Maternal evaluation of early child development: a cognitive task analysis

The literature on the evaluation of early child development has tended to frame it as a professional task that parents support by reporting relevant observations and by compliance with professionally prescribed practices. Descriptions of parents’ own strategies of evaluation have not been as well developed, although some informal models exist which can be characterised as affect-as-information, comparison to population norms, and comparison to peers. A static style of evaluation, however, seems inconsistent with the intensive and ongoing interactions between parents and children. Additionally, a mismatch between parental and professional evaluation of children has been reported in the literature, which suggests different strategies. The aim of the current thesis was therefore to frame parental appraisal as distinct from the professional task and to describe it in detail. A cognitive task analysis approach was used to emphasise the characteristics of the evaluation task, and a mixed methods approach was used to gather observations. Databases of parents’ concerns existed that were gathered by maternal child health nurses at routine appointments using The Parents’ Evaluation of Development Status (PEDS) survey (Glascoe, 1997). The first study reanalysed PEDS data collected from parents of children between 4 to 42 months within one council area of suburban Melbourne over a year. The main findings were that the likelihood of parents expressing concerns increased with child’s age, but only in the domains of language, behaviour and social-emotional development. The data patterns also indicated that parents who expressed concerns needed some prompting to do so, which could be sign of the complexity or ambiguity of the questions about concerns to parents. The second study was a protocol analysis with 15 mothers of children aged 10-24 months, in Lima, Peru. Mothers were interviewed twice about their evaluations of their children’s development. Although mothers did mention comparison to norms and peers, a large part of their evaluation strategy was not explicitly comparative. Rather, mothers linked their mostly positive evaluations to their repeated observations of their children’s daily activities, including mealtimes, playing and interacting with others. Mothers also described their own active involvement teaching and eliciting behaviours from their children. A main theme of the results was the time-dependant nature of many maternal evaluation strategies, including prediction, wait and see, observation of change, and accumulation of information over time. These findings contrasted with previous research which has highlighted strategies of comparison. Consequently, a new theory was developed to account for the iterative, interactive, predictive and dynamic aspects of maternal evaluation. This theory was based on positive and negative feedback loops from which sustained cognitions emerge, such as parents’ concerns and assessments of their children’s traits and vulnerabilities. The final study aimed to further describe any long-term qualities of parental evaluation by reanalysis of parents’ concerns on a U.S. database that included multiple appointments for parents of children aged 4-47 months (n=64,321). Results revealed that although most concerns were resolved by the next appointment, a substantial minority (45%) persisted, even when appointments were many months apart. Therefore, many parents’ concerns might be considered long-term states or reoccur over the long-term. Further, an interaction between concern persistence and child’s age was interpreted as a gradual polarisation of parents into concerned or not concerned states, possibly reinforced by professionals. In conclusion, early child development may be conceived as an ongoing process involving the child’s regular practice of actions such as social interaction, movement, learning, concentration and eating. Mothers were continually involved in in these actions of development, and their evaluations of development were based on the process as it occurred. Comparison of children to population norms is a step away from this process-based style of appraisal. It was argued that professionals’ use of a more process-oriented approach to appraisal could be conducive to more effective communication between parents and professionals. The theory presented here was tentative and required further validation; limitations and suggestions for further research were discussed.