Removing the Mystery: Evaluation of a Parent Manual by Adolescent Parents
Lambert, Connie, Adolescence
Every thirty-one seconds an adolescent becomes pregnant in the United States and every two minutes one gives birth (Hardy& Zabin, 1991). The U.S. adolescent birthrate is the highest among Western countries (Hardy & Zabin, 1991; Thomas, Rickel, Butler, & Montgomery, 1990; Merrill, 1989), with approximately one million teens under the age of 18 becoming pregnant each year (Hardy & Zabin, 1991; Voydanoff & Donnelly, 1990). Just under fifty percent of these adolescents give birth, over ninety percent of whom elect to keep their children (Hardy & Zabin, 1991; Levine, Coil, & Oh, 1985). According to the Washington State Board of Health (1992), teenage mothers are 1.4 times more likely than nonteenage mothers to experience the death of their infants. This infant mortality rate may be due to the mother's lack of prenatal care, lack of knowledge concerning appropriate childcare techniques, or to tobacco, alcohol, or other drug use prior to and following the birth of her child.
Early parenthood disrupts personal and family development, school completion, and economic self-sufficiency. Many adolescent parents drop out of school, are unemployed, and live in poverty. Thus, the adolescent mother must cope with restricted resources which, in turn, can limit the quality of life she can offer her child (Cooper, Dunst, & Vance, 1990).
Because of age and stressful events that frequently accompany youthful pregnancy, researchers have questioned the ability of adolescents to parent their young in ways that promote optimal development (Dickinson & Cudaback, 1992). Many adolescent mothers have inadequate social support networks, lack adequate knowledge of child development, and possess inappropriate child-rearing attitudes.
Typical Mother-Child Interaction
Quality parent-child interactions are necessary for the child to develop appropriately within the context of a trustful, secure relationship. Since an infant is dependent upon others, especially the mother, to tend to basic biological and social needs, infant-caregiver bonding is determined by the quality of their interactions and the infant's subsequent feelings of security that these needs will be met. Lawrence (1983) has stipulated that maternal attachment (affectionate ties that ensure that the infant will indeed be cared for by the mother) is essential to the healthy psychological development of the child. Maternal playfulness, sensitivity, encouragement, and responsiveness at three months of age have been found to be positively related to attachment at nine months (Owens, 1992).
Anastasiow (1983) has defined optimal parental behavior as responsiveness to the infant's emotional and educational needs, monitoring the infant's health, promoting language development, providing psychological warmth, and encouraging the infant to master developmental tasks at age-appropriate stages. Elster, McAnarney, and Lamb (1983) have added parent sensitivity as an appropriate parental behavior. Sensitivity is described as the ability to provide contingent, consistent, and appropriate responses to the infant's signals, perceive the infant's cues, interpret the cues correctly, and implement proper responses in an effective manner.
The early relationship between infant and caregiver, especially the mother and child, is one of being close and interacting in a variety of ways, such as touch and eye gaze. These early interactions "teach" the infant about turn taking, social interaction, communication, and language. If the interactions are positive, they also let the infant know that he or she is important and has ways of controlling the environment.
Early language is learned through interactions between the child and caregivers at home. In the very early stages of infancy, most caregivers use language as one means of communicating socially. Although adults are aware that infants do not yet understand language, they use language as if the child is understanding what is said. This is the beginning of language as an integral part of the communication process.
Lieven (1984) has discussed how particular aspects of adult talk may affect how children learn to talk, emphasizing the importance of quality parent-child interactions. The interactional style of language learning is described as an adult-child verbal. interchange that is centered on the child's interests and needs, and where the child's language processing capacities interact directly with the situation in which language is being learned. The child's utterances are reinforced, elaborated upon, and expanded by the caretaker; thus language learning occurs in contexts. When caregivers are deficient in skills that promote healthy, appropriate, related language/communication and interactive skills, the child is at risk for developmental delay as an infant and, later, in school, where the severity of the deficit is likely to increase (Lieven, 1984).
Teenage Mother-Child Interaction
Many adolescent mothers struggle with the developmental tasks of adolescence and motherhood; they are still trying to resolve conflicts in which they are the child - not the parent (Dickinson & Cudaback, 1992; Weinman, Schreiber, & Robinson, 1992; Sahler, 1983). The adolescent mother's ability to cope with her parenting role is heavily dependent upon the social support she receives. A supportive environment is one of the most critical factors in the development of both the infant and adolescent mother and is highly related to the adolescent mother's maternal role behavior.
