Black and white mother and child perceptions of child anxiety

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Title:
Black and white mother and child perceptions of child anxiety the effects of stress and health status
Alternate title:
Effects of stress and health status
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vi, 106 leaves : ; 29 cm.
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English
Creator:
Walton, Janice Wachtel
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Subjects / Keywords:
Research   ( mesh )
Anxiety -- Child   ( mesh )
Anxiety -- Infant   ( mesh )
Perception   ( mesh )
Stress, Psychological   ( mesh )
Health Status   ( mesh )
Mothers -- psychology   ( mesh )
Mother-Child Relations   ( mesh )
Child Psychology   ( mesh )
African Americans -- psychology   ( mesh )
European Continental Ancestry Group -- psychology   ( mesh )
African Continental Ancestry Group -- psychology   ( mesh )
Cross-Cultural Comparison   ( mesh )
Data Collection   ( mesh )
Questionnaires   ( mesh )
Psychological Tests   ( mesh )
Department of Clinical and Health Psychology thesis Ph.D   ( mesh )
Dissertations, Academic -- College of Health Professions -- Department of Clinical and Health Psychology -- UF   ( mesh )
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bibliography   ( marcgt )
non-fiction   ( marcgt )

Notes

Thesis:
Thesis (Ph.D.)--University of Florida, 1997.
Bibliography:
Bibliography: leaves 97-105.
Statement of Responsibility:
by Janice Wachtel Walton.
General Note:
Typescript.
General Note:
Vita.

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University of Florida
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All applicable rights reserved by the source institution and holding location.
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aleph - 002286907
oclc - 48616461
notis - ALP0054
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Full Text











BLACK AND WHITE MOTHER AND CHILD PERCEPTIONS OF
CHILD ANXIETY: THE EFFECTS OF STRESS AND HEALTH STATUS












By

JANICE WACHTEL WALTON


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA


1997





















TABLE OF CONTENTS


LIST OF TABLES .............


LIST OF FIGURES ............


ABSTRACT ...................


INTRODUCTION...............


LITERATURE REVIEW ..........


PURPOSE OF RESEARCH........


HYPOTHESES .................


MATERIAL AND METHODS.......


Design ................
Subjects ..............
Assessment Instruments
Procedure.............


RESULTS ....................


NOTE .......................


DISCUSSION .................


REFERENCES .................


BIOGRAPHICAL SKETCH ..................................... 106


page


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iv


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LIST OF TABLES


Table page

1 Sociodemographic and Clinical Characteristics of
Black and White Children............................. 60

2 Marital Status of Black and White Mothers........... 61

3 Health Status of Black and White Children .......... 62

4 Differences between the Current Sample and the
Normative Sample on the STAIC-State Scale........... 63

5 Differences between the Current Sample and the
Normative Sample on the STAIC-Trait Scale........... 64

6 Differences between the Current Sample and the
Normative Samples on the Social Desirability
Questionnaires...................................... 65

7 Summary of ANOVA Results for State Anxiety......... 66

8 Summary of ANOVA Results for Trait Anxiety......... 67

9 Summary of ANCOVA Results for State Anxiety with
Social Desirability as Covariate..................... 68

10 Summary of ANCOVA Results for Trait Anxiety with
Social Desirability as Covariate..................... 69

11 Means and Standard Deviations of the STAIC......... 70

12 Means and Standard Deviations on the STAIC within
Race and Location................................... 71

13 Means and Standard Deviations on the STAIC within
Location and Health Status ......................... 72

14 Means and Standard Deviations on the STAIC within
Race and Health Status............................... 73


iii















LIST OF FIGURES


Figure page

1 Respondent X Race Interaction for State and Trait
Anxiety ............................................ 74

2 Respondent X Race X Location Interaction for State
Anxiety ............................................ 75

3 Respondent X Location X Health Status Interaction
for State Anxiety................................... 76

4 Respondent X Race X Health Status Interaction for
Trait Anxiety....................................... 77

5 Respondent X Gender X Location Interaction for
Trait Anxiety....................................... 78














Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

BLACK AND WHITE MOTHER AND CHILD PERCEPTIONS OF CHILD'S
ANXIETY: THE EFFECTS OF STRESS AND HEALTH STATUS

By

Janice Wachtel Walton

August 1997

Chairperson: Suzanne Bennett Johnson, Ph.D.
Major Department: Clinical and Health Psychology

This study attempts to replicate previous race-related

differences in children's anxiety as perceived by the

children themselves and as reported by their mothers. The

study sample consisted of 167 children, ages 10 to 18 years,

and their mothers. Forty-seven percent of the subjects were

Black and 53 percent were White. Approximately half of the

sample of children were chronically ill and half were

healthy. Approximately half of the sample were assessed in

a stressful setting (clinic) and half were assessed in a

nonstressful setting (restaurant). The State Trait Anxiety

Inventory for Children (STAIC), a self-report questionnaire

assessing child anxiety, was completed by the children and

their mothers. The predicted Race X Respondent interaction

was replicated when assessing state anxiety in the stressful

setting, regardless of children's health status (chronically








ill or healthy). Furthermore, this Race X Respondent

interaction was replicated when assessing trait anxiety in

chronically ill children, regardless of setting (clinic or

restaurant). Specifically, Black children rated themselves

as more anxious than did their Black mothers, while White

children perceived themselves as less anxious than did their

White mothers. Additionally, Black children rated

themselves as more anxious compared to White children. In

direct contrast, however, these same Black children were

perceived by their mothers as significantly less anxious

compared to ratings by mothers of their White children. The

implications of these findings include the following:

routine assessment of the influence of race in studies

including a heterogenous sample is important, clinicians

should not rely solely on mothers' reports of children's

anxiety, further research into intraracial causes of anxiety

in children is necessary, and further research into the

validity of children's and parents' reports of child anxiety

is necessary.














INTRODUCTION


Currently, there is considerable controversy among

scientists regarding research conducted with Black children.

The debate centers on the appropriateness of comparing the

behavior of Black to White children, interpreting

differences found between these two groups as deficits, and

using tests normed on White children to assess Black

children (McLoyd, 1990a). McLoyd (1990a) reports that

although the criticisms of race-comparative studies in the

literature are well-founded, current research involving race

comparisons suggests that biases noted by critics are not

inherent to race-comparative studies. She notes that many

studies attempt to identify the mechanisms that account for

ethnic group differences, rather than being strictly outcome

oriented. Reynolds and Brown (1984) argue cogently that

given the history of racism in biology, anthropology, and

psychology, it is not surprising that some minorities view

present evidence of racial differences as "just another of

the wolves of preconceived racist beliefs masquerading in

the sheep's clothing of pseudoscientific evidence" (pp.12).

They note that because of this, extraordinary care on the

part of present-day researchers and theoreticians is










necessary as is increased scientific skepticism. They

further stress the importance of caution not to repeat, but

to correct for errors of the past.

Ethical and appropriately conducted race comparative

studies depend on the intent of the researcher, which

influences the analyses of the data and the interpretations

of the findings. In fact, given that race is one

demographic variable, it could be argued that race should be

assessed routinely, as are gender and age. Following this

argument, care should be taken in researchers'

interpretations of racial differences; these differences

should be viewed just as that, differences between Blacks

and Whites (similar to differences between males and

females, or children and adolescents), not as "deviations"

of Blacks from the "normal" population.

It is important to consider the subjects' socioeconomic

status (SES) in any study assessing race, since SES can be

an influential explanatory variable. According to Anderson

et al.'s (1980) definition of a confounding factor, SES

becomes a confounding factor when the following two

conditions exist: (1) The risk groups differ according to

SES, and (2) SES itself influences the outcome.

Kessler and Neighbors (1986) note that since the late

1950s, "it has been known" that in America, Blacks have

higher rates of psychological distress than Whites.

However, they note that beginning in the 1970s, numerous










studies found that greater levels of distress in Blacks

attenuated after controls for SES were introduced. The

authors challenge these findings by noting that the research

failed to consider the possibility of an interactive effect

of race and class. Kessler and Neighbors (1986) conducted

an analysis of eight different epidemiologic surveys between

1957 and 1976; after reanalyzing the data and testing for

interactions between race and SES, they found that race was

significantly related to psychological functioning among

lower social class individuals, but not individuals in

higher SES categories, and concluded that "racial

discrimination exacerbates the health-damaging effects of

poverty among blacks."

Ulbrich, Warheit, and Zimmerman (1989) confirmed these

findings in a study of the relationship among race and SES

and psychological distress. A total of 2115 people (450

Blacks, 1648 Whites) from north central Florida were

interviewed. A significant interaction was found among

race, SES, and psychological distress. The data revealed

that Blacks had significantly higher levels of psychological

distress than Whites at lower levels of both income and

occupational status, with a convergence between the races as

SES increased. For occupational status only, there was a

reversal of racial differences at the highest status levels.

Additionally, the authors found that undesirable life events

were strongly associated with psychological distress only










for the lower SES Blacks, but economic difficulties were

associated with psychological distress for both races,

regardless of their SES.

Ulbrich et al. (1989) note that race differences in

distress for lower social class people likely reflect the

extent to which institutionalized racism has shaped the life

conditions of lower SES Blacks. Kessler and Neighbors

(1986) offer the following explanations for the findings of

race differences in psychological distress: (1) a greater

proportion of Blacks compared to Whites have their mobility

aspirations thwarted; (2) the combined effects of poverty

and discrimination could have synergistic effects; and (3)

resources for coping with stress might be less readily

available to lower-class Blacks than to lower-class Whites.

Numerous authors also have noted that higher rates of mental

health or stress-related problems found in Blacks are due to

racism and/or poverty (Barbarin & Soler, 1993; Jackson,

1973; McLoyd, 1990b; Peters & Massey, 1983; Vargas & Willis,

1994). For example, Vargas and Willis (1994) report that

ethnic minority children are more likely to experience

poverty, discrimination, violence, substance abuse, and

teenage pregnancy, and consequently to experience associated

psychological problems. Barbarin and Soler (1993) state

that influences on functioning that are driven by poverty

and racism include such life circumstances as prenatal

insults, family instability, parental economic distress,








5

divorce, and exposure to violence. Indeed, according to the

1988 Report on Minorities in Higher Education, one-third of

the U.S., "constituting mainly ethnic minorities,"

experiences poverty and discrimination (Harrison, Wilson,

Pine, Chan, & Buriel, 1990). In contrast to the purely

environmental hypotheses of the previous researchers, Dreger

(1973) concludes that the dissimilarities between Blacks and

Whites suggest either that constitutionally the races have

different basic patterns of traits, that their experiences

have changed some traits, or that genetic differences

combine with experience to produce differences in traits.

The United States Bureau of the Census (1991) reports

that Blacks comprise 11.7 percent of the United States

population. Nevertheless, mental health providers and

researchers are not keeping pace with the need for research

involving the assessment and treatment of ethnic minorities

(Vargas & Willis, 1994). Epidemiological data on rates of

disturbances usually are not disaggregated by race, and

therefore the nature of problems most often affecting Blacks

cannot be specified. Given that previous studies have found

racial differences in mental health problems, it is

important to identify the types of mental health problems

that affect Blacks in order to implement prevention

programs, as well as to implement and test the efficacy of

various treatment options.










It appears that currently Black children are not

receiving adequate mental health services. For example,

Saunders, Resnick, Hoberman, and Blum (1994) conducted a

study on help-seeking behavior and found that nonwhite,

lower SES students were the least likely to obtain help for

mental health problems, whereas middle to upper-middle class

Whites were the most likely to obtain help. Furthermore, it

has been noted that ethnic minority children often present

with mental health problems in settings such as the school,

health care, or juvenile justice system, rather than at

mental health facilities (Vargas & Willis, 1994).

Empirical research that has been conducted on the

mental health of Black children has focused primarily on

externalizing disorders (e.g., delinquency, aggression), as

well as social and academic problems (e.g., reviews by

Barbarin, 1993; Slaughter-Defoe, Nakagawa, Takanishi, &

Johnson, 1990). Despite the urging of various researchers

in the literature (e.g., Casas, 1988; Neal & Turner, 1991),

little research has been conducted on affective development

and mood disturbances in Black children. Barbarin (1993)

stresses the importance of research focused on Black

children's affect regulation and mood disturbances,

highlighting the known relationship between these variables

and other developmental outcomes, such as psychological

adjustment and educational achievement. Although numerous

studies have been conducted on affective disorders in










middle-class White children, the Black population has been

largely neglected in this area. It often is assumed that

findings from studies assessing primarily White children can

be generalized to Black children. Furthermore, many of the

studies that assess both Black and White children do not

compare results between the two races, assuming that the two

races form a homogenous group.

