducted and videotaped. The CDIIT was administrated by a trained pediatric physical therapist after a 5-minute break. The mental age of each child was calculated immediately after this test and used for choosing an estimated initially appropriate difficulty level for later mastery tasks. After another 5-minute break, the child was tested using the individualized structured mastery task method while the mother filled out the DMQ in the same room with her back facing the child.
Data Reduction and Analysis
Mother-child interactive behaviors were coded using the videotaped NCATS teaching session.5 Two certified coders had an interrater reliability of 80% agreement for 5 videotapes of mother-child dyads. For motivation during the mastery tasks, Mangold INTERACT software (Mangold International and Thought Technology Ltd, Arnstorf, Germany)59 was used to code the toddler's most prevalent behavior during every 5-second interval of the 4-minute video recording of each mastery task. The intercoder reliability was acceptable (puzzle task: kappa=.81; cause-effect task: kappa=.85) when 2 coders blinded to the child's status separately coded 10 videos of children with and without MD.
The variables were examined for normality and analyzed using SPSS software, version 17.0 (SPSS Inc, Chicago, Illinois). Descriptive statistics were used to present basic information about the children, their families, and the scores of various measures. For comparison of the differences between the 2 groups, paired t tests were used for continuous variables with normal distribution because the 2 groups were matched on sex and mental age. For paired t tests, effect sizes (ESs) were calculated as d=mean difference in 2 paired groups/standard deviation of the paired differences.60 Because previous reviews indicated that maternal education had an influence on maternal behavior,9,11 we further analyzed the group differences using analysis of covariance (ANCOVA) to control for maternal education. The correlations of maternal behavior with children's DQs and motivation were analyzed by using Pearson correlations. To further examine the group differences, we used Fisher r-to-z transformation analysis to assess the significance of the difference between correlation coefficients of the MD and TD groups.61
Role of the Funding Source
This study was supported, in part, by Grant NSC 96-2314-B-002-074-MY3 awarded by the National Science Council of Taiwan.
Results
Group Characteristics
The descriptive data of children with MD (age range=24–47 months) and with TD (age range=15–29 months) and their families are reported in Table 1. In addition to MD, 13 children had other medical diagnoses: cerebral palsy (n=4), Down syndrome (n=2), Williams syndrome (n=1), microcephalus (n=1), failure to thrive (n=1), and genetic disorders (n=4). Although there were significant differences in DQs between the 2 groups, there were no differences in developmental age on any of the domains of the CDIIT, except the social domain (Tab. 1). Based on the norms in the CDIIT manual,52 6 children in the MD group scored in the borderline range for motor delay, and 12 scored in the borderline range for cognitive delay; 4 scored in the mild range motor delay, and 3 scored in the mild range for cognitive delay; 8 scored in the moderate range for motor delay, and 7 scored in the moderate range for cognitive delay; and 4 scored in the severe range for motor delay, and none scored in the severe range for cognitive delay.
Comparisons of the Characteristics of Children With and Without MD and Their Familiesa
Children with MD had significantly lower parental DMQ ratings of motivation than those with TD, but there were no significant group differences in motivation measured with the individualized mastery tasks (Tab. 1). There were no group differences in family variables (ie, maternal age, SES, and annual household income), except maternal education (z=2.39, P=.017). All mothers in the TD group had earned a college or graduate degree, but significantly fewer (68%) in the MD group had earned those degrees. Family socioeconomic class (SES) levels were based on the father's education and occupational status and varied from I to IV, with I representing the highest SES.62 Almost all participants (93%) were middle class (SES III) or higher, with similar percentages in the MD group (9%, 59%, 18%, and 14%) and in the TD group (4%, 64%, 32%, and 0%). Annual household income was ranked based on 7 categories varying from >NTD 0.4 million to <NTD 3 million. The average ranks (3.86 for the TD group and 3.55 for the MD group) were not significantly different. One Taiwan dollar was equivalent to about US$0.0323, and the average annual household income in Taipei was about NTD 1.5 million (approximately US$48,450) at the time of the study.
Group Differences on Maternal Interactive Behavior
Comparisons between the MD and TD groups on the NCATS subscales are shown in Table 2. Children with MD were rated significantly lower on maternal total scores and cognitive growth-fostering scores than children with TD (t=−2.28 and −3.00 respectively, both P<.05) with medium-sized effects (ES=0.49 and 0.64, respectively).63 There were no significant differences on other subscales between groups.
Comparison of Maternal Interactive Behavior of Mental Age- and Sex-Matched Children With and Without MD on the Subscales of the Nursing Child Assessment Teaching Scalea
The ANCOVA showed that, after controlling for maternal education, the cognitive growth fostering behavior of the mothers of toddlers with MD was still lower than that of mothers of toddlers with TD (F=4.87, P=.030). Maternal total score was no longer significant after controlling for mother's education, and the other 3 NCATS subscales remained nonsignificant (F=0.03∼1.51, all P>.10).