Adolescent mothers have demonstrated limited knowledge about children and their developmental processes as well as shown less nurturing behavior than have adults (Lawrence, 1983). Emotional immaturity and basic inexperience with child rearing may affect adolescents' parenting behavior, which in turn may place their children at risk for abuse and neglect as well as social, emotional, and cognitive disabilities (Weinman, Schreiber, & Robinson, 1992; Causby, Nixon, & Bright, 1991; Anastasiow, 1983).
Anastasiow (1983) has noted that a disproportionate number of children of adolescent mothers are in need of special educational services. He has further stated that lack of parental child-care knowledge and skills may cause children who are normal at birth to suffer from disabilities by school age due to inadequate stimulus and responsiveness and to various forms of abuse and neglect. In short, the adolescent mother may provide an environment that fails to fulfill the child's genetic potential.
Through early intervention and education, parents may learn the skills necessary to provide their children with a nurturing environment in which to develop. As one possible early intervention strategy, a parent manual was developed with the help of parents whose children attended a Head Start program at an urban center. A parent-child interaction model was used as the philosophical base for the manual. The, manual presents examples of age-appropriate parent-child interactions, and parents are encouraged to participate in activities that are meaningful. and functional for their children. Communication and literacy activities are also integrated throughout. The manual was designed for parents with low literacy levels and includes a simple format, large print, easy language, and photographs to illustrate the text. This paper presents the results of an evaluation by pregnant and parenting adolescents to determine if they could read and understand the manual, if it contained relevant information, and if they would use it and recommend it to others.
Initially, the parent manual was evaluated by 13 parents who were older (average age = 27.5 years) and better educated (average education level = 12.8 years) than many parents of young children. In order to determine if younger, less educated parents could also read and understand the manual, a group of adolescents was investigated.
Thirteen. ethnically diverse adolescents were recruited from a special program at an urban high school. The 1.3 females ranged in age from 14 to 18, with an average age of 16.8 years. Four of the subjects were pregnant with their first child. Each of the remaining 9 had one child, ranging in age from 4 to 18 months. The subjects were in grades 8 through 12, with an average education level of 10.2 years.
Parent manual. The manual covers information about communication, safety, nutrition, behavior management, developmental milestones, and parenting. It is divided into nine units. Each of the first six units covers three months of development, from birth to 18 months of age. Each of the last three units covers six months of development, from 18 to 36 months of age.
Format evaluation. If the manual is to be used, it is essential that; it is attractive and functional. Therefore, as part of the evaluation process, the adolescents were asked to review the format of the manual. The Format Evaluation. Form was designed so that participants could comment on such things as layout and attractiveness as well as the style of binding (taped, plastic spiral, and three-ring notebook) and the size of the print. It consisted of five questions pertaining to the physical presentation of the manual. Participants circled the response that best described their opinion and were asked to elaborate upon their answers by using the comment section provided on the form.
Readability evaluation. In order to determine if the adolescents could understand the wording and vocabulary, they were asked to carefully and thoroughly read a portion of the manual. Each adolescent was given a packet that contained the table of contents, introduction, and two units of the manual. Rather than use an evaluation form, participants wrote directly on the pages of the packet, circling words they did not understand and marking areas that appeared unclear.
Content evaluation. In order to evaluate the information provided in the manual, the adolescents were given a complete copy. After reviewing the manual, they completed two tasks: (1) they circled words they did not understand and marked areas that appeared unclear, and (2) they completed the Content Evaluation Form. This form consisted of six open-ended questions. Four questions concerned participants' opinions about the information contained in the manual (for example, whether they would like more information about topics that were included or had suggestions for including topics that were not covered). The last two questions asked whether they would actually use the manual and how they envisioned it being used (for example, individually or in groups). The Content Evaluation Form concluded with a section on demographic information: date of birth, highest grade in school completed, and age of child.
The director of the school program was asked to facilitate the evaluation process because it was felt that participants would feel more comfortable and provide honest responses about the manual. The evaluation occurred during regularly scheduled classes, and materials were not allowed to leave the room. The format evaluation took place on the first day and the readability and content evaluations on the second and third days, followed by group discussion on the fourth day.
The program director began by explaining the purpose of the evaluation: to determine the usability and usefulness of a parent manual that had been developed specifically for parents of young children (birth to three years). She emphasized that comments and opinions were important and would be carefully considered during the revision process. In order to reduce anxiety about having to produce written responses on the evaluation forms, the director stressed that complete sentences were not necessary. Instead, adolescents were encouraged to write notes or comments as personal reminders for use during the group discussion.