A recent study conducted by the principal investigator

and her colleagues assessed the correspondence of mothers'

and children's ratings of the children's anxiety for

children undergoing invasive medical procedures (Wachtel,

Rodrigue, Geffken, Graham-Pole, & Turner, 1994). A

significant interaction involving race and informant was

found when assessing both state and trait anxiety. The

testing instrument used was the State Trait Anxiety

Inventory for Children (STAIC; Spielberger, 1973) and the

effects of SES were statistically controlled. Findings

revealed that Black children perceived themselves as more

anxious compared to White children. In direct contrast,

however, these same Black children were perceived by their

mothers as less anxious compared to mothers' perceptions of

their White children. Furthermore, Black children rated

themselves as significantly more anxious than did their

Black mothers, while White children perceived themselves as

significantly less anxious than did their White mothers.

Thus, whereas the degree of mother-child correspondence was










similarly low for Blacks and Whites, the direction of the

discrepancy was quite different for the two races. Since 60

percent of the sample were chronically ill, and 85 percent

of the Black children were chronically ill, it is unclear

whether the effects are representative of healthy children

as well.

Consequently, in the present study we plan to explore

the interaction found in the 1994 study by Wachtel et al.

further by testing whether this interaction would reproduce

with (1) a healthy (i.e., not chronically ill) sample in the

hospital setting, (2) both healthy and chronically ill

children studied outside of the hospital setting, and (3)

whether social desirability may have influenced findings.

The results of the present study could have great

implications regarding interventions with minority children.

It is possible that the reason minority children do not

obtain needed mental health care compared to White children

is that minority children's parents do not perceive their

children as in need of help. Indeed, children typically are

referred for treatment by adults, usually a parent or

teacher (LaGreca, 1990). Should the significant interaction

between race and informant replicate with a healthy sample,

this would suggest that one cannot rely on adult recognition

of the child's need for help, and that new methods of

ensuring that minority children obtain needed help should be

implemented.














LITERATURE REVIEW


Although very few studies have been conducted which

involve epidemiology of anxiety disorders in childhood and

adolescence, those that have been conducted have found

anxiety disorders to be the most common type of psychiatric

disorders in adolescents (Kashani & Orvaschel, 1988; McGee,

Feehan, Williams, Partridge, Silva, & Kelly, 1990).

Unfortunately, these studies did not disaggregate the

findings by race. Barbarin and Soler (1993) noted that it

is unclear whether existing estimates of rates of childhood

disorders in the general population adequately account for

those of Black children, who are more likely to experience

many physical, environmental, and social hazards which

threaten their well-being.

As noted earlier, children typically are referred for

treatment by parents or teachers (LaGreca, 1990). As a

consequence, many children with anxiety or depressive

disorders, especially Black children, may not receive

treatment due to the failure of parents and/or teachers to

recognize internalized distress. Indeed, the reliance on

parent reports of children's feelings has been challenged in

the literature, stressing that children's thoughts and










feelings about themselves are best obtained from the child

(e.g., LaGreca, 1990; Offer, Howard, Schonert, & Ostrov,

1991). Findings from the study conducted by Wachtel et al.

(1994) provide further support for the importance of

obtaining information about children from children in order

to ensure that distressed children in need of psychological

treatment are referred appropriately. Left untreated,

chronically high levels of anxiety can result in personal

agitation, cognitive impairment, and somatic problems

(Argulewicz & Miller, 1984).

Studies assessing parent-child agreement regarding

children's anxiety have found low to moderate agreement

(e.g., Edelbrock, Costello, Dulcan, Conover, & Kala, 1986;

Engel, Rodrigue, & Geffken, 1993; Kashani, Orvaschel, Burk,

& Reid, 1985; Verhulst, Althaus, & Berden, 1987). Although

certain demographic variables, such as age (e.g., Edelbrock

et al., 1986; Engel et al., 1993; Verhulst et al., 1987) and

gender (e.g., Engel et al., 1993; Rey, Schrader, & Morris-

Yates, 1992; Verhulst et al., 1987), have been assessed as

mediating variables in parent-child agreement, race has been

assessed in only one study evaluating parent-child

correspondence of anxiety ratings (Wachtel et al., 1994).

In contrast, race effects have been assessed in the

following areas: parent-child correspondence of children's

depression, parents' reports of their children's concurrent

depression and anxiety, children's reports of anxiety, and










combined parent-child reports of children's anxiety.

Unfortunately, only a few of these studies adequately tested

for the influence of SES. The studies conducted in each of

the previously noted areas will be reviewed.

Parent-Child Correspondence of Children's Depression

Race effects similar to those found by Wachtel et al.

(1994) were obtained in a study of parent-child

correspondence regarding depression conducted by Kazdin,

French, and Unis (1983b). These authors evaluated agreement

regarding children's depression between children (ages 6-13;

42 White, 6 Black) and their parents at a psychiatric

intensive care facility. Race was significantly related to

correspondence on the Children's Depression Inventory (CDI;

Kovacs, 1981), for both child-mother and child-father

ratings. In Black families, parents' ratings tended to

underestimate child ratings on the CDI, whereas in White

families parent ratings tended to overestimate child

ratings.

Kazdin, Esveldt-Dawson, Unis, and Rancurello (1983a)

further examined agreement between 120 children from a

psychiatric intensive care facility (ages 7-13; 99 White, 21

Black) and their parents on measures of depression and

aggression. Using the CDI and the Bellevue Index of

Depression (BID; Petti, 1978), children rated the severity

of depression and aggression as less severe than did their

parents, and this relationship reportedly did not vary as a










function of the child's gender, IQ, diagnosis, or "other

subject and demographic variables." While the authors did

not specify race as a control variable, it is likely that

this variable was included given its inclusion in the

previously noted study (Kazdin et al. 1983b). Inconsistent

findings between these two studies regarding the influence

of race on the direction of parent-child discrepancies may

be due to the fact that both had a low number of Black

subjects.

Studies by Kazdin et al. (1983b) and Wachtel et al.

(1994) are inconsistent with the remaining literature, which

generally reports that children endorse more affective and

anxiety symptoms than parents, regardless of race (e.g.,

Edelbrock et al., 1986; Hodges, Gordon, & Lennon, 1990;

Moretti, Fine, Haley, & Marriage, 1985; Reich & Earls, 1987;

Rey, Schrader, & Morris-Yates, 1992). One explanation for

this inconsistency could be that parents in studies by

Kazdin et al. (1983b) and Wachtel et al. (1994) are more

aware of their children's internalizing symptomatology

because the children are under considerable stress, i.e.,

the sample in the study by Kazdin et al. (1983) consisted of

inpatients in a psychiatric hospital setting, while subjects

in the study by Wachtel et al. (1994) were about to undergo

invasive medical procedures. However, several of the

studies that found parents' reports of child affective

symptomatology to be less severe than the children's self-










reports, obtained their sample from inpatient and/or

outpatient mental health facilities (e.g., Edelbrock et al.,

1986; Hodges et al., 1990; Moretti et al., 1985; Rey et al.,

1992).

The percentages of Blacks versus Whites in the subject

pool is another important factor to consider when attempting

to understand this inconsistency regarding direction of

parent-child discrepancies. Most studies neglected to

report the race of subjects (Hodges et al., 1990; Moretti et

al., 1985; Reich & Earls, 1987; Rey et al., 1992). The

sample in the study by Edelbrock et al. (1986) consisted of

60 percent White and 39 percent Black children. It is

possible that the samples consisted of a large percentage of

Black children and/or that discrepancies between Black

children and their parents were significantly larger than

those of White parent-child dyads. There was no indication

of testing for race effects in any study reviewed.

Unfortunately, the importance of assessment of race has not

been recognized in the past. Indeed, in a review of the

literature involving parent-child correspondence of

psychopathology, Klein (1991) mentions six factors which

might influence parent-child agreement: assessment

instruments used, children's ages, severity of children's

psychiatric conditions, gender, socioeconomic background,

and parental psychopathology. Race or ethnicity was not

mentioned as a factor.










Finally, it is possible that the specific construct

measured (e.g., anxiety, fear, depression) may have

contributed to the inconsistency regarding the direction of

parent-child discrepancies in the literature. Given the

various assessment instruments used in the studies, and

consequently the many possible constructs measured, it is

difficult to assess the influence of various constructs

directly.

Parents' Reports of their Children's Depression

In the study conducted by Kazdin et al. (1983b)

reviewed earlier, the authors found significant differences

between Black and White parents' reports of their children's

depression. Using the CDI, the BID, and the Depression

Symptom Checklist (DS-CL; Weinberg, Rutman, Sullivan,

Penick, & Dietz, 1973), mothers of White children rated

their children as significantly more depressed than did

mothers of Black children. Additionally, fathers of White

children rated their children as significantly more

depressed on the BID than did fathers of Black children.

Kazdin et al. (1983a) also found similar race effects

in parents' reports of children's depression. Using the CDI

and BID, mothers rated their White children as significantly

more depressed than did mothers rate their Black children,

and using the BID fathers rated their White children as

significantly more depressed than did fathers rate their

Black children.










Despite the significant findings of race effects

involving Black versus White parents (Kazdin et al., 1983a;

Kazdin, French, & Unis, 1983), as well as parent-child

discrepancies (Kazdin et al., 1983b), the authors of both

studies neglected to stress the implications of these

results in their articles. Kazdin et al., (1983b) briefly

reported the effects in their discussion section, without

stating implications, hypothesizing on the possible causes,

or recommending further research. Kazdin et al. (1983a) did

not mention race differences in their discussion section at

all.

The relationship between race and parent and child

ratings of children's depression reported by Kazdin et al.

(1983a) and Kazdin et al. (1983b) are very similar to those

found in the 1994 study by Wachtel et al. involving anxiety.

Not surprisingly, a link between anxiety and depression has

been found in adults and a similar relationship has been

demonstrated in children (Bernstein & Garfinkel, 1986;

Hershberg, Carlson, Cantwell, & Strober, 1982; Kolvin,

Berney, & Bhate, 1984; Strauss, Last, Hersen, & Kazdin,

1988).

Parents' Reports of their Children's Anxiety (and Other
Affective Symptomatology)

In addition to those studies conducted by Kazdin and

his colleagues (1983) assessing children's depression, two

studies were located that assessed the relationship between

race and parents' reports of children's anxiety/affective








16

symptomatology (Achenbach & Edelbrock, 1981; Lapouse & Monk,

1959). In a study acquiring normative data for the Child

Behavior Checklist (CBCL), Achenbach and Edelbrock (1981)

assessed parents' reports of their children's internalizing

(and externalizing) behaviors. The sample consisted of the

parents of 2600 children (20% Black, 80% White; ages 4-16),

half of which were clinic-referred and half normal controls;

83 percent of the CBCLs were completed by the children's

mothers, while the remaining 17 percent were completed by

fathers or other caregivers. Four of the eight items on

which White children scored significantly higher than Black

children primarily were associated with internalizing

syndrome, while only one of the six items on which Black

children scored higher was associated with internalizing

syndrome. These findings are consistent with those of

previous studies, suggesting that White mothers report

greater anxiety/affective symptomatology in their children.

Lapouse and Monk (1959) interviewed the parents of 482

children (ages 6-12; 85% White, 15% Black) regarding their

children's fears and worries; the unpublished interview

consisted of 200 items, most of which were short answer.

Thirty-nine percent of mothers of White children reported 7

or more fears/worries in their children, while 63 percent of

mothers of Black children reported 7 or more fears/worries

in their children. The findings of this study sharply

contrast with the general literature of race effects in










parent reports of children's affective symptomatology.

However, it is important to note that this study was

conducted decades earlier than the other studies reviewed,

possibly reflecting changes in parents' perceptions of their

children's anxiety and/or changes in the children's actual

experiences of anxiety. It also is possible that constructs

of "fear" and "worries" measured by these authors' specific

interview are very different from the construct "anxiety"

measured by the various other interviews and by the STAIC.

