Nihms 1755921
Nihms 1755921
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Abstract
Background: Family-based assessments of risk factors for adolescent emotional, behavioral, and
substance use problems can be used to identify adolescents who are at risk and intervene before
problems cause clinically significant impairment. Expanding traditional methods for assessing
risk, this study evaluates whether lability, referring to the degree to which parent-adolescent
relationships and parenting fluctuate from day to day, might offer additional value to assessment
protocols aimed at identifying precursor risk factors.
Methods: This study sampled 151 adolescents and caregivers, collecting data at a baseline
assessment, a 21-day daily diary protocol, and a 12-month follow-up assessment. Daily diary
data were used to calculate within-family lability scores in parenting practices, parent-adolescent
connectedness, and parent-adolescent conflict.
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Conclusions: These findings provide evidence for substantial value added when including
dynamic assessments of family lability in predicting long-term adolescent risk outcomes and call
for integration of dynamic methods into assessment practices.
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Keywords
Family Risk Assessment; Adolescent Psychopathology Risk; Adolescent Substance Use Risk;
Parent-Adolescent Relationships; Parenting Practices
This paper is currently In Press at the Journal of Child Psychology and Psychiatry.
Conflict of interest: The authors have no conflicts of interest to declare.
Fosco et al. Page 2
Introduction
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Family functioning plays a central role in adolescent well-being, with effects that persist into
adulthood (Fosco, Caruthers, & Dishion, 2012). Positive family relationships and effective
parenting are well-established protective factors, while family environments characterized
by poor relationships, harsh parenting, and high conflict undermine adolescent mental health
and elevate risk for engaging in antisocial behavior (ASB) and substance use (Greenberg
& Lippold, 2013; Repetti, Taylor, & Seeman, 2002). Perhaps equally important is the
accumulating evidence that these family factors are malleable and amenable to family-
centered preventive interventions (Redmond et al., 2009). Thus, accurate assessments of
malleable family risk and protective factors can identify adolescents at risk and guide
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We argue that it is important to distinguish between traditional approaches that assess levels
of family risk or protective factors and dynamic approaches that assess lability – the extent
to which risk and protective factors fluctuate within families. Traditional, global assessments
capturing levels of family risk or protective factors, such as single-occasion surveys or
observations, represent the vast majority of extant basic research to date. These assessments
offer information about overall perceptions of how close and connected an adolescent feels
toward his/her parent, or the degree to which parents use effective parenting practices.
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time, offer additional information about risk that is not captured in global assessments (Ram
& Gerstorf, 2009). Lability refers to the degree to which parenting practices, parent-child
connectedness, and parent-child conflict fluctuate around their average levels over time
(Lippold, Fosco, Ram, & Feinberg, 2016). As an illustration, two families may report
identical levels of overall relationship quality in a global assessment, but one family may
have the similar scores each day (low lability), while the other fluctuates from extreme high
to extreme low scores across days (high lability). Although indistinguishable in terms of
their levels of relationship quality, adolescents in these two families have fundamentally
different relationship dynamics at home. An assessment of lability would be necessary
to differentiate risk in these families that would otherwise go undetected in traditional
assessments.
High lability may be an additional risk factor for maladjustment. From a deviance
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parent-adolescent relationships should signal risk for poorer long-term adolescent outcomes.
Emerging evidence highlights lability as a unique and robust predictor of adolescent mental
health and substance use outcomes, even when accounting for levels of those family factors.
High lability in parenting from year to year is a risk factor for substance use, delinquency,
and depression, even when accounting for average levels of parenting during that time
(Lippold et al., 2016; Lippold, Hussong, Fosco, & Ram, 2018). At a daily timescale, high
lability in parental warmth was associated with diminished youth well-being, accounting
for average levels across days (Lippold, Davis, Lawson, & McHale, 2016). The current
study evaluates whether assessments of day-to-day lability in parenting practices, parent-
adolescent connectedness, and parent-adolescent conflict provide additional predictive value
– uniquely or in combination with traditional global assessments of these constructs–
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in predicting adolescent risk for depression, anxiety, ASB, and substance misuse. Such
information could guide improvements to standard practices in risk screening.