The program director provided directions and materials for completing each phase of the evaluation and stayed with the group to answer questions. Directions were given both orally and in written form.
During the evaluation process, participants were asked to comment on fourteen specific items within the three major areas under investigation: (1) Format (6 items) - binding, print size, table of contents, introduction, organization, and attractiveness; (12) Readability (2 items) - words not understood and areas that were unclear; (3) Content (6 items) - whether they liked or disliked the manual, if some areas of the manual were better than others, additional information they would like included, if they would use it, if they would recommend it to others, and how they thought the manual could best be used.
A qualitative approach was used to analyze the data from the written evaluations and group discussion. The program director was the key informant and results were discussed with her before final revisions were made to the manual.
There were patterns of consistency in four of the six format items, in both readability areas, and in five of the six content items.
Evaluations of the format indicated that the manual is indeed simple to follow and understand. The size 16 font was chosen because it is easy to read and still allows for sufficient text on each page. The two-page format, with developmental milestones on the left page and corresponding activities on the right, was chosen so that readers could see all of the pertinent information at one time. The consistency of the format and overall organization was also apparent when participants did not select specific areas of the manual that they thought were better. The format of each unit was the same, with similar amounts of information in each.
Evaluations of the introduction varied. The introduction was seven pages long and defined the areas of development (i.e., communication, motor development, cognitive development, play, social and emotional development, and self-help behaviors). The introduction also explained the format of the book and the organization of the units. Five of the participants thought that the length of introduction was acceptable, 'but eight thought it was too long. One stated that she did not read introductions because she did not think they contained important information. Another suggested that the introduction be called a "prologue" because students "know from reading novels that if you skip over the prologue, you miss something."
The introduction stated that developmental milestones are behaviors and skills that are considered "typical" for a specific age group. Additionally, the introduction stressed that children develop at different rates and that development was usually uneven because one child may develop faster in one area and more slowly in another. Although this was explained, two of the participants may have viewed the developmental milestones as concrete skills their child should have by a certain age. They appeared to think that if their child could not perform these skills, then there was something wrong. One subject stated, "Some kids may develop later than others. So what if my baby doesn't uncover a toy - is he mentally developing wrong? I don't think so." Another participant seemed to question the need to include developmental milestones at all: "We know what our kids are doing and that children develop at different ages. For example, my son is only 18 months old, wears 3T clothes, and forms simple sentences."
Participants had specific comments about the different styles of type that were used in the introduction. Developmental areas were emphasized by the use of italics and underlining simultaneously. Other information was set in bold type. Six subjects commented negatively on the use of underlining and italics for emphasizing information and stated that they thought only bold lettering should be used.
Other than mixed responses regarding the type of binding preferred and the introduction, parents' responses concerning size of print, table of contents, and overall organization and attractiveness of the manual were consistently favorable.
Four participants who did not think the manual was attractive were pregnant with their first child at the time of the evaluation. Because these prospective mothers did not have personal experiences to draw from in order to adequately comment on the substance of the manual, they may have chosen to comment on its appearance. Three of the four also stated that they did not like the manual - that it was too long and boring. Reactions by those
expecting their first child would seem to indicate that information in the parent manual may not; be relevant; to some pregnant adolescents. Examples of age-appropriate developmental milestones and activities that promote quality parent-child interactions may be more applicable when they have a child with whom to interact. For expectant adolescents, information concentrating on basic child care may be more useful.
Group sessions facilitated by a knowledgeable leader may be the most appropriate way to present information on parent-child interactions for expectant adolescents. A group leader can pace information to match the interests of group member's and explain or expand the information if needed. Contrary to the comments by participants expecting their first child, none of the participants who had children stated that they disliked the manual or that it was unattractive; their comments were favorable.
Great care was also taken to ensure that the language of the parent manual was kept simple. Professional jargon was kept to a minimum, and when it was used, it was explained. None of the participants circled words they did not understand or marked areas that were unclear, thus indicating that the manual was indeed readable regardless of education level.
The recommendations by the high school participants included providing more information about basic caretaking skills, such as diapering, bottle care, and discipline. Further, they agreed that if the manual was to be titled Removing the Mystery: Your Baby and You!, then it should contain more information specifically targeting parents - the you part of the manual. Suggestions for additional topics included postpartum depression, how parental moods affect responses to children, and how to deal with violent behavior. Finally, the adolescents agreed that the manual could best be used as a resource for group discussions, similar to those held in class, instead of using it independently in their homes.