Overall, racial differences in parent perceptions regarding

children's internalizing symptomatology have received very

little attention in the literature and must be explored

further before firm conclusions can be made.

Children's Reports of Anxiety

Seven studies have assessed children's reports of fear

and/or anxiety in a sample of both Black and White children

(Beidel, Turner, & Trager, 1994; Clawson, Firment, & Trower,

1981; Johnson, 1989; Kashani & Orvaschel, 1988; Last &

Perrin, 1993; Neal, Lilly, & Zakis, 1993; Wolf, Sklov,

Hunter, Webber, & Berenson, 1982). Two of these studies

assessed test anxiety (Beidel et al., 1994; Clawson et al.,

1981), three assessed general experiences of anxiety and/or

fears in children (Johnson, 1989; Last & Perrin, 1993; Neal

et al., 1993), one assessed children's self-esteem, a

component of which involved a measure of anxiety (Wolf et

al., 1982), and one assessed diagnoses of anxiety disorders










(Kashani & Orvaschel, 1988). An additional study assessed

anxiety in a sample of Black children and compared the

results to normative data (Papay & Hedl, 1978).

Specifically, Clawson et al. (1981) assessed 262 junior

high school students (203 White, 56 Black) with the Test

Attitude Inventory (TAI), a questionnaire developed by

Spielberger and his associates to assess state and trait

test anxiety. Black children reported significantly greater

state and trait test anxiety than did White children.

Frequency data indicated that 13.8 percent of the White

children had high trait test anxiety while 28.6 percent of

Black children had high trait test anxiety. Additionally,

Black children in the 7th grade had significantly lower

grade point averages, and Blacks in the 7th and 9th grades

performed significantly poorer on skills tests assessing

math and language. The authors concluded that the higher

test anxiety in Blacks is a "probable influence" on poorer

academic performance.

Beidel et al. (1994) assessed 195 children (143 White,

52 Black; mean ages=10 years and 10.3 years, respectively)

recruited from elementary schools using the Test Anxiety

Scale for Children (Sarason, Davidson, Lighthall, Waite, &

Ruebush, 1960). Observable, but not significant differences

in test anxiety scores between Black and White children were

displayed: 38 percent of the White children and 52 percent

of the Black children scored above the cutoff indicating










significant test anxiety. Furthermore, of test anxious

children (31 Black; 31 White), significantly more Black

children met DSM-III-R criteria for social phobia.

Johnson (1989) assessed 447 Black and 613 White

adolescents (ages 15-17) regarding their anxiety, anger, and

blood pressure. The State-Trait Personality Inventory

(STPI), developed by Spielberger and his colleagues, was

used to measure state and trait anxiety, anger, and

curiosity. Black adolescents reported significantly more

state and trait anxiety than did White adolescents. Females

also reported significantly higher state and trait anxiety

than did males; however, there was no significant race by

sex interaction. Black adolescents also had significantly

higher blood pressure than White adolescents. Overall,

Johnson (1989) concluded that adolescents with elevated

blood pressure can be identified by psychological factors

such as trait anxiety and anger.

Last and Perrin (1993) assessed 169 treatment seeking

children in an anxiety disorders clinic for children and

adolescents (30 Black, 139 White; ages 5-17) using the

Revised Fear Survey Schedule for Children (FSSC-R;

Ollendick, 1983), the Children's Manifest Anxiety Scale-

Revised (RCMAS; Reynolds & Paget, 1981), and the Modified

State-Trait Anxiety Inventory for Children (STAIC-M; Fox &

Houston, 1983). While no significant differences between

races were found on the RCMAS or the STAIC-M, it was found








20

that Black children had significantly higher total scores on

the FSSC-R than did White children.

An additional study focused on the child's reported

self-esteem, which included an assessment of the child's

anxiety. This study produced similar findings regarding

less anxious symptomatology endorsed by White children (Wolf

et al., 1982). Specifically, 348 children (authors did not

give race percentages) ages 10-17 were given the Piers-

Harris Children's Self-Concept Scale (Piers & Harris, 1969).

Seven of ten factors had sufficient loadings to be

interpretable, one of which was an anxiety factor; White

children reported significantly less anxious symptomatology

than Black children.

Neal et al. (1993) assessed Black (n=109) and White

(n=124) children (ages 6-12) with the FSSC-R. Following

exploratory factor analyses, a three-factor solution was

found for Black children and a five-factor solution was

displayed for White children. Overall, fears were very

similar for the two races (fears of death, danger, and small

animals; fears of the unknown and things that crawl; medical

fears). The most notable difference between races was the

absence of a school-fears factor for Black children. Black

children also did not display a fear of embarrassment

factor; however, this factor contained only three items with

high loadings for the White children. Unfortunately the

authors did not assess for differences in mean intensity










ratings based on race. Therefore, although these findings

suggest that Black and White children experience similar

types of fear, it does not assess differences in intensity

of fear.

Kashani and Orvaschel (1988) assessed 150 adolescents

(ages 14-16) from a Midwestern public school using the

Diagnostic Interview for Children and Adolescents (DICA;

Herjanic & Reich, 1982) and found that there was a

significantly lower prevalence of anxiety diagnoses among

White than among non-White adolescents. It is important to

note that only a small number of subjects were nonWhite

(N=8).

An important study conducted by Papay and Hedl (1978)

assessed anxiety in 1522 3rd and 4th grade Black, lower SES

children using the STAIC (Spielberger, 1973). When compared

to STAIC normative data (Spielberger, 1973), this sample

scored significantly higher on the trait scale of the STAIC;

no significant differences between scores of current and

original samples on the state scale were found. The STAIC

(Spielberger, 1973) originally was standardized on 1551

children (60% White, 40% Black) in the 4th through 6th

grades from a wide range of socioeconomic backgrounds in

Florida; normative data were not specified by race. It is

important to note that in addition to race, socioeconomic

status and/or geographical location could contribute to










differences between the sample in the 1978 study by Papay

and Hedl and the standardized sample.

Taken together, recent studies assessing anxiety in

children have found that Black children report greater

levels of anxiety than White children; however, the actual

fears and symptoms of anxiety of Black and White children

may be similar.

The finding of greater anxiety reported by Black

children does not replicate consistently in treatment-

seeking populations. Last and Perrin (1993) note that

although approximately one-third of the children who are

referred to the Western Psychiatric Institute and Clinic in

Pittsburgh, Pennsylvania, are Black, only 18 percent of the

children at the anxiety specialty clinic are Black. Perhaps

the reason that fewer Black children receive treatment for

anxiety is that parents do not recognize the anxiety these

children experience.

Combined Parent-Child Reports of Children's Anxiety.

In the Last and Perrin (1993) study noted earlier, in

addition to children's self-reports, interviews were

conducted with these treatment-seeking children (30 Black,

139 White; ages 5-17) and their parents using a modified

version of the Schedule for Affective Disorders and

Schizophrenia for School-Age Children (K-SADS; Last, 1986).

Using combined interview data from parents and children,

White children were more likely to present with school








23

refusal, and clinicians rated the primary anxiety disorders

of White children as more severe than Black children. In

contrast, Black children were more likely to have a history

of posttraumatic stress disorder (PTSD). It is important to

recognize that the inconsistency of these data with other

data could be due to the fact that the subjects were

treatment-seeking children and/or anxiety was assessed via

combined parent and child reports. Since parent and child

reports of the child's affective symptomatology can be quite

discrepant and have been found to interact with race

(Kazdinet al., 1983b; Wachtel et al., in press), combined

parent-child reports contribute little to research assessing

for the influence of race.

Studies that Controlled for SES

Only four of the studies reviewed above adequately

controlled for the influence of socioeconomic status

(Achenbach & Edelbrock, 1981; Beidel et al., 1994; Kazdin et

al., 1983b; Last & Perrin, 1993). However, none of these

studies reported testing for an interaction between SES and

race, as recommended by Kessler and Neighbors (1986).

Achenbach and Edelbrock (1981) controlled for the influence

of SES by including a broad SES range within each race,

which minimized the effects of multicollinearity between SES

and race (Pearson r=.27). Similar race and SES

distributions were formed at each age; subjects were 1/3

upper, 1/3 middle, and 1/3 lower SES, with 80 percent Whites










and 20 percent Blacks at each SES level. Since condition

one of the definition of a confounding factor noted earlier

(Anderson et al., 1980) no longer holds, SES cannot distort

the estimate of the effect of race on the findings. Beidel

et al. (1994) analyzed all data with and without the

inclusion of SES as a covariate, with none of the results

differing when SES was controlled.

Kazdin et al. (1983b) found that parents' ratings of

their children's anxiety differed as a function of race and

welfare status. The authors further noted that differences

"could not be explained by other subject or demographic

variables confounded with the variable of interest." It is

assumed that this statement indicates that the authors

controlled for welfare status when assessing for differences

due to race.

Last and Perrin (1993) adequately controlled for SES by

analyzing data with SES as the covariate. The higher rates

of school refusal and the higher severity ratings assigned

to White children, as well as the higher rate of fears in

Black children, could not be accounted for by SES

differences between the two groups.

Studies that did not Control for SES

Unfortunately, most of the studies reviewed above did

not control for SES adequately. While a few included some

attempt at measurement of the relationship between SES and

psychological distress (Kashani & Orvaschel, 1988; Kazdin et








25

al., 1983a; Lapouse & Monk, 1959; Neal et al., 1993), others

did not assess association with SES in any form (Clawson et

al., 1981; Johnson, 1989; Wolf et al., 1982).

Kashani and Orvaschel (1988) tested for differences in

SES between anxious and nonanxious subjects; no significant

differences were found. However, the authors did not

control for SES when assessing for differences in anxiety

due to race, nor did they test for differences in SES

between races. Since SES could have been distributed

differently between races, it was necessary to control for

SES in this study. Kazdin et al. (1983a) found differences

in the children's and mothers' reports of child depression

due to race and welfare status, separately; however, the

authors failed to control for welfare status when assessing

the effect of race.

Lapouse and Monk (1959) assessed the mothers of 482

children, 15 percent of whon were Black. They report that

51 percent of the 482 children were in the two upper

socioeconomic quartiles, while 49 percent were in the two

lower SES quartiles. For an unspecified reason, the authors

tested for differences between White upper SES children

versus White lower SES children, but did not include Black

children in these analyses. No significant differences

between the mother-reported fears of White upper and lower

SES children were found. SES was not controlled in the

assessment of race differences. Finally, Neal et al. (1993)








26
note that in their study information about the students' SES

was prohibited by the school district; however, enough

information was available (i.e., lunch program, residents of

neighborhoods) to conclude that children came from primarily

working-class and low-income families. Nevertheless, due to

this limitation, authors were unable to control for SES.

1994 Study by Wachtel et al.

As noted earlier, in the 1994 study by Wachtel et al.

assessing the correspondence of mothers' and children's

ratings of the children's anxiety for children undergoing

invasive medical procedures, a significant interaction

between race and informant was displayed. Additional

details of the 1994 study by Wachtel et al. which pertain to

the present study will be described. First, the White

children and Black mothers in this study reported

significantly less trait anxiety than the normative sample

(Spielberger, 1973), while the Black children and White

mothers reported average levels of anxiety. Spielberger's

normative sample was made up of approximately 40 percent

Black and 60 percent White children. Unfortunately,

Spielberger did not report normative data by race.

Additionally, Pearson Product Moment correlations showed

that, while overall parent-child correspondence was low,

differences emerged when disaggregating correlations by

race; White parent-child dyads displayed low, but

significant correlations (Pearson r=.35), while Black dyads










displayed insignificant correlations (Pearson r=.12).

Regarding state anxiety, a significant interaction involving

race and informant when assessing state anxiety also was

displayed. Similar to effects of trait anxiety, Black

mothers reported significantly less state anxiety in their

children than did White mothers, and White children

perceived themselves to be significantly less anxious than

did their White mothers. However, unlike trait anxiety, no

significant differences were found between Black and White

children's self-reports of state anxiety, and no significant

differences were displayed between Black mothers and their

children's reports of child state anxiety.