Correlations of Maternal Interactive Behaviors and Developmental Quotients
The results revealed that the maternal total scores and cognitive growth fostering scores were significantly related to cognitive, motor and whole DQs in the whole group (Tab. 3). In both the MD and TD groups, maternal total scores were significantly related to the whole DQ. The cognitive DQ and motor DQ also were significantly related to maternal total scores (r=.52 and .45, respectively) and sensitivity to cues (r=.45 and .64, respectively) in the MD group, and they were significantly related to the cognitive growth fostering behaviors in the TD group. In both groups, the other 2 indicators of maternal behavior were not significantly correlated with the 3 DQs (r=.04–.39, P=.08–.85 in the MD group; r=.02–.31, P=.16–.95 in the TD group). All of the significant correlations were at moderate levels (r=.43–.65).
Correlation Coefficients Between Maternal Interactive Behaviors, Developmental Outcomes, and Mastery Motivation in Toddlers With MD (n=22) and in Toddlers With TD (n=22)a
Based on Fisher r-to-z transformation analysis, no differences of the values of the correlation coefficients between the MD and TD groups (z=−0.86, 1.52; P=.13–.92) were found. These results indicate that the positive correlations between maternal behavior and DQs were similar in toddlers with and without MD.
Correlation Between Maternal Interactive Behaviors and Mastery Motivation
In the whole group, the maternal total and cognitive growth fostering scores were significantly correlated with DMQ scores but not with the individualized mastery task scores (Tab. 3). However, the correlations between maternal behavior and motivation indicators were different in the 2 groups. In the MD group, the maternal total scores and cognitive growth fostering behaviors were significantly correlated with DMQ mastery pleasure, and cognitive growth fostering behaviors correlated with DMQ persistence. In the TD group, the maternal total score was only significantly associated with persistence on the individualized mastery tasks. Again, the significant correlations were of moderate size (r=.38–.56).
Comparing the correlation coefficients between the 2 groups, the results showed no group differences in magnitudes of the correlation coefficients (z=−1.84, 1.67; P=.07–.98) except for maternal total score with DMQ mastery pleasure (z=2.00, P=.0455). Thus, it appears that the relationship between maternal interactive behaviors and children's mastery motivation is not very different in the 2 groups, except for perceived pleasure.
Discussion
The key findings of this study were that mothers of toddlers with MD exhibited lower cognitive growth fostering behaviors than mothers of toddlers with TD. Higher quality of maternal behavior was positively correlated with whole DQs in both groups. However, the associations of maternal behavior and children's motivation were somewhat different in the 2 groups. Possible reasons for the key findings are discussed below, along with clinical implications.
Group Differences in Maternal Interactive Behavior
Our findings indicated that mothers of toddlers in the MD group showed less cognitive growth fostering behavior than mothers of toddlers in the TD group, even when controlling for maternal education. Thus, our hypothesis about group differences in cognitive growth fostering behavior between mothers of toddlers with and without MD was supported. However, there were no differences in sensitivity to cues, response to child's distress, and social growth fostering between the 2 groups.
There are several possible reasons to explain the group differences in cognitive growth fostering behavior. First, compared with the TD group, the mothers of toddlers in the MD group allowed less time for their children to manipulate the task after the first instruction. They restricted their children from trying non-task play after the original presentation of the teaching materials. Previous studies demonstrated that mothers of children with MD provided more restrictions and more directions when teaching than mothers of children with TD, probably because children with MD exhibited few initiations and responded to their mothers more slowly than children with TD did.8,14,64 A previous study also demonstrated that mothers of children with MD perceived lower mastery motivation in their children even though their children actually did not show lower motivation for mastering tasks that were moderately difficult for them.42 Furthermore, in the current study, mothers of children with MD seldom described perceptual qualities of the task materials to the child, and the mothers seldom used both vocal descriptions and modeling simultaneously in teaching any part of the task. They probably perceive their children as unlikely able to understand complicated sentences, vulnerable, and in need of physical assistance because of their children's disabilities.8,14
Correlations Between Maternal Interactive Behavior and Developmental Quotients
Another key finding of this study was that maternal total scores were positively correlated with the whole DQs in both groups. This result is similar to the findings of previous studies23–27 and supports Vygotsky's theory. Vygotsky22 claimed that skilled caregivers' scaffolding support could facilitate children's learning. Scaffolding means that caregivers have a good grasp of children's present ability levels and provide adequate teaching strategies to help children learn new skills and achieve better developmental outcomes.22 The concept of scaffolding was similar to cognitive growth fostering behaviors and sensitivity to cues in the present study. Our hypothesis about positive association between high quality of maternal behavior and developmental outcomes in toddlers with and without MD was supported. In addition, the associations between indicators of maternal behavior and DQs showed similar patterns in the 2 groups.