The literature concerning adolescent parenting indicates that these mothers tend to be less socially, emotionally, and cognitively mature (Brooks-Gunn & Furstenberg, 1988; Causby, Nixon, & Bright, 1991; Dickinson & Cudaback, 1992; Merrill, 1989; Whitman, Borkowski, Shellenbach, & Nath, 1987). Adolescents are less knowledgeable about children and developmental processes and are less prepared to provide for their babies' needs. According to Elster, McAnarney, and Lamb (1983), "the cognitive immaturity of adolescents produces a self-centeredness which may prevent them from placing their infants' needs ahead of their own desires." (p. 498). Young mothers tend to assume that their infants have only physical needs and limited mental capacities.
Loevinger's theory of ego development includes nine sequential stages in which each represents a progressively more complex way of perceiving oneself in relation to the world (in Levine, Coll, & Oh, 1985). They range from the impulsive stage, when one's view of the world is concrete and egocentric, to the autonomous and integrated stages. Levine, Coil, and Oh (1985) found adolescent parents to be at the conformist stage, in which morality is only partly internalized and interpersonal relations are seen in terms of actions and events rather than feelings or motives. Nonadolescent mothers were found to be a full stage higher than adolescent mothers - at the self-aware stage, in which there is a growing self-awareness and capacity for criticism and introspection. More mature mothers typically have higher ego development and see their infants as separate individuals who need to be nurtured rather than "toys to fulfill their own needs" (Levine, Coll & Oh, 1985, p. 28). Thus, in the present study, the adolescents' suggestions for more basic child-care information, as well as information targeting parental emotional concerns, may be the result of low ego development and cognitive immaturity.
The cognitive immaturity of the adolescents in this study may have increased the amount of stress they encountered in the more complex and demanding role of parent (Whitman et al., 1987). Thus, their need for social support networks may be greater than that of more mature parents. Elster, McAnarney, and Lamb (1983) have described social support as cognitive guidance, social reinforcement, tangible assistance, social stimulation, and emotional support. Social support often mediates the effects of stress associated with parenting, increases the parent's knowledge of child development, enhances maternal self-esteem, and provides practical assistance. This support can be provided by the father of the child, family of origin, peers, and outside agencies, and it influences the child's development through its effects on parental competence and parenting style.
Due to the adolescents' early transition to parenthood, their social supports may be limited. The spouse has been found to be the most important source of support for mothers (Colletta, 1981; Whitman et al., 1987), but adolescent mothers often remain single and the baby's father may not be available. Therefore, adolescent mothers commonly must rely upon other sources of support. However, young mothers may be isolated from peers and social activities due to the responsibilities of motherhood and, depending on the reaction to the child, adolescents' families may be unsupportive. Thus, social isolation is a possibility for many adolescent mothers.
All of the adolescent parenting programs reviewed for this study were group oriented (Thomas et al., 1990; Causby, Nixon, & Bright, 1991; Kissman, 1992; Weinman, Schreiber, & Robinson, 1992). Many of these programs were offered during school hours, when pregnant or parenting adolescents could easily attend. The adolescents in the present study likewise expressed support for using the manual in group settings. This preference may be a result of the adolescents' need for the support of other adolescent mothers, especially if there is little or no social support from their families.
Suggestions provided by the adolescents were considered when revisions to the manual were made. The child-care topics of burping an infant, teething, weaning, and colic were included, but diapering and bottle use were not. In addition, because the primary focus of the manual is quality parent-child interactions, topics that could be perceived as negative (such as postpartum depression or parental reactions to violent behavior) were not included. There are numerous resources available that contain this information, and many of these are provided throughout the manual as additional references for parents to consult. At the conclusion of the discussion about the title of the manual, one adolescent suggested changing the title from Removing the Mystery: Your Baby and You! to include the words "child development." Therefore, the revised title of the manual is Removing the Mystery: A Developmental Guide for Your Baby's First Three Years.
If this study were to be conducted again, changes would be made in how subjects were recruited and who facilitated the evaluation process. Because of the negative comments that were made about the manual by the pregnant high school adolescents, only those with young children would be recruited to evaluate future manuals.
The participants may have needed more time to read and understand the material. The reason the director of the high school program elected not to send evaluation materials home with the participants was because she was concerned about return of the materials. If the participants had been allowed to take the materials home prior to the formal evaluation, additional comments may have been generated. Finally, a few of the participants did not respond to all of the items on the evaluation forms. The investigator would ensure that forms were completed prior to participants receiving honorariums.