It is important to recognize that, as noted earlier,

the sample was comprised primarily of chronically ill

children undergoing invasive medical procedures.

Furthermore, trait anxiety in Black and White mothers did

not differ significantly. The literature reports a

relationship between affective disorders in mothers and

their children (e.g., Cytryn & McKnew, 1980; Neal & Turner,

1991). Although the 1994 study by Wachtel et al. did not

find a significant relationship between maternal anxiety and

the child's self-reported anxiety, a significant and

moderate correlation between maternal trait anxiety and

mother's report of the child's trait anxiety (pearson r=.43)

was displayed. Nevertheless, since there were no

differences in maternal anxiety between races, it appears










that maternal anxiety did not influence the discrepancy

between anxiety in Black and White children.

Differences between the races remained after

controlling for SES and gender. Furthermore, there was no

significant interaction between race and SES.

Interestingly, mother's marital status varied as a function

of race; 77.3 percent of White mothers were married, 16.7

percent were divorced, 4.5 percent were separated, and 1.5

percent were single. In contrast, 36.4 percent of Black

mothers were married, 30.3 percent were single, 24.2 percent

were divorced, 6.1 percent were widowed, and 3.0 percent

were separated. Despite discrepancies in marital status

between races, race effects remained after controlling for

marital status. When testing for the influence of marital

status on parent and child reports of child anxiety, a

significant effect emerged in the mothers' perceptions of

their children's trait anxiety; divorced mothers reported

significantly more anxiety in their children than single

mothers. No other significant effects emerged which

involved marital status.

Although it is assumed that the children's self-reports

were more accurate than parents' reports of their children's

anxiety, it is possible that the reports of children were

invalid, while the parents' reports represented accurate

accounts of the children's anxiety. However, this is

unlikely for several reasons. First, according to Offer et










al. (1991), psychometrics show that the self-report of the

adolescent is valid and reliable (Achenbach & Edelbrock,

1987). Indeed, numerous researchers have stressed the

importance of obtaining self-reported information from the

child regarding internalizing disorders (e.g., Herjanic &

Reich, 1982; Verhulst et al., 1987). Second, children would

appear to be better able to report their own internal

feelings than their parents, given that parents must rely on

inference or behavioral observation when reporting their

children's feelings. This is supported by the fact that

previous research has found parent-child agreement of

externalizing behaviors (which are more objective and

observable) to be higher than internalizing behaviors

(Edelbrock et al., 1986; Hodges, Gordon, & Lennon, 1990; Rey

et al., 1992; Silverman & Eisen, 1992). Poor mother-child

agreement could be due to additional factors, including

ambiguity of the assessment instrument, threshold

uncertainty (e.g., "I feel very scared" versus "I feel

scared"), or some combination of these factors.

If children are presumed to be more accurate reporters

of their experienced anxiety, one might wonder why Black

children experience more anxiety than White children. As

noted earlier, poverty, racism, and violence have been

hypothesized as reasons for higher mental health problems.

Additionally, the following hypotheses regarding higher

anxiety, in particular, have been made: differences in








30

parental discipline styles (Johnson, 1989); perceived locus

of control (Phillips, Martin, & Meyers, 1972); defenses and

coping mechanisms (Phillips, Martin, & Meyers, 1972);

vulnerability to stress following negative life events

(McLoyd, 1990b); and perceived isolation and exclusion from

American society (Phillips et al., 1972). Other variables

which might contribute to higher levels of anxiety involve

conditions of communities in which the children live:

degree of political activism, presence of mental health and

human service organizations, incidence of crime, influence

of churches and religious organizations, presence and

quality of child-care centers, and amount of support

provided by neighbors (McLoyd, 1990b).

Another plausible explanation for higher self-reports

of anxiety by Black children is response set. Since

questions on the trait scale of the STAIC all are scored in

the same direction (i.e., higher score means higher

anxiety), it is possible that Black children tended to

respond in the direction of higher levels of anxiety without

clearly delineating their responses, while White children

responded more selectively. However, this seems unlikely

since similar findings of high anxiety were found on the

state scale of the STAIC, which consists of both direct and

reversed scored items; therefore, high anxiety would not be

found if children displayed a response set on the state

scale. Additionally, examiner effects could have influenced










children's reports of anxiety. Perhaps higher anxiety is

due to being evaluated by a White examiner. Although some

of the studies which have found higher anxiety in Black

children used only White examiners (e.g., Johnson, 1989;

Wachtel et al., 1994), these studies found significantly

higher trait anxiety in Black children; it would be expected

that state anxiety, not trait anxiety, would be influenced

by the examiner.

Finally, it is possible that social desirability played

a role in the lower reported anxiety by White children. In

the normative study assessing social desirability using the

Children's Social Desirability Scale (CSD; Crandall,

Crandall, & Katkovsky, 1965), it was found that Black

children displayed a significantly greater number of

socially desirable responses than White children.

Additionally, using the Marlowe-Crowne Social Desirability

Scale (MC-SDS; Crowne & Marlowe, 1960), social desirability

has been found to be significantly higher among Black than

White adults (Fisher, 1967; Klassen, Hornstra, & Anderson,

1975). It is possible that the Black children in the 1994

study by Wachtel et al. felt that it was socially desirable

to appear anxious in a medical setting. Perhaps White

children are less concerned with social desirability, as the

1965 study by Crandall et al. suggests, or it could be that

social desirability means something different to Black than

to White children. White children may have felt it was more








32

socially desirable to appear calm, while Black children felt

it was more socially desirable to appear anxious.

Regarding the lower reports of child trait anxiety by

Black mothers when compared to White mothers in the 1994

study by Wachtel et al., various hypotheses must be

considered. Assuming that children's self-reports are the

more accurate assessments of their anxiety, it is possible

that Black mothers are responding in the more socially

desirable manner, which as noted earlier is consistent with

the social desirability literature of greater social

desirable responses in Black adults (Fisher, 1967; Klassen

et al., 1975). Perhaps in the 1994 study by Wachtel et al.,

Black mothers reported less anxiety in their children

because they were attempting to present their children as

"emotionally healthy" due to concerns about the perceptions

of the experimenter and/or hospital personnel. Perhaps the

White mothers did not have these same concerns; indeed, they

may have been interested in portraying their children as

more anxious, therefore needing more attention and care.

Furthermore, it is possible that social desirability means

something different for Blacks than for Whites, and in

effect, both races are responding in a socially desirable

manner.

Finally, one last variable that is important to

consider in any study assessing differences due to race is

test bias. Many differing views regarding test bias are








33

held, and the definition of test bias, itself, has produced

unresolved debate among researchers (Reynolds & Brown,

1984). Bias is an accepted statistical term denoting

systematic or constant error of measurement as opposed to

random errors of measurement. Most of the debate regarding

cultural bias in psychological assessment has centered on

ability and achievement testing (Reynolds, Plake, & Harding,

1983). Indeed, many psychologists are unsure about how to

interpret personality scale performance for those people who

are not members of the majority culture (Reynolds et al.,

1983). As Reynolds and Brown (1984) note, personality and

overt behavior most likely are more culturally determined

than are one's intellectual skills; however, this does not

mean that minorities demonstrating problems considered

significant according to majority norms should be presumed

to be the result of cultural bias. If this were the case,

then many Blacks would not be afforded the appropriate

treatment alternatives.

Bias in construct validity exists when a test is shown

to measure different psychological constructs between groups

or to measure the same construct, but with differing degrees

of accuracy (Reynolds & Brown, 1984). Reynolds and Brown

(1984) note that construct validity can be investigated

through equivalent internal consistency estimates, as well

as factor analysis. Papay and Hedl (1978) examined the

psychometric properties of the STAIC using 1522 Black










children (3rd-4th grades) to determine if the measure was

reliable and valid for this population. Internal

consistency reliability coefficients for the present sample

and Spielberger's (1973) normative sample were remarkably

similar. Additionally, Hedl and Papay (1982) factor

analyzed the STAIC using 1786 Black children (K-4th grades).

The three factors identified were remarkably similar to

those found by Dorr (1981) and Gaudry and Poole (1975).

These studies help validate the use of the STAIC with a

Black sample.

In summary, assessment of race effects often is

neglected in research studies examining mental health

problems in general, and anxiety in children in particular.

A recent study with children undergoing invasive medical

procedures conducted by Wachtel et al. (1994) found a

significant interaction between race and informant (child

vs. mother), when assessing child state and trait anxiety.

This interaction could have profound treatment implications

and needs to be further explored with a healthy (i.e., not

chronically ill) sample, as well as with a sample of

children outside of the hospital setting. Indeed, the fact

that Black children are underrepresented at anxiety clinics

could be due to their parents' lack of recognition of these

problems in their children. However, care must be taken

when evaluating race effects. Variables such as SES must be

controlled for, and alternative hypotheses must be explored.














PURPOSE OF RESEARCH


The purpose of this study is to explore further the

relationship between race and reports of anxiety in

children. While the assessment of race effects, unlike

gender or SES, is not routine in research studies, it is

becoming more widely recognized as an important variable to

examine (e.g., Beidel et al., 1994; Neal & Turner, 1991;

Vargas & Willis, 1994). This research study will examine

the following:

(1) whether significant race effects found when assessing

child's anxiety as reported by the child and mother

replicate in a healthy sample of children visiting the

pediatric dental clinic as well as in another sample of

chronically ill children at the pediatric oncology clinic;

(2) whether race effects replicate outside of the hospital

setting, where children are not undergoing stressful

procedures (i.e., fast-food restaurants);

(3) whether the following variables influence the findings:

SES, gender, age, or social desirability.














HYPOTHESES


(1) Significant race effects previously found with

chronically ill children will replicate with a new sample of

chronically ill children and with a healthy sample of

children undergoing medical procedures. Since it is

expected that chronically ill children will experience

higher levels of trait anxiety than healthy children, it is

possible that race effects will not replicate with the

healthy sample due to floor effects of low levels of trait

anxiety; nevertheless, trends toward the expected race

effects should be evident. Children's health (chronically

ill vs. healthy) should not have an effect on state anxiety

and, therefore, race effects on state anxiety are expected

to occur with both chronically ill and healthy children.

Similar race effects have been found with depression when

assessed in psychiatric inpatient children (Kazdin et al.,

1983a; Kazdin et al., 1983b). Other studies have found

self-reports of anxiety to be higher and/or more common in

Black than in White children (Beidel et al., 1994; Clawson

et al., 1981; Wolf et al., 1982). Unfortunately, studies of

race effects involving parent reports of children's anxiety

are scarce; the few that have been conducted displayed








37
inconsistent findings (Achenbach & Edelbrock, 1981; Lapouse

& Monk, 1959), and therefore more research is needed in this

area.

(2) It is hypothesized that race effects will replicate

outside of the hospital setting. This finding would be

consistent with prior research that has been conducted in

non-hospital settings regarding children's self-reported

anxiety (Beidel et al., 1994; Clawson et al., 1981; Wolf et

al., 1982). Since it is expected that children in the

hospital setting will experience higher levels of state

anxiety than those outside of the hospital, race effects on

state anxiety may not replicate with subjects outside of the

hospital setting due to floor effects; nevertheless, trends

toward these race effects should be evident. Setting should

not have an effect on trait anxiety and, therefore, it is

expected that race effects on trait anxiety will be

displayed in both settings.

(3) It is hypothesized that SES, gender, and age will not

influence findings of race effects. These variables did not

influence findings by Wachtel et al. (1994).

(4) Social desirability will influence mother reports of

child anxiety. Specifically, one of two influences

involving social desirability is hypothesized to occur: (a)

Black mothers may be more concerned with social desirability

than White mothers and therefore report less anxiety in

their children. This would be consistent with findings of








38

higher levels of social desirability in the Black population

(Fisher, 1967; Klassen et al., 1975); (b) It also may be

that social desirability means different things between the

races. Both races may be concerned with social

desirability, but the difference in what is considered

socially desirable might cause Black mothers to report less

anxiety in their children and White mothers to exaggerate

reports of anxiety in their children. Furthermore, the

influence of social desirability on Black and White

children's self-reports of anxiety is uncertain. Three

possibilities exist: (a) Black children might view higher

anxiety in medical settings as socially desirable, while

White children may view lower anxiety as more socially

desirable; (b) Black children could be influenced by social

desirability, while White children may not; in this case,

Black children would view higher anxiety as more socially

desirable; and (c) Black children may experience more

anxiety than White children, and social desirability may not

influence Black or White children's self-reports of anxiety

in divergent manners.