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over traditional assessments because they minimize recall bias by shortening the reporting
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timeframe, are more sensitive to capturing low-intensity experiences, and offer ecological
validity by assessing family members in their natural environment (Shiffman, Stone, &
Hufford, 2008). We leveraged a 21-day daily diary design to assess lability in parenting
practices, parent-adolescent connectedness, and parent-adolescent conflict. These lability
indicators were then evaluated as predictors of adolescent well-being alongside baseline
global assessments of these constructs (akin to a traditional screening tool). Our guiding
research questions were: a) does lability contribute unique predictive value for adolescent
depressive symptoms, anxiety symptoms, ASB, and substance use one year later? and b)
is lability associated with these outcomes at all levels of baseline family functioning (i.e.,
baseline level as a moderator of lability and outcomes)? It is possible that lability is only a
risk in certain families (e.g., in the context of moderate to low relationship quality).
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Methods
Sample
Participants were 151 families of 9th and 10th grade adolescents who participated in part
of the larger Penn State Family Life Optimizing Well-being (FLOW) study, which was
approved by the University Institutional Review Board. Families were recruited through
high schools and family referrals to take part in a longitudinal study that included a daily
diary assessment. Families were eligible for the study if they met the following criteria:
adolescents lived in one, two-caregiver household continuously, Internet access and means to
complete the daily surveys at home, English fluency, the participating adolescent was in 9th
or 10th grade, and both parent and adolescent agreed to participate (via consent and assent).
The adolescents (61.5% female) were between the ages of 13 and 16 years old (M = 14.60,
SD = 0.83) and majority Caucasian (83.4%). Caregivers (95.6% female) were on average
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43.4 years of age (Range 30–61), majority Caucasian (90.1%), with the majority of parents
being married (88.7%), having a median income of $70,000-$79,999, and at least a high
school degree (96.6%). In this specific study, families who participated completed baseline
assessments and then were assigned to complete daily assessments across 21 days and a
follow-up at 12 months. Daily questionnaires took approximately 5 minutes to complete and
were sent out nightly at 7 p.m. and access to links were available until 9 a.m. the following
morning.
Attrition—Of the 151 families, 10 youth did not complete the 12-month assessment.
Comparisons of demographic (e.g., sex, age, family income), baseline family factors (e.g.,
parent-child relationship), and baseline adolescent factors (e.g., anxiety, ASB) revealed only
two predictors of attrition: younger parents (t(141) = −1.98, p = .05) and low child anxiety
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(t(32.40) = - 7.16, p < .001) were slightly more likely to drop out of the study. The final
analytic sample for this study was 141 adolescents and their parents.
Measures
Baseline Risk Assessment.—Parents reported on their parenting practices at baseline
using the General Child Management scale (Spoth, Redmond, & Shin, 1998). The 13 items
were rated from 1 (Never) to 5 (Always), capturing parental monitoring, positive discipline,
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consistency, and harsh parenting (reverse-coded) and had good reliability (α = .72). Parent-
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Daily Measures for Lability.—The baseline risk measures were mirrored in daily
assessments, adapted as needed to fit a daily timescale. All items were rated on a 10-point
sliding scale (with 0.1 increments). Parents reported on daily parenting practices, including
5 items that tap into warmth, praise, consistency, and effective limit setting. This scale
exhibited good between-person reliability across diary days (R1F = .83). Parents and
adolescents rated 4 items assessing parent-adolescent connectedness on a daily basis. A
sample item included “I felt close and connected to my [parent/child] today”. Reliability
was good for parent (R1F = .90) and adolescent reports (R1F = .95). Finally, parents
and adolescents rated two items assessing parent-adolescent conflict (e.g., “How much
tension was there between you and your child?”). Reliability was good for parents (R1F =
.57) and adolescents (R1F = .77). After missing data were removed, lability scores were
computed using mean squared successive differences (MSSD), which captures the extent of
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individuals’ change from one day to the next across all days (temporal instability) and is
less vulnerable to trends in the data (Jahng, Wood, & Trull, 2008). This resulted in three
variables: parenting lability, connectedness lability, and conflict lability.