The interest generated by this project reveals that a parent manual of this type is wanted, but is not currently available. Many of the existing parent curricula are written like textbooks, with small print, complex text, and limited numbers of photographs and illustrations. Others contain developmental milestones but do not include lists of children's books or activities for parents and children to share. Still others contain only early literacy books and activities. Removing the Mystery provides developmental milestones and corresponding activities, lists children's literature, and offers parent information all in one resource that is easily readable. Participants who evaluated the manual found it understandable, liked the format, felt there were no areas that were irrelevant, said they would use it, and would recommend it to others. Responses were mixed concerning areas that needed to be modified, added, or expanded. By conducting more evaluations of the manual it can be fine-tuned to be applicable to a variety of parents and programs.
Anastasiow, N. J. (1983). Adolescent pregnancy and special education. Exceptional Children, 49(5), 393-401.
Brooks-Gunn, J, & Furstenberg, F. G., Jr. (1986). The children of adolescent mothers: Physical, academic, and psychological outcomes. Developmental Review, 6, 224-251.
Causby, V., Nixon, C., & Bright, J. M. (1991). Influences on adolescent mother-infant interactions. Adolescence, 26(103), 619-630.
Colletta, N. D. (1981). Social support and the risk of maternal rejection by adolescent mothers. The Journal of Psychology, 109, 191-197.
Cooper, C. S., Dunst, C. J, & Vance, S. D. (1990). The effect of social support on adolescent mothers' styles of parent-child interaction as measured on three separate occasions. Adolescence, 25(97), 49-57.
Dickinson, N. S., & Cudaback, D. J. (1992). Parent education for adolescent mothers. The Journal of Primary Prevention, 13(1), 23-35.
Elster, A. B., McAnarney, E. R, & Lamb, M. E. (1983). Parental behavior of adolescent mothers. Pediatrics, 71(4), 494-503.
Hardy, J. B., & Zabin, L. H. (1991). Adolescent pregnancy in an urban environment: Issues, programs, and evaluation. Washington, DC: The Urban Institute Press.
Kissman, K. (1992). Parent skill training: Expanding school-based services for adolescent mothers. Research on Social Work Practice, 2(2), 161-171.
Lawrence, R. (1983). Early mothering by adolescents. In E. R. McAnarney (Ed.), Premature adolescent pregnancy and parenthood (pp. 207-218). New York: Grune & Stratton.
Levine, L, Coll, C. T. G., & Oh, W. (1985). Determinants of mother-infant interaction in adolescent mothers. Pediatrics, 75(1), 23-29.
Lieven, E. V. M. (1984). Interactional style and children's language learning. Topics in Language Disorders, September, pp. 15-23.
Merrill, M. A. (1989). Teenage pregnancy and parenthood education. In M. J. Fine (Ed.), The second handbook on parent education: Contemporary perspectives (pp. 173-192). San Diego, CA: Academic Press.
Owens, R. E., Jr. (1992). Language development: An introduction. New York: Macmillan Publishing Company.
Sahler, O. J. Z. (1983). Adolescent mothers: How nurturant is their parenting? In E. R. McAnarney (Ed.), Premature adolescent pregnancy and parenthood (pp. 219-230). New York: Grune and Stratton.
Thomas, E., Rickel, A. U., Butler, C, & Montgomery, E. (1990). Adolescent pregnancy and parenting. Journal of Primary Prevention, 10(3), 195-206.
Voydanoff, P., & Donnelly, B. W. (1990). Adolescent sexuality and pregnancy. Newbury Park, CA: Sage Publications.
Washington State Board of Health. (1992). Washington State health report: 1992. Olympia, WA: Author.
Weinman, M. L., Schreiber, N. B., & Robinson, M. (1992). Adolescent mothers: Were there any gains in a parent education program? Family and Community Health, 15(3), 1-10.
Whitman, T, L., Borkowski, J. G, Shellenbach, C. J., & Nath., P. S. (1987). Predicting and understanding developmental delay of children of adolescent mothers: A multidimensional approach. American Journal of Mental Deficiency, 92(1), 40-56.…
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Publication information: Article title: Removing the Mystery: Evaluation of a Parent Manual by Adolescent Parents. Contributors: Lambert, Connie - Author. Journal title: Adolescence. Volume: 33. Issue: 129 Publication date: Spring 1998. Page number: 61+. © 1999 Libra Publishers, Inc. COPYRIGHT 1998 Gale Group.