MATERIALS AND METHODS


Design

The study was a 2 (Race: Black Vs. White) X 2

(Location: Clinic Vs. Restaurant) X 2 (Health Status:

Chronically Ill Vs. Healthy) design with one repeated

measure (Respondent: Mother Vs. Child) and with unequal n.

Children's state and trait anxiety served as the dependent

measures.

Subjects

Subjects were 167 children aged 10-18 years with no

evidence of mental retardation or severe developmental

disabilities. Forty-seven percent (n=78) were Black and 53

percent (n=89) were White. The sociodemographic and

clinical characteristics of the two groups are presented in

Table 1. There was no significant difference between the

Black and White children in age, grade, gender, or health

status (percent chronically ill versus healthy). However, a

significantly greater percentage of White children received

treatment for anxiety in the past as compared to Black

children. Additionally, SES was significantly higher for

White families than Black families. Finally, there were

significant differences between White and Black mothers;










White mothers were older, better educated, and more likely

to be married than Black mothers.

Fifty-four percent of the sample (n=90) were children

diagnosed with a chronic illness (see Table 3 for a

breakdown of illnesses by race) and 46 percent of the sample

were healthy children (n=77). There were significant

differences between Black and White groups of children

regarding particular diagnoses. Specifically, a

significantly higher percentage of White children were

diagnosed with cancer, while many Black children and no

White children were diagnosed with sickle cell disease.

Additionally, a significantly greater percentage of White

children were diagnosed with immuno-deficiency disorders

than Black children.

Since the diagnosis of sickle cell only occurred within

the Black population, t-tests comparing scores on the State

Trait Anxiety Inventory for Children (STAIC; Spielberger,

1973) were conducted within the Black sample between

subjects who were diagnosed with sickle cell and those with

other diagnoses. No significant differences were found.

Additionally, since a higher percentage of White children

were diagnosed with cancer and immuno-deficiency disorders,

t-tests comparing STAIC scores were conducted within the

White sample between those with cancer and those with other

diagnoses, as well as between those with immuno-deficiency

disorders and those with other diagnoses. No significant










differences were found between children with cancer and

other diagnoses. Regarding children with immuno-deficiency

disorders, mothers reported that their children experience

significantly more state anxiety (M=36.4, SD=8.98) than

mothers of White children with other disorders (M=30.8,

SD=5.0; p<.05); no significant differences were found in

mothers' reports of trait anxiety or children's reports of

state and trait anxiety.

The chronically ill children were obtained through the

University of Florida's Oncology or Diabetes Pediatric

Clinics of Shands Hospital. The refusal rate for

chronically ill Black and White subjects was

52 percent and 40 percent, respectively. Healthy children

were obtained either through the University of Florida's

Dental Clinic or at a fast-food restaurant. The refusal

rate for healthy Black and White subjects was 49 percent and

31 percent, respectively. A chi-square analysis was

conducted in order to assess whether there were significant

differences in refusal rates between Black and White

subjects. A significant difference emerged (X2 = 7.18, p <

.01), with Black subjects having a significantly greater

refusal rate than White subjects.

Assessment Instruments

The Demographics Questionnaire obtained the following

information: child's sex, race, age, and grade; mother's

race and age; mother's and significant other household










member's education, occupation, and marital status; number

of household members; type of medical procedure child would

be receiving; child's medical diagnosis. Information

regarding whether the child had received psychological

treatment or medication for anxiety also was obtained.

Family social class was calculated by the Hollingshead Four

Factor Index of Social Status (Hollingshead, 1975) using

head(s) of households' education and occupation.

The State-Trait Anxiety Inventory for Children (STAIC;

Spielberger, 1973) consists of 40 items, each rated on a one

to three point scale, and takes approximately 10 minutes to

complete. The state anxiety portion of the scale (20 items)

appraises the anxious feelings of the child at any given

moment while the trait section (20 items) assesses

generalized feelings of anxiety. Higher scores indicate

that the child experiences greater anxiety. Internal

consistency (coefficient alpha) estimates for the STAIC-

State were high for this study's Black and White mothers and

children (Black mothers, a = .92; Black children, a = .91;

White mothers, a = .89; White children, a = .90). The

STAIC-Trait scale also was highly reliable (Black mothers, a

= .89; Black children, a = .90; White mothers, a = .86;

White children, a = .87).

The Social Desirability during Medical Appointments

Form (SDMA) was constructed by the author to assess mothers'

and children's perceptions of socially desirable behavior










for children receiving medical care. The 12 item SDMA was

used to assess whether Black and White mothers, as well as

Black and White children, consider the same types of

behaviors socially desirable; higher scores indicate

stronger views that a child should look calm in the doctor's

office. Internal consistency estimates for this sample were

adequate (Black mothers, a = .68; Black children, a = .70;

White mothers, a = .76; White children, a = .72).

The Marlowe-Crowne Social Desirability Scale (Crowne &

Marlowe, 1960) is a 33 item self-report measure that

measures social desirability defined as a person's need to

"obtain approval by responding in a culturally appropriate

and acceptable manner" (pp. 353). Higher scores indicate

greater frequency of responding in a socially desirable

manner. Internal consistency for this sample of mothers was

high (Black mothers, a = .82; White mothers, a = .84).

The Children's Social Desirability (CSD) Questionnaire

(Crandall, Crandall, & Katkovsky, 1965), patterned after the

Marlowe-Crowne (Crowne & Marlowe, 1960), consists of 48

true-false items. Higher scores indicate greater frequency

of responding in a socially desirable manner. Internal

consistency for this study sample of children was high

(Black children, a = .91; White children, a = .89).

Procedure

Questionnaires were administered by one of five White

undergraduate researchers (two males, three females) or by










the primary experimenter (White female). Black and White

subjects were evenly distributed across interviewers.

All children and mothers were given gift-certificates

for a meal at a fast-food restaurant (i.e., Arby's, Burger

King, or Popeye's) in exchange for their participation in

this study. Gift-certificates were provided before the

assessment instruments were administered.

Chronically ill children were identified through the

Pediatric Oncology or Diabetes Clinics. Approximately half

of these children and their mothers were approached in the

clinic's waiting area. If consent was obtained, the

participants were assessed in the clinic's general waiting

area after they checked in for their scheduled appointments,

but before the child experienced any invasive procedure.

Mothers of the remaining chronically ill children were

contacted by phone and if they gave consent to participate,

the child and mother were met at the fast-food restaurant.

Healthy children undergoing dental examinations were

identified through the Dental Clinic and were greeted by the

experimenter in the waiting area. The study was explained

and, if consent was obtained, the children were assessed in

the waiting area prior to any invasive dental procedure.

Healthy children also were approached at fast-food

restaurants if they seemed to meet appropriate age and race

demographics and were with adults who appeared to be their










mothers. Health Status and demographic information were

confirmed prior to study participation.

The basic protocol for the study was the same

regardless of location or diagnosis. The study was

explained and the Informed Consent Form was read to the

mother and child. Any questions were answered and

signatures were obtained at that time. The demographics

questionnaire then was administered orally to the mother.

The mother and child were each given a copy of the STAIC

(Spielberger, 1973); the child completed the STAIC based on

his/her own feelings and the mother completed the STAIC

according to how she believed the child felt. Mothers also

were given the Marlowe-Crowne Social Desirability Scale

(Crowne & Marlowe, 1960) and the SDMA, while children were

given the Children's Social Desirability Questionnaire

(Crandall et al., 1965) and the SDMA. The STAIC always was

given prior to social desirability questionnaires to ensure

that reports of anxiety were not influenced by questions

involving social desirability. The social desirability

questionnaires were given after the STAIC but in counter

balanced order. Both written and verbal instructions were

given to the mother and the child. The child's ability to

read the items was assessed and, when necessary, the

experimenter read the items aloud to the child. In this

situation the experimenter read the items from a separate

questionnaire so the child could mark responses in a








46

confidential manner. Time to complete all study

questionnaires was approximately 10 to 20 minutes.














RESULTS


Comparison of Study Sample to Normative Sample

Differences between the study sample and the

instruments' normative samples were examined using Welch's t

statistic. This particular statistical analysis was chosen

because of the unequivalent variances and significant sample

size discrepancies between the current sample and the

normative samples (Welch, 1951). Tests were conducted by

Race (Black Vs. White), Respondent (mother Vs. child), and

Location (nonstressful/restaurant Vs. stressful/clinic) for

state anxiety (see Table 4). The children in the non-

stressful setting (i.e., restaurant) are most appropriate

for comparison with the normative sample since the normative

sample was assessed in a nonstressful setting (i.e., the

classroom). Within the nonstressful setting, both Black and

White boys reported experiencing significantly less state

anxiety than the normative sample.

For trait anxiety, tests were conducted by Race,

Respondent, and Health Status (chronically ill Vs. healthy;

see Table 5). The healthy children are most appropriate for

comparison with the normative sample, since the normative

sample most likely was primarily composed of healthy










children (Health Status was not reported in Spielberger's

1973 publication). Within the healthy sample, Black girls

and White boys reported experiencing significantly less

trait anxiety than the normative sample.

It is important to note that no normative data are

available regarding mothers' reports of child state or trait

anxiety, making it difficult to interpret the mothers'

scores in this study. Therefore, since there are no norms

with which to compare mothers' scores, it is most

appropriate to focus on children's reports rather than

mothers' reports of anxiety. Additionally, it is notable

that Spielberger's (1973) sample is composed of 35 to 40

percent Black children and is not disagregated by race.

Social desirability questionnaires' comparisons were

conducted by Race and Respondent (see Table 6). Significant

differences between Black and White boys and the normative

sample, as well as between Black and White mothers and the

normative sample, occurred. Specifically, both Black and

White boys responded in a more socially desirable manner

than the normative sample of boys, and both Black and White

mothers also responded in a more socially desirable manner

than the normative sample of women.

Analyses of Main Hypotheses

A repeated measures Analysis of Variance (ANOVA) was

conducted with one within subjects factor (Respondent) and

three between subjects factors (Race, Location, Health








49

Status). The analysis was conducted for both state anxiety

(see Table 7) and trait anxiety (see Table 8).

Main Hypothesis

In the previous study, Wachtel et al. (1994) found that

Black children in the clinic setting reported experiencing

more state and trait anxiety than their mothers reported

them to experience, while White children reported less state

and trait anxiety than their mothers reported them to

experience. Additionally, Black children reported

experiencing more state and trait anxiety than White

children, and Black mothers reported their children to

experience less state and trait anxiety than White mothers

reported in their children.

For state anxiety, it was expected that previous

Respondent X Race effects would replicate with both

chronically ill and healthy children, but would depend on

the setting; i.e., the Respondent X Race X Location

interaction would be significant. The Respondent X Race

effects were expected to occur in the stressful setting

(clinics), but not in the nonstressful setting

(restaurants), since children generally experience state

anxiety in clinics, but not in restaurants (floor effects).

For Trait Anxiety, the Respondent X Race interaction

was expected to replicate with chronically ill children, but

possibly not with healthy children since healthy children

were expected to experience less general anxiety (floor










effects), i.e., the Respondent X Race X Health Status

interaction would be significant.

Respondent X Race Replication

Current results support the hypothesis of a Respondent

X Race replication. The Respondent X Race interaction was

significant for both state anxiety (see Table 7) and trait

anxiety (see Table 8). See Figure 1 for diagrams of state

and trait anxiety. When looking at Figure 1, it is

remarkable that for both state and trait anxiety, Black

mothers report that their children experience less anxiety

than their children self-report, while White mothers report

that their children experience more anxiety than their

children self-report. Additionally, Black children report

more anxiety than White children, while Black mothers report

their children to experience less anxiety than White

mothers. Follow-up tests were performed comparing dyads

within state and trait anxiety (see Table 11). According to

an independent t-test there was a significant difference

between White and Black mothers' reports of their children's

trait anxiety, with White mothers reporting that their

children experience significantly more trait anxiety than

Black mothers reported their children to experience, t(165)

= -2.06, p < .05. Additionally, according to dependent t-

tests, White mothers reported that their children experience

significantly more trait anxiety, L(88) = 2.66, p < .01, and










state anxiety, t(88) = 2.68, p < .01, than White children

self-reported.