(e.g., “feeling nervous, anxious, or on edge”), from Not at All (1), Several Days (2),
More Than Half the Days (3), Nearly Everyday (4). Reliability was good at baseline and
follow-up (α = .90, .94). ASB was assessed using the 10-item Antisocial Behavior Scale
(Dishion & Cavanaugh, 2003). Adolescents rated past-month frequency of behaviors such
as “intentionally hit or threatened to hit someone” from Never (1), Once or Twice (2), 3–5
Times (3), 6–10 Times (4), 11–20 Times (5), More Than 20 Times (6). This scale had
good reliability at baseline and follow-up (α = .87 and .95). Substance use was assessed as
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past-month frequency of being drunk and smoking marijuana, using a single item for each:
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“How many times did you [get drunk/smoke marijuana] in the past month?”
Results
Descriptive statistics and bivariate correlations among study variables are presented in Table
1. Correlations indicated that baseline levels of parenting and connectedness were only
modestly correlated with lability scores (r’s = −.18 to −.27). However, baseline levels of
conflict and conflict lability were more highly correlated (r’s = .42 to .47), yet still distinct
constructs.
Table 2 presents three sets of hierarchical regression analyses in which 12-month outcomes
were regressed on baseline levels of family variables and lability scores. Baseline scores of
outcomes, age, and gender were added as covariates. In a second step, an interaction term
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for baseline levels and lability was entered in the equation. Before analysis, all predictors
and outcomes were standardized. In order to minimize risk of false discovery rate due to
multiple statistical tests, p-value calculations were adjusted using the Benjamini-Hochberg
(1995) approach.
The first set of analyses focused on parenting practices. All models, except that predicting
marijuana use, accounted for statistically significant variance in the outcomes. Baseline
parenting practices were not associated with any of the outcomes. Higher parenting lability
was associated with increases in adolescents’ depressive symptoms (β = .29), anxiety
symptoms (β = .18) and drunkenness (β = .29) at 12-month follow-up. Neither baseline
parenting nor parenting lability were associated with ASB. None of the interaction terms for
baseline parenting*lability were statistically significant.
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lability was associated with increases in ASB (β = .47), drunkenness (β = .52), and
marijuana use (β = .65) at relatively high (but not low) levels of baseline connectedness.
Specificity is offered in calculations of the region of significance, such that connectedness
lability was associated with increases in ASB when baseline connectedness was −0.27 SD
or higher (values were standardized), with drunkenness when baseline connectedness was
−0.70 SD or higher, and with marijuana use when baseline connectedness was greater than
−0.49 SD. These findings suggested minimum levels of connectedness needed for lability
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to serve as a risk factor for these three outcomes were below the sample average. However,
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at extremely low levels of baseline connectedness, lability was negatively associated with
marijuana use (−2.33 SD; 1.4% of the sample).
The third set of analyses focused on parent-adolescent conflict using adolescent and parent
report of conflict. Of the 10 models run, only one finding emerged as statistically significant.
Parent report of conflict lability was associated with increases in adolescent depressive
symptoms (β = .34).
that the pattern of results was robust, relative to the baseline ratings and relative to the
average ratings (across days) of family functioning.
Discussion
This study evaluated whether there is added predictive value gained by incorporating
assessments of family lability to traditional (single-assessment) screening approaches when
predicting adolescent depression, anxiety, ASB, and substance use. Lability in parenting
practices and parent-adolescent connectedness exhibited robust predictive value for most
of these outcomes. However, parent-adolescent conflict and conflict lability were not
significant predictors in this sample. Overall, this study underscores the promise of
integrating dynamic assessments of family lability into traditional screening approaches as a
means of strengthening precursor risk screening in adolescents.
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Parenting lability was a risk factor for adolescent depression, anxiety, and drunkenness,
regardless of baseline levels of parenting. Vacillations in the quality of parenting from day
to day reflect a family context in which there are days when family rules are upheld and
good behavior is praised and other days when limits are not enforced and good behavior
may go unacknowledged. From this view, adolescents may experience parenting lability
as intermittently rejecting, unpredictable, and stressful. Over time, these experiences may
undermine adolescents’ sense of security in the family and/or may accumulate to overwhelm
their coping resources, undermining their mental health, as indicated by increases in
depression and anxiety (Repetti et al., 2002; Rohner, 2004). In addition, the link between
parenting lability and increases in drunkenness are consistent with a deviance model of
risk in which intermittent periods of diminished parenting may also create opportunities for
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but not when predicting depression or anxiety outcomes. These findings may indicate that
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there are different underlying risk processes at work for these outcomes.