Correlations Between Maternal Interactive Behavior and Mastery Motivation
The results of this study showed that the associations between different indicators of maternal behavior and the 2 indicators of motivation were somewhat different in the MD and TD groups. We found that maternal behavior was significantly correlated with perceived motivation but not with task motivation in Taiwanese toddlers with MD. Thus, our hypothesis about positive association between high quality of maternal behavior and mastery motivation in toddlers with and without MD was partially supported. The results suggest that maternal behaviors affect some aspects of motivation more than others and affect the motivation of children with MD and TD differently.
However, in contrast to our findings of no relation of maternal behavior and task motivation, several previous studies from Western countries have shown positive associations between maternal behavior and task motivation in toddlers with delays or disabilities.10,39–41 Thus, cultural differences may be a factor influencing the relationship between maternal behavior and child motivation. Furthermore, for toddlers with developmental problems in Western countries, maternal perceived motivation was significantly correlated with task motivation of children,65 but these variables were not significantly correlated for toddlers in Taiwan.42 As we mentioned previously, Taiwanese mothers of children with MD might be more influenced by having a child with special needs. They may perceive lower mastery motivation of their children even though their children did not exhibit lower task motivation when given tasks that were moderately difficult for them.42 Mothers' perceptions mutually interact with their behaviors and their children's regulatory processes.66 That might have produced significant correlations between maternal behavior and perceived motivation for Taiwanese toddlers with MD in this study.
Clinical Application
The results of this study demonstrated that, in the teaching context, mothers of children with MD had lower interactive behaviors compared with mothers of mental age–matched peers with TD. Maternal behavior was significantly correlated with children's DQs and perhaps was affected by their perceptions of children's motivation. There is strong scientific evidence for the significant developmental impacts of early experiences, caregiving relationships, and environmental threats on child development.67 Young children, compared with older children, may be particularly vulnerable to detrimental experiences derived from low-quality caregiving.67 Therefore, family-centered training or assistance should be the practice focus in early childhood intervention.68 Clinicians should collaborate with parents and emphasize instruction and consultation with parents as well as procedural intervention.69 Clinicians could instruct parents or demonstrate the “one-step ahead” approach,70 in which adults provide appropriate and necessary assistance to help the child attain the next level of performance.70 Therapists also could educate parents about how to observe and support children's mastery attempts, offer cognitively stimulating activities and toys in various settings, give emotional support, and provide teaching strategies that match the child's skills.71–73 If parents show clear, consistent, and contingent behavior in response to their children's actions, it would help children learn a sense of having an effect on their environment74 and to participate actively.
Limitations
Some limitations of this study were: (1) the study design does not allow us to know whether maternal behavior has a causal effect on toddlers' development and motivation; (2) there was sample homogeneity because most participants in this study had middle to upper middle SES (thus, whether the results could be generalized to parent-child dyads of lower class needs further study); (3) large within-sample variability on the mastery tasks and the relatively small sample sizes made it impossible to control potential influencing factors, such as different activity levels and sex; (4) mothers probably show different interactive behaviors when observed by a tester and in different settings, such as the home or laboratory; (5) mothers of older children with cognitive delay probably perceive their children differently than mothers of mental age–matched children with TD, so our matched pairs are not equivalent in this sense; (6) maternal interactive behaviors and children's development, as well as children's mastery motivation, could be influenced by many factors (ie, child temperament,17 SES,43 quality of home environment43–47) that were not measured or not fully controlled in this study; and (7) the relations between maternal interactive behaviors and mastery motivation might be bidirectional.17 More longitudinal studies are needed to clarify how interplay between maternal behavior and mastery motivation evolves during the early years for children with and without developmental delay.
In conclusion, the findings of this study indicate that mothers of toddlers with MD exhibited fewer cognitive growth fostering behaviors than mothers of toddlers with TD even when controlling for maternal education. Furthermore, higher-quality maternal behavior was associated with higher DQs for both groups. In regard to children's motivation, lower perceived mastery pleasure was associated with poorer maternal interactive behavior for the MD group. Therapists should encourage parents of toddlers with special needs to participate in early intervention programs and model high-quality parenting behaviors in order to enhance parents' as well as children's outcomes.
Footnotes
Ms Wang, Dr Hwang, and Associate Professor Liao provided concept/idea/research design and data analysis. Ms Wang, Dr Morgan, and Associate Professor Liao provided writing. Ms Wang and Associate Professor Liao provided data collection and project management. Associate Professor Liao provided fund procurement, facilities/equipment, institutional liaisons, and administrative support. Dr Morgan, Dr Chen, and Associate Professor Liao provided consultation (including review of the manuscript before submission). The authors thank all participating children and their parents. The authors acknowledge the Pitotech Company for providing them with a trial version of Mangold INTERACT software for data analysis.
This study was supported, in part, by Grant NSC 96-2314-B-002-074-MY3 awarded by the National Science Council of Taiwan.
- Received November 18, 2013.
- Accepted August 11, 2014.
- © 2014 American Physical Therapy Association
References
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