Influence of Health Status and Location on State

Anxiety

It was hypothesized that the Respondent X Race

interaction for state anxiety would occur in the clinic

location, but not outside of the hospital setting, since

children are not generally state anxious in nonstressful

settings (i.e.,restaurants). The predicted Respondent X

Race X Location (clinic/stressful vs.

restaurant/nonstressful) interaction was confirmed (see

Table 7 and Figure 2). It is clear from the figure that the

Respondent X Race interaction occurs in the stressful

setting, but not in the nonstressful setting. Follow-up

tests were conducted comparing appropriate dyads within and

across race and location (see Table 12). According to

dependent t-tests White mothers of children in clinics

reported their children to experience significantly more

state anxiety than their children self-reported, t(42) =

2.26, p < .05. In contrast, Black mothers of children in

clinics reported their children to experience significantly

less state anxiety than their children self-reported, t(36)

= -2.81, p < .01. Furthermore, according to independent t-

tests Black children in clinics reported experiencing

significantly more state anxiety than Black children in

restaurants t(58) = -3.08, p < .01. Finally, White mothers








52
of children in clinics reported their children to experience

significantly more state anxiety than White mothers of

children in restaurants t(80) = -2.08, p < .05.

An unpredicted Respondent X Location X Health Status

interaction for state anxiety was also found (See Table 7)

Figure 3 shows the expected main effect for location; state

anxiety was higher in the clinic than the restaurant. It

seems that the interaction was produced by the extreme

difference between chronically ill children's self-reported

anxiety in clinics versus restaurants, with reports of

anxiety in clinics being higher as expected. Follow-up

tests were conducted between appropriated dyads within and

across location and health status (see Table 13). According

to independent t-tests, mothers of healthy children in

clinics reported their children to experience significantly

more state anxiety than mothers of healthy children in

restaurants, t(60) = -2.10, p < .05. Additionally,

chronically ill children in clinics reported experiencing

significantly more state anxiety than chronically ill

children in restaurants t(81) = -3.61, p < .01. Finally,

mothers of chronically ill children in restaurants reported

their children to experience significantly more state

anxiety than mothers of healthy children in restaurants

t(85) = -2.55, p < .05.










Influence of Child's Health Status and Location on

Trait Anxiety

It was hypothesized that regardless of location the

Respondent X Race interactions previously found with

primarily chronically ill children would replicate with a

new sample of chronically ill children when reporting trait

anxiety but would not replicate with healthy children given

generally lower levels of trait anxiety in healthy children.

The predicted Respondent X Race X Health Status interaction

approached significance (see Table 8). Figure 4 shows that

the Respondent X Race interaction occurs with chronically

ill children and their mothers' reports of anxiety, but not

with healthy children and their mothers' reported anxiety.

Follow-up tests were conducted. Dependent t-tests indicated

that White mothers of chronically ill children reported

their children to experience significantly more trait

anxiety than the children self-reported, t(48) = 3.58, p <

.01. Independent t-tests indicated that Black chronically

ill children reported experiencing significant more trait

anxiety than White chronically ill children, t(87) = 2.72, p

< .01.

Influence of Demographic Variables on Race Effects

Analyses of Covariance (ANCOVAs) were conducted using

as covariates demographic variables which were significantly

different for Black and White samples. These variables

included SES, mother's age, and mother's education.' These








54
ANCOVAs did not change the previously reported ANOVA results

(i.e., the same significant and nonsignificant interactions

were found).

Although there were no significant differences in

gender distribution between Black (males n=31, females n=47)

and White (males n=43, females n=46) samples, X2(l, N = 167)

= 1.24, p > .25, there was a preponderance of females in the

Black sample. Additionally, female children reported

significantly greater state anxiety (M = 31.8, SD = 7.16)

than male children (M = 29.5, SD = 6.57), t(162) = -2.13, p

< .05. Female children also reported significantly greater

trait anxiety (M = 36.2, SD = 8.64) than male children (M =

32.4, SD = 6.60), t(165) = -3.19, p < .01. In contrast,

mothers' reports of children's state and trait anxiety did

not differ significantly based on the child's gender. When

gender was added to the ANOVA for state anxiety, no change

in the previously reported ANOVA results occurred. However,

the addition of gender to the trait anxiety ANOVA model

yielded a main effect for gender, F(1,151) = 6.45, p < .05

and a Respondent X Gender X Location interaction, F(1,151) =

4.61, R < .05. Figure 5 shows a Respondent X Gender

interaction within the restaurant setting, but not within

the clinic setting. Although girls reported more anxiety

than boys in both the clinic and restaurant settings,

mothers reported that girls experienced more anxiety than

boys in the clinic but not in the restaurant setting.








55

T-tests were conducted for appropriate dyads within and

across gender and location. Girls in restaurants reported

significantly more trait anxiety than boys in restaurants,

t(85) = -2.95, p < .01. Additionally, mothers reported that

their sons in restaurants experience significantly more

trait anxiety than these boys self-reported, t(38) = 3.24, p

<.01. Furthermore, mothers reported that their sons in

restaurants experience significantly greater anxiety than

mothers reported their sons in clinics to experience, t(71)

= 2.56, p < .05. Finally, there was a trend toward girls in

clinics reporting more trait anxiety than boys in clinics,

t(72) = -1.97, p = .053. Interestingly, with gender in the

ANOVA trait anxiety model, the Respondent X Race interaction

previously found remained significant, F(1,151) = 8.98, p <

.01. However, the previous trend for a Respondent X Race X

Health Status effect no longer occurred, F(1,151) = 1.90, p

= .17.

Influence of Social Desirability

It was hypothesized that social desirability would

influence mother reports of child anxiety. The results

partially support this hypothesis. Black mothers' scores on

the Marlowe-Crowne correlated significantly with their

reports of children's state anxiety (r = -.48) and trait

anxiety (r = -.36). The more mothers were concerned with

appearing socially desirable, the less anxiety they reported

their children to experience. Black mothers' scores on the










Marlowe-Crowne also correlated significantly with their

children's self-reports of state anxiety (r = -.39), but not

trait anxiety (r = -.16). White mothers' scores on the

Marlowe-Crowne correlated with their reports of children's

trait anxiety (r = -.21), but not with state anxiety (r = -

.03) or with their children's self-reports of state (L =

.05) or trait (r = -.01) anxiety.

It was hypothesized that one of two possibilities

involving social desirability might occur: (a) Black mothers

may be more concerned with social desirability than White

mothers and therefore report less anxiety in their children,

or (b) social desirability might mean different things to

each race, with both races being equally concerned with

social desirability. Regarding the former, t-tests were

performed; no significant differences between Black and

White mothers on the Marlowe-Crowne were found. Regarding

the latter, mothers' scores on the Marlowe-Crowne were

correlated with scores on the SDMA. When analyzed by race,

this correlation was not significant for Black mothers.

However, White mothers' scores on the Marlowe-Crowne

correlated significantly with their scores on the SDMA (r =

.24, p <.025), indicating that the more concerned White

mothers were with appearing socially desirable, the more

they felt that their children should appear calm and not

allow others to recognize their anxiety during a medical

appointment. Additionally, a significant difference








57
between Black and White mothers' scores on the SDMA emerged,

with Black mothers (M = 2.0, SD = 2.19) scoring higher than

White mothers (M = 1.2, SD = 1.49), t(133) = 2.63, p < .01;

this indicates that Black mothers felt children should

appear calmer and should show less anxiety during a medical

appointment than did White mothers. Finally, Black or White

mothers' reports on the SDMA did not correlate significantly

with their reports of children's anxiety or the children's

self-reports of anxiety.

The influence of social desirability on children's

self-reports also was analyzed. Black children's scores on

the CSD correlated significantly with their self-reports of

state anxiety (r = -.30), but not trait anxiety (r = -.15).

White children's scores on the CSD correlated significantly

with their self-reports of both state anxiety (r = -.24) and

trait anxiety (r = -.22). These significant and negative

correlations indicate that the more concerned children were

with appearing socially desirable, the lower their self-

reported anxiety. Neither White nor Black children's

scores on the CSD correlated significantly with their scores

on the SDMA. Furthermore, neither Black nor White

children's scores on the SDMA correlated with their self-

reports of state anxiety. White children's scores on the

SDMA correlated significantly with their self-reports of

trait anxiety (r = -.32), indicating that the more concerned

they were about not showing anxiety during a medical










procedure, the less trait anxiety they reported. In

contrast, Black children's scores on the SDMA did not

correlate with their self-reports of trait anxiety. To test

whether Black and White children experience different levels

of concern with social desirability a t-test was performed

between Black and White children's scores on the CSD; no

significant differences emerged. However, there was a

significant difference between Black and White Children's

scores on the SDMA, with Black children (M = 3.3, SD = 2.36)

scoring higher than White children (M = 2.6, SD = 2.06),

t(155) = 2.03, p <.05, indicating that like their mothers,

Black children reported that they should appear calmer and

less anxious in the medical setting than White children

reported.

In order to test whether social desirability influenced

the results found in the previous ANOVAs, two ANCOVAs were

run. The first used the Marlowe-Crowne and the CSD scores

as the covariates after transforming the raw scores to

standard scores (M = 0, SD = 1) based on gender specific

norms (Crowne & Marlowe, 1964; Crandall et al., 1965). The

ANCOVA results were similar to the ANOVA results with a few

exceptions (see Tables 9 and 10 for state and trait anxiety,

respectively). A main effect for Health Status on state

anxiety emerged, indicating that chronically ill children

and their mothers reported experiencing more state anxiety

than healthy children and their mothers reported, regardless








59
of location. The trend toward a Respondent X Race X Health

Status interaction for trait anxiety became significant.

Given the previous findings that the trend was lost when

gender was added to the earlier ANOVA model, gender was

added to this ANCOVA. With gender in the model, the

Respondent X Race X Health Status interaction was not

significant, F(1,150) = 2.65, p = .11.

The second set of ANCOVAs used the scores from the

mother and child completed SDMAs as covariates. The ANCOVAs

with SDMAs as covariates had no substantive effect on the

results.

Note

'There also were differences between Black and White
samples regarding percentage of children who received
treatment for anxiety in the past and mothers' marital
status. However, these variables were not entered into the
ANOVA model given the small number of children who had
received treatment for anxiety (n = 15), and the skewed
distribution of marital status in the Black and White
samples.










Table 1

Sociodemographic and Clinical Characteristics of Black and White
Children



Group


Black White
n=78 n=89



Child

Age, Years (SD) 13.1(2.3) 13.2(2.3)
Grade (SD) 7.4(2.2) 7.6(2.5)
Gender, % Male 39.7 48.3
Health, % Chronically Ill 52.6 55.1
Anxiety Treatment, % Yes 2.6 14.6*
Mother
Age, Years (SD) 36.8(11.0) 39.8(7.3)**
Highest Grade (SD) 12.5(1.7) 13.9(2.2)*
Marital Status, % Marrieda 41.6 78.7*
SES, Hollingshead (SD)b 2.3(1.0) 3.5(1.1)*
Number People Living In Home 3.8(1.9) 4.1(1.2)


aSee Table 2 for further breakdown.
bSocioeconomic Status (SES) was calculated using Hollingshead
Four Factor Index of Social Status (Hollingshead, 1975).
*P < .01.
**E < .05.










Table 2

Marital Status of Black and White Mothers


Black
n=78


Married

Divorced

Separated

Single

Widowed

Total


41.0

14.1

10.3

25.6

7.7

98.7b'


Note. Data are presented as percentage of mothers reporting
specific marital status within each race.
aChi-Squared analysis was not conducted due to insufficient n.
bTotal does not equal 100 percent due to missing data.
*P < .01.


White
n=89


78.7*

10.1

4.5

6.7*

0

100.0










Table 3

Health Status of Black and White Children


Black White
n=78 n=89



No Chronic Illness 47.4 44.9

Asthma 1.3 3.4

Cancer 5.1 24.7*

Immuno-Deficiency Disorder 2.6 15.7*

Sickle Cell Disease 30.8 0*

Diabetesa 6.4 2.3

Other 5.1 6.7

Total** 98.7 97.7



Note. Data are presented as percentage of children with specific
diagnosis within each race.
aChi-Squared analysis was not conducted due to insufficient n.
*E < .01.
**Not equal to 100 percent due to rounding of numbers.












