Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Nursing Science

Research Advisor

Joyce Carolyn Graff, PhD


Sara W Day, PhD Tamekia L Jones PhD Bruce L Keisling, PhD Sarah J Rhoads, PhD


child development, child health, neurocognitive development, parenting, parenting stress


Problem. Although the United States rates high in economic resources, the neurocognitive development (NCD) of children falls behind many other developed nations. Levels of parenting stress may be linked to sociodemographic factors such as the high incidence of poverty in children or health disparities in children, which in turn may affect NCD in children. Using the data from an observational, longitudinal cohort study of a diverse population could provide information related to parenting stress, child health, and related factors to guide and support interventions with families and policies to improve child NCD. Aims. The overall aim of this study was to examine the contributions of parenting stress and child health to NCD in a sample of diverse, urban mother-child dyads. In addition, the study aimed to describe maternal and child characteristics associated with child neurocognitive development (NCD) at age 3 years. We examined the differences in parenting stress levels in mothers of 3-year-old children with and without special health care needs. The primary factors of child health and parenting stress along with child and maternal characteristics and covariates (i.e., maternal depression, IQ, and knowledge of child development) were examined for their contributions to child NCD. Method. The Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study data was used for a secondary data analysis for this study after submission and approval of a Manuscript Analysis Plan Proposal (MAPP) from the CANDLE primary investigation team and IRB approval by University of Tennessee Health Science Center. The CANDLE study has a large, longitudinal collection of data on a diverse sample of urban mother-child dyads in the southern U.S. that examines contributions of maternal and child factors to child development. Applying the bioecological model of Bronfenbrenner, this study uses descriptive analysis, chi-square method, and linear models based of CANDLE study data to examine the relationship of parenting stress, child health, and child NCD at age three years and associated child and maternal characteristics. Finally, models will be created to explain the effect of child health and parenting stress on NCD, considering select covariates. Results. Sixteen percent, 171 of 1039 children met the criteria of special health care needs. Of the children identified with special healthcare needs, 25% of mothers reported concerns regarding their child’s health and or development compared to 9% of mothers of children who do not have any special health care needs. Nine percent of mothers of children not identified with special health care needs reported concerns over health and development. Parenting stress scores were significantly higher in mothers of children with special health care needs (odds ratio = 1.72; 95% CI = 1.158-2.6753; p=.0152). Cognitive scores were significantly different between children with and without special health care needs controlling for parenting stress with an effect of 0.5 (SE= 0.17; p=.0056). Models examining associations of child health and parenting stress, considering covariates, found that child health and parenting stress explained child NCD, specifically receptive communication. Implications. Efforts to increase child NCD in this population are needed. Reduction of parenting stress related to psychological, biological, and environmental factors can assist in promoting the development of children in this sample. Identifying, intervening, and reducing these sources of stress through appropriate screening, education, policies, and support is needed. In addition, the consequences of child health can influence parenting stress and child NCD. Support for child health initiatives such as health promotion, illness prevention, and appropriate early intervention will contribute to the reduction of parental stress and can improve child NCD. Sustained interventions to promote child health and reduce parenting stress will lead to a more optimistic future for children and their NCD.

Declaration of Authorship

Declaration of Authorship is included in the supplemental files.




2022-006-Farrell-DOA.pdf (218 kB)
Declaration of Authorship

Available for download on Thursday, May 16, 2024