From a deviance perspective, our results indicate that “gaps” from day to day in
connectedness are a risk factor for ASB and substance use, in the context of a close overall
relationship. During periods of disconnect, adolescents may not seek parental guidance or
advice when navigating developmental challenges (e.g., peer substance use), or may even
seek connection with a deviant peer group that amplifies their risk for ASB and substance
use outcomes (Ackard et al., 2006; Dishion et al., 2004). However, in families with low
general connectedness, lability would not create “gaps” in supervision or guidance, thereby
not conferring risk for deviant behaviors.
However, connectedness lability is a risk factor for depression and anxiety, regardless of
baseline relationship levels. These relationships, characterized by days of feeling close
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and connected and days of feeling disconnected may reflect a context of intermittent and
unpredictable nurturance, leading to accumulating stress that erodes adolescents’ mental
health over time (Repetti et al., 2002). Another interpretation may be that disrupted security
in the parent-adolescent relationship may elicit emotional distress over time (Rohner, 2004).
Findings for parent-adolescent conflict were surprising: neither level nor lability were
associated with adolescent outcomes (except depression), which is inconsistent with past
work. This raises questions about whether these measures were not capturing risk processes
sufficiently, or if this sample had unusually low levels of conflict. Regardless, we advise
caution when interpreting these null results until systematic replication is conducted.
However, the pattern of correlations among baseline and lability scores for conflict,
compared to parenting and connectedness, was noteworthy. Specifically, conflict lability
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was considerably more highly correlated with the baseline level than the others, perhaps
shedding light onto conflict as a process. Distinguishing between level and lability in
conflict may be less appropriate. By definition, conflict may be an episodic process, such
that families with higher conflict may experience more conflict events (e.g., a “spiky”
line), whereas parenting and connectedness may reflect a continuous (rather than episodic)
process, characterized by smooth lines across days. Research characterizing couple conflicts
underscores the importance of capturing frequency and intensity of conflict in the home
(Fosco, DeBoard, & Grych, 2007). Alternatively, the high correlation between lability and
level of conflict may also indicate a “floor effect” limiting the measurement of lability.
Future work using higher-risk samples, should explore these issues.
This study has implications for family risk assessment and/or screening, family-based
interventions, and basic family science. First and foremost, the current findings call for
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be integrated into family risk assessments. This calls for the development of accessible and
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engaging assessments with added potential for real-time feedback delivery to families.
This study also holds implications for family-based interventions. Intervention evaluations
should incorporate dynamic assessments of family functioning to better understand the
change processes underlying their effects. Currently, little is known about whether
interventions can reduce lability in these processes. Systematic work is needed to a)
evaluate whether existing interventions effectively reduce lability in these relationships and
b) develop new intervention content or components that can bolster intervention effects
regarding lability. An important first step is to incorporate daily diary designs in pre-post
assessments of family-based interventions.
Finally, the current study points to new gaps in family theory that await explicit evaluation.
We identified several perspectives – deviance models, parent-adolescent bonding, and
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stressor accumulation – that may explain associations between family lability and adolescent
outcomes. However, the next step for this basic family research is to better explicate which
of these processes explain the effects presented in this study, or refine theories to better
explicate the underlying processes.
There were several limitations to this study. First, this sample was relatively low-risk.
Future work should replicate these findings in a sample of families with a greater range
of risk across family conflict, relationship quality, and adolescent risk. Moreover, greater
racial, socioeconomic, and family structure diversity would provide a more generalizable
test of lability in family functioning as a precursor risk factor for adolescent mental
health problems and substance misuse. Future work should also include other domains of
family functioning that may inform family risk assessments, such as family-level cohesion
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and sibling relationship quality. Finally, other dynamic characteristics, such as rigidity
or reactivity in family functioning, may also offer promise as precursor risk factors for
adolescent problem outcomes (Ram & Gerstorf, 2009).