Table 4


Differences between the Current Sample and the Normative Sample on the STAIC-
State Scale



Current Sample Normative Sampleb
STAICa-State STAIC-State

Female Male Female Male
M(SD) M(SD) M(SD) M(SD)
N N N N


Stressful Setting


Black
Mother

Child

White
Mother

Child

Non-stressful
Setting


Black
Mother

Child

White
Mother

Child


31.6(7.6)
23
35.0(9.0) *
23

33.2 (5.3) *
22
31.1(5.5)
22


30.0(3.4)
24
30.3(6.0)
24

30.9(5.9)
24
30.9(7.2)
24


30.1(7.7)
14
32.8(8.2)
14

33.5(8.6)
21
31.0(8.0)
21


29.5(4.8)
17
27.5(3.6)*
17

30.3 (5.1)
22
27.6(4.6)*
22


(1973).
to 40 percent


30.7(6.0)
737



30.7(6.0)
737


30.7(6.0)
737



30.7(6.0)
737


31.0(5.7)
817



31.0(5.7)
817


31.0(5.7)
817



31.0(5.7)
817


aState Trait Anxiety Inventory for Children, Spielberger
'Spielberger's (1973) normative sample was made up of 35
Black children.
*Significantly different than normative sample, p < .05.











Table 5


D4 f f ,-- 411 andLL Meii NoLrmatd.Lve Sample oni te STAIC-


Trait Scale


Current Sample Normative Sampleb
STAICa-Trait STAIC-Trait

Female Male Female Male
M(SD) M(SD) M(SD) M(SD)
N N N N



Healthy

Black
Mother 33.3(5.9)* 33.2(3.8)*
24 13
Child 33.8(7.2)* 35.7(7.2) 38.0(6.7) 36.7(6.3)
24 13 737 817
White
Mother 36.7(6.1) 33.3(7.2)
24 16
Child 37.9(9.1) 31.8(5.8)* 38.0(6.7) 36.7(6.3)
24 16 737 817


Chronically Ill

Black
Mother 35.2(7.1) 34.2(7.2)
23 18
Child 38.9(8.1) 33.6(5.6)* 38.0(6.7) 36.7(6.3)
23 18 737 817
White
Mother 37.2(7.2) 36.5(7.5)
22 27
Child 34.1(9.4) 30.4(6.9)** 38.0(6.7) 36.7(6.3)
22 27 737 817



aState Trait Anxiety Inventory for Children, Spielberger, 1973.
bSpielberger's (1973) normative sample was made up of 35 to 40 percent
Black children.
*Significantly different than normative Sample, p < .05.











Table 6

Differences between Current Sample and the Normative Samples on the Social
Desirability Questionnaires



Current Sample Normative Sample

M(SD) M(SD)
N N



Children's Social Desirability Scale (CSD)a

Black
Female 20.3(9.9) 17.5(8.6)
47 93
Male 20.7(8.5)* 16.0(9.1)
31 69


White
Female 19.4(8.3) 17.5(8.6)
46 93
Male 20.9(8.4)* 16.0(9.1)
43 69

Marlowe-Crowne Social Desirability Scale (Marlowe-Crowne)b

Black 19.6(6.2)* 16.8(5.5)
78 2400

White 18.4(5.8)* 16.8(5.5)
89 2400


aNormative sample for CSD obtained from Crandall
et al. (1965), 9.6% of sample was Black.
'Normative sample for Marlowe-Crowne obtained from Crowne & Marlowe
(1964), race of sample not given.
*Significantly different than normative Sample, p < .05.












Table 7

Summary of ANOVA Results for State Anxiety


Dependent DF F Value Signif-
Variable icance
of F


Race

Location

Health Status

Race X Location

Race X Health Status

Location X Health Status

Race X Location X Health Status

Respondent

Respondent X Race

Respondent X Location

Respondent X Health Status

Respondent X Race X Location

Respondent X Race X Health Status

Respondent X Location X Health Status

Respondent X Race X Location X Health Status


1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159


0.07

8.46

2.86

0.09

3.56

1.13

1.18

0.49

8.94

1.56

1.12

6.54

0.71

9.79

0.03


.793

.004

.093

.762

.061

.290

.279

.485

.003

.213

.292

.012

.400

.002

.866












Table 8

Summary of ANOVA Results for Trait Anxiety


Dependent DF F Value Signif-
Variable icance
of F


Race

Location

Health Status

Race X Location

Race X Health Status

Location X Health Status

Race X Location X Health Status

Respondent

Respondent X Race

Respondent X Location

Respondent X Health Status

Respondent X Race X Location

Respondent X Race X Health Status

Respondent X Location X Health Status

Respondent X Race X Location X Health Status


1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159

1,159


0.00

0.63

0.21

3.25

1.82

0.75

0.58

0.28

9.10

2.56

3.09

1.60

3.77

0.00

1.02


.965

.430

.649

.073

.180

.387

.448

.60

.003

.112

.081

.208

.054

.950

.314












Table 9

Summary of ANCOVA Results for State Anxiety with Social Desirability as
Covariate



Dependent DF F Value Signif-
Variable icance
of F


Race

Location

Health Status

Race X Location

Race X Health Status

Location X Health Status

Race X Location X Health Status

Respondent


Respondent

Respondent

Respondent

Respondent

Respondent

Respondent

Respondent


Race

Location

Health Status

Race X Location

Race X Health Status

Location X Health Status

Race X Location X Health Status


1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158


0.01

10.06

6.20

0.76

3.08

0.34

1.32

0.52

8.36

1.38

0.77

8.23

0.93

9.60

0.06


.903

.002

.014

.386

.081

.560

.253

.470

.004

.243

.382

.005

.337

.002

.813












Table 10

Summary of ANCOVA Results for Trait Anxiety with Social Desirability as
Covariate



Dependent DF F Value Signif-
Variable icance
of F


Race

Location

Health Status

Race X Location

Race X Health Status

Location X Health Status

Race X Location X Health Status

Respondent

Respondent X Race

Respondent X Location

Respondent X Health Status

Respondent X Race X Location

Respondent X Race X Health Status

Respondent X Location X Health Status

Respondent X Race X Location X Health Status


1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158

1,158


0.03

0.61

0.70

1.32

1.51

1.37

0.62

0.34

8.43

2.24

2.19

3.50

4.89

0.00

0.86


.865

.438

.405

.252

.221

.243

.433

.564

.004

.136

.141

.063

.029

.967

.355











Table 11

Means and Standard Deviations on the STAIC


STAICa-State

M(SD)


STAIC-Trait

M(SD)


Child

Black (n=78) 31.5(7.5) 35.6(7.4)


White (n=89) 30.2(6.5) 33.6(8.4)

Mother

Black (n=78) 30.4(5.9) 34.0(6.2)

White (n=89) 31.9(6.4) 36.2(7.0)


aState Trait Anxiety Inventory for Children, Spielberger, 1973.











Table 12

Means and Standard Deviations on the STAIC-State within Race and Location



STAICa-State

M(SD)


Non-stressful (Restaurant)


Child
Black (n=41)
White (n=46)

Mother
Black (n=41)
White (n=46)


29.1(5.2)
29.3(6.2)


29.8(4.0)
30.6(5.5)


Stressful (Clinic)


Child
Black (n=37)
White (n=43)

Mother
Black (n=37)
White (n=43)


34.2 (8.6)
31.1(6.8)


31.1(7.6)
33.4(7.0)


aState Trait Anxiety Inventory for Children, Spielberger, 1973.











Table 13

Means and Standard Deviations on the STAIC-State within Location and Health
Status



STAICa-State

M(SD)


Non-stressful (Restaurant)

Child
Healthy (n=43)
Chronically Ill

Mother
Healthy (n=43)
Chronically Ill

Stressful (Clinic)


Child
Healthy (n=34)
Chronically Ill

Mother
Healthy (n=34)
Chronically Ill


(n=44)



(n=44)


(n=46)



(n=46)


30.0(5.8)
28.5(5.7)


28.9(4.6)
31.5(4.8)


30.7(7.0)
33.8(8.1)


31.6(6.1)
32.8(8.1)


aState Trait Anxiety Inventory for


Children, Spielberger, 1973.











Table 14

Means and Standard Deviations on the STAIC-Trait within Race and Health Status


STAICa-Trait

M(SD)


Healthy


Child
Black (n=37)
White (n=40)

Mother
Black (n=37)
White (n=40)


34.4(7.2)
35.5(8.4)


33.2(5.2)
35.3(6.7)


Chronically Ill


Child
Black (n=41)
White (n=49)

Mother
Black (n=41)
White (n=49)


36.6(7.5)
32.0(8.2)


34.8(7.1)
36.8(7.3)


aState Trait Anxiety Inventory for Children, Spielberger, 1973.































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DISCUSSION


Replication of Effects

This study explored the influence of race on mothers'

and children's perceptions of child state and trait anxiety.

Children were either chronically ill or healthy and were

either in a stressful (clinic) or a nonstressful

(restaurant) setting. The following results were obtained:

(1) A significant Respondent X Race interaction was found

for both state and trait anxiety, with Black mothers

reporting that their children experience less anxiety than

their children self-report, and White mothers reporting that

their children experience more anxiety than their children

self-report; (2) the Respondent X Race interaction for state

anxiety occurred in the stressful (clinic) location, but not

in the nonstressful (restaurant) setting; (3) the Respondent

X Race interaction for trait anxiety occurred in the

chronically ill sample, but not in the healthy sample of

children.

The significant Respondent X Race interaction was

expected to occur since it was found in a previous study

with children undergoing invasive medical procedures

(Wachtel et al., 1994). In that study it was found that









Black children rated themselves as more anxious than did

their Black mothers, while White children perceived

themselves as less anxious than did their White mothers.

Additionally, Black children rated themselves as more

anxious compared to White children. In contrast, however,

these same Black children were perceived by their mothers as

significantly less anxious compared to ratings by mothers of

White children. It was important to replicate this finding

in both chronically ill and healthy children, given that the

1994 study by Wachtel et al. used primarily chronically ill

children. Additionally, it was important to replicate this

finding in both stressful and nonstressful settings, since

the sample in the 1994 study by Wachtel et al. was assessed

only in a stressful setting (i.e., prior to undergoing

invasive medical procedures).

When assessing state anxiety, the Respondent X Race

interaction did not depend on health status, occurring in

both chronically ill and healthy children. However, the

Respondent X Race interaction with state anxiety did depend

on location, occurring in the stressful, but not the

nonstressful setting. Both findings were expected, given

that the score on the state scale of the STAIC is an

indication of the level of transitory anxiety (i.e., how

child feels at that moment) experienced by the child

(Spielberger, 1973). Transitory anxiety would not be

expected to vary depending on health status (i.e., both









healthy and chronically ill children were expected to feel

more nervous in the clinic and more relaxed in the

restaurant). Furthermore, since higher transitory anxiety

would likely be experienced in a stressful setting, it was

expected that the interaction would occur in the stressful

setting; however, given floor effects of anxiety in the non-

stressful setting, the interaction would not be expected to

occur in this setting.

For trait anxiety the expected Respondent X Race

interaction occurred regardless of location, but showed a

trend to be dependent on health status (i.e., occurring in

chronically ill, but not healthy children). Again, this is

intuitively appealing when one considers that the trait

scale of the STAIC measures generalized feelings of anxiety

(Spielberger, 1973). Severity of generalized worries and

concerns would not be expected to vary depending on location

due to the stability of this construct. In contrast, level

of generalized anxiety would be expected to vary depending

on health status, given the findings of greater risk of

emotional problems in chronically ill children (Breslau,

1985; Mattsson, 1972; Wallander, Varni, Babani, Banis, &

Wilcox, 1988). Therefore, it is understandable that the

Respondent X Race interaction would be produced in the

chronically ill children, but due to floor effects this

interaction might not occur with healthy children reporting

trait anxiety.










When assessing state anxiety, in addition to the

expected main effect for location, an unexpected interaction

involving Respondent X Location X Health Status was found.