In conclusion, this study provides compelling preliminary evidence for the importance of
incorporating dynamic characteristics of the family – in this case, lability in parenting and
parent-adolescent connectedness – into family risk assessments for adolescent depression,
anxiety, antisocial behavior, and substance misuse. Beyond traditional approaches to family
screening that focus on the presence or absence of risk and protective factors (i.e., levels
of family functioning), understanding the degree to which families exhibit lability in
functioning can provide unique insight into adolescent risk. These findings call for expanded
assessments of family functioning and enhanced evaluation of family-based interventions.
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Supplementary Material
Refer to Web version on PubMed Central for supplementary material.
Acknowledgments
This study was supported by the Karl R. and Diane Wendle Fink Early Career Professorship for the Study of
Families. Authors were supported by several funding sources: the Penn State Social Science Research Institute
(Fosco), the National Institute on Drug Abuse (Mak: T32 DA017629 and P50 DA039838; LoBraico: T32
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Fosco et al. Page 10
DA017629; Lippold: R03 DA038685), and Institute of Education Sciences (R305B090007) and the John Templeton
Foundation (GF13361–152622) (Ramos). The content is solely the responsibility of the authors and does not
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necessarily represent the official views of the NIDA, NIH, IES, or the John Templeton Foundation.
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Key Points
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• Our findings, using daily diary methods, reveal that lability (day-to-day
variability) in parenting practices and parent-adolescent connectedness
were robust predictors (accounting for traditional screening measures) of
adolescent mental health problems, antisocial behavior, and substance use.
• Future work should integrate dynamic methods into family risk assessments.
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Figure 1.
Example plot of baseline connectedness*connectedness lability in relation to adolescent
antisocial behavior. 1a presents plotted simple slopes for connectedness lability and ASB
at 1 SD above and below the mean level of baseline connectedness. 1b presents the region
of significance for connectedness lability at different levels of baseline connectedness in
relation to ASB. Simple slopes are significant outside the lower and upper bounds (dotted
vertical lines).
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Table 1.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
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1. Depressive Symptoms --
8. Baseline Connect (P) −.25* −.14 −.15 −.08 −.03 .53* .39* --
9. Baseline Conflict (A) .34* .28* .12 .04 .00 −.14 −.34* −.15 --
10. Baseline Conflict (P) .29* .20* .06 .10 .06 −.49* −.26* −.41* .44* --
11. Parenting Lability (P) .33* .21* .27* .34* .13 −.19* −.07 −.23* .16 .21* --
12. Connect Lability (A) .38* .25* .26* .30* .32* −.12 −.18* −.21* .34* .24* .43* --
13. Connect Lability (P) .30* .17* .40* .29* .18* −.21* −.06 −.27* .23* .20* .72* .51* --
14. Conflict Lability (A) .28* .10 .17* .03 .06 −.14 −.10 −.05 .42* .24* .31* .58* .41* --
15. Conflict Lability (P) .35* .19* .18* .15 −.04 −.28* −.22* −.22* .32* .47* .52* .26* .44* .39* --
16. Age .03 −.07 .01 .01 −.01 −.07 .10 −.09 −.12 −.04 .04 .07 −.04 .05 .02 --
17. Male Gender −.14 −.17* .28* .16 .01 −.11 −.02 −.20* −.03 .17* .27* .05 .20* .06 .17* .11 --
M 1.54 1.58 1.18 0.12 0.17 4.11 4.22 4.16 1.69 2.09 1.90 2.64 2.41 4.60 4.76 14.74 0.38
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SD 0.63 0.77 0.55 0.61 0.92 0.42 0.68 0.60 0.70 0.57 1.82 4.40 2.62 6.67 5.48 0.72 0.49
Note:
*
p < .05. Parenting = Parenting practices, Connect = Parent-Adolescent Connectedness, Conflict = Parent-Adolescent Conflict, A = adolescent report of family variable, P = parent report of family variable.
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Table 2.
Parenting Practices β β β β β
Step 1 (R2) (.37**) (.23**) (.15**) (.19**) (.02 ns)
Baseline Parenting Practices P −.16 −.15 −.08 −.02 --
Connectedness
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Conflict
Note: β = Standardized Coefficients (unstandardized regression coefficients were used for the categorical variable Gender). Baseline*Lability reflects the interaction term between baseline family variable
and the lability score. A = adolescent report of family variable, P = parent report of family variable.
*
p < .05,
**
p < .01.
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