This interaction seems to be due to the large discrepancy

between chronically ill children in restaurants versus

clinics, which was significant. These chronically ill

children reported a huge increase in anxiety when in clinics

compared to restaurants, whereas healthy children only

reported a slight increase in anxiety when in clinics versus

restaurants. It is possible that for chronically ill

children, who repeatedly must visit clinics for various

uncomfortable procedures, the restaurant is perceived as

much more positive and the clinic as more negative. Healthy

children may have different perceptions in these

experiences; relatively speaking, healthy children may

perceive their experiences in these situations as less

extreme in divergence. Additionally, it also is possible

that the dental clinic, where healthy children were seen,

was not as anxiety provoking as the oncology clinic, where

the chronically ill children were seen.

Influence of Demographic Variables

The influence of demographic variables was explored

since there were discrepancies between the Black and White

samples. A very important variable for which to control was

SES. Even when SES was used as a covariate in the model,

all significant effects remained. This is especially










important given the confound of SES and race, and the

significant role this has played in the literature (e.g.,

Kessler and Neighbors, 1986; Ulbrich et al., 1989).

In addition to having higher SES, White mothers were

older, more educated, and more often married than Black

mothers. Age and education were controlled and found to

have no influence on the results. Unlike other demographic

variables, the effect of marital status independent of race

could not be teased out; however, this one variable does not

seem to be a likely explanation of the Race X Respondent

interaction.

The finding that gender significantly influenced the

children's reports of trait anxiety was expected since the

literature generally finds girls reporting greater anxiety

than boys (Abe & Masui, 1981; Kashani & Orvaschel, 1988;

Loupouse & Monk, 1959). However, this gender difference

did not occur in mothers' reports of child anxiety. Very

few studies have looked at gender differences in parent-

reported child anxiety. Two studies previously examined

gender differences of child internalizing disorders/fears as

reported by parents. Like children's self-reports, parents

reported significantly greater levels of internalizing

disorders/fears in their daughters as compared to their sons

(Achenbach & Edelbrock, 1981; LaPouse & Monk, 1959). It is

important to note that when controlling for gender in the

present study, the Respondent X Race interaction remained,









demonstrating the robustness of this finding. In contrast,

the Respondent X Race X Health Status was lost, possibly the

result of reduced power with so many variables in the model

and the disproportionate percentage of females in the Black

sample. However, a new and unexpected Respondent X Location

X Gender effect emerged. Mothers' and children's reports of

anxiety in clinics were congruent according to gender, with

girls experiencing greater anxiety than boys. However, in

restaurants, while the girls and their mothers continued to

report more anxiety than the boys' self-reports, the boys'

mothers indicated that their sons experienced relatively

high levels of anxiety compared to the boys' self-reports of

anxiety. This is difficult to explain and attests to the

need for further studies looking at gender differences in

parent and child reports of child anxiety.

Influence of Social Desirability

Overall, social desirability was found to play a very

minor role in the racial discrepancies of mother and child

reports of child anxiety. When controlling for social

desirability, the Respondent X Race interaction remained,

suggesting that social desirability was not the major cause

of the race and respondent influences in reported anxiety.

Additionally, the previous Respondent X Race X Health Status

trend became significant when social desirability was

controlled, indicating that difference in social










desirability initially suppressed (rather than explained)

this finding.

Similar concerns with social desirability were found

between Black and White mothers, as well as between Black

and White children, supporting the conclusion that

differences in concern with social desirability were not the

source of racial discrepancies in reported anxiety. Black

mothers and children did score higher on the SDMA than White

mothers and children, but there was no relationship between

SDMA scores and reported anxiety in the medical setting.

This suggests that Black mothers' and children's beliefs

that a child should appear calm and not show anxiety in the

clinic setting are not related to a desire for general

social approval, nor did they appear to influence the

children's reported anxiety in the clinic setting.

Influence of Medical Setting

It is notable that the Response X Race interaction

occurred in situations either related to the medical

institution directly (i.e., clinic setting) or indirectly

(i.e., chronically ill children identified through clinics).

It could be that the relationship with the medical setting

influenced these findings. It is known that Blacks

experienced discrimination in medical institutions in the

past (Harwood, 1981; Van Horne, 1988). Interestingly, in a

recent study conducted by Chestnut (1994) it was found that

Black guardians of children with sickle cell disease









perceived Whites as receiving better service through a

medical center than Blacks. Furthermore, the medical staff

also viewed Whites as getting better treatment than Blacks

in this setting. This study included 22 parents or

guardians of children with sickle cell disease, as well as

various medical staff. Guardians and medical staff were

administered a test involving 12 sets of pictures including

various combinations of Black and White children and/or

adults, and were asked which person would receive better

service if they were to get sick. Results were analyzed for

race, gender, and age. Chestnut (1994) found that race was

the most influential factor related to perceived service.

When generalizing these findings to the current study, it

seems that these perceptions would influence the comfort

level of the children's mothers with medical staff, which in

turn might lead them to respond in a guarded manner to

questionnaires administered by medical affiliates (i.e.,

assessors who administered the questionnaires). These

assessors likely would have been perceived as being medical

affiliates since subjects were obtained through medical

clinics. Additionally, perceptions of Blacks receiving

worse treatment might lead children to experience more state

anxiety in the medical setting, as well as trait anxiety

when their lives involve frequent visits to this setting.

It also is important to note the cultural differences

in perception of illness. According to Jackson (1981)








87

considerable attention is focused on the etiological role of

stress in inducing physical illnesses among urban Blacks.

Jackson (1981) gave the example that "many Blacks believe

that diabetes is induced by 'worriation', and some ministers

have reinforced this notion. ." (pp.76). When Black

mothers in the present study were asked about their

children's anxiety, it is possible that they felt the

questions were related to the etiology of their children's

illnesses and were more guarded in their answers. Further

research is needed to explore the possible influence of the

medical setting and cultural differences.

Only two studies in the literature have found similar

Respondent X Race interactions when assessing children's

affective experiences (Kazdin et al., 1983b; Wachtel et al.,

1994). Subjects in the 1983 study by Kazdin et al. were

inpatients at a psychiatric hospital, while subjects from

the 1994 study by Wachtel et al. were in a medical setting

(cancer center). Although this interaction has not been

confirmed in nonmedical/mental health settings, the racial

differences of children's self-reported anxiety have been

found in non-medical settings (Clawson et al., 1981; Johnson

& Michigan, 1989; Kashani & Orvaschel, 1988; Wolf et al.,

1982), with Black children reporting more anxiety than White

children. Therefore, Black-White differences in child

reported anxiety appear to be robust and not confined to the

medical setting.









Racial differences in parent report of child anxiety

rarely have been studied, but have been found in non-medical

settings (Kazdin et al., 1983a, 1983b) as well as medical

settings (Wachtel et al., 1994). This suggests that the

Respondent X Race interaction is not limited to medical

settings. However, further research is needed.

Other Possible Influences

Regarding racial differences in children's self-reports

of anxiety, it is possible that Black children experience

more anxiety than White children due to more frequent

confrontation with daily stressors in society (e.g.,

poverty, racism). It also could be that mothers' beliefs

directly affected children's anxiety. Specifically, it is

possible that the White children experience less anxiety

since their mothers recognize and deal with their children's

nervousness. Perhaps the Black children experience more

anxiety since it goes unrecognized by their mothers,

therefore decreasing the chance of mitigation by mother's

concern and attention to symptomatology. Interestingly, in

the present study significantly more White children were

treated for anxiety than Black children. The fact that

White children receive more treatment for anxiety is

congruent with the literature on outpatient treatment for

emotional problems in general (Cuffe, Waller, Cuccaro,

Pumariega, & Garrison, 1995; Scheffler & Miller, 1989) and

for anxiety disorders specifically (Last & Perrin, 1993).









Furthermore, it has been found Black children are at

greater risk for dropping out of treatment than White

children (Kazdin, Stolar, and Marciano, 1995). Predictors

of dropping out of treatment shared by Black and White

families included stress of the parent, antisocial behavior

of the child, parent history of antisocial behavior, and

adverse child-rearing practices. Predictors of dropping out

of treatment for White families only included socioeconomic

disadvantage and family constellation (e.g., single-parent

family); it is important to note that there was less

variability in these latter two predictors within the Black

sample, likely leading to lack of predictability in this

sample. These risk factors could have contributed to Black

mothers' lack of recognition of children's anxiety in the

current study.

The race of the experimenter could have been a factor

influencing the children's reports. Black children could

have been made more anxious, as compared to White children,

by the presence of White experimenters. However, it seems

that if this were the case then there would not have been a

three-way interaction (i.e., Race X Respondent X Location),

but only a two-way interaction (i.e., Race X Respondent),

since it would be expected that children's anxiety would

remain relatively high regardless of location. Finally, it

is possible that children's self-reports are inaccurate,

while mother's reports are more accurate. However, this










hypothesis is not congruent with the general literature

regarding accuracy of child-reported emotional experience

(Achenbach & Edelbrock, 1987; Angold et al., 1990; Moretti

et al., 1985; Offer et al., 1991; Reich & Earls, 1987;

Verhulst et al., 1987).

Regarding mothers' interpretation of child anxiety, it

is possible that White mothers perceive their children to

experience higher anxiety due to their own experience of

higher anxiety, while Black mothers perceive their children

to experience lower anxiety due to their own experience of

lower anxiety. Indeed, in the 1994 study by Wachtel et al.,

mothers' level of anxiety correlated significantly with

their reports of children's anxiety. It also is possible

that Black mothers may have concealed their true feelings

regarding perceptions of children's anxiety as compared to

White mothers, either due to the assessor's relationship to

the medical field (as discussed earlier) or due to general

discomfort with White examiners (i.e., experimenter

effects). All experimenters in the present study were

White, as were experimenters in the 1994 study by Wachtel et

al.. Race of experimenter was not reported in the study by

Kazdin et al. (1983b). However, once again this seems

unlikely since a three-way interaction was found. Finally,

as noted earlier, it is possible but unlikely that mothers

are accurate reporters of children's anxiety, while the

children are under/over-reporting anxiety.










Sample Characteristics

The high refusal rate of subjects in this study could

also have affected the average levels of reported anxiety.

Indeed, it is possible that those refusing to participate

might have experienced generally higher (or possibly lower)

levels of anxiety than those who agreed to participate.

Furthermore, the finding of a significantly higher

percentage of Blacks than Whites refusing to participate in

the study is an important area for further research. The

low participation rate of Black subjects is rarely addressed

in the psychological literature. This problem was addressed

in a few articles when discussing the lack of research that

includes minority subjects (McLoyd, 1990b; Neal & Turner,

1991; Slaughter & McWorter, 1985). These researchers noted

that the paucity of research including minorities is

partially due to Blacks' hesitancy to participate in

studies. Specifically, Neal and Turner (1991) reported

that the high refusal rate of Black subjects could be due to

the "less than honorable" reputation of research resulting

from the history of large-scale abuse through research

projects conducted in Black communities (pp. 401). McLoyd

(1990b) and Slaughter and McWorter (1985) agreed with the

view that psychological researchers' reputation of abusing

research results could reduce Black participation rates.

McLoyd (1990b) added that the presence of stressors in the








92

lives of Blacks also makes participation in research studies

burdensome.

Interestingly, a similar issue is found in the medical

transplantation field, with less Black donors compared to

White donors (e.g., Callender, Bayton, Yeager, & Clark,

1982; Howard, Gore, Hows, Downie, & Bradley, 1994; Kerman,

Kimball, Van Buren, Lewis, Cavazos, Heydari, & Kahan, 1992;

Perez, Schulman, Davis, Olson, Tellis, & Matas, 1988; Pike,

Kahn, & Jacobson, 1990; Ryu, Thompson, & Crouse, 1989).

Hypotheses regarding the lower donor rate in Blacks included

various fears about the organ-donation process, as well as

general distrust of the medical community. It is important

to better understand this finding of lower participation

rates of Blacks compared to Whites, so that actions can be

taken to increase the percentage of Black volunteers.

Inadequate numbers of Black subjects in research studies

reduces the generalizability of findings to this population.

Indeed, as the current study shows, Black subjects can have

very different responses to research protocol compared to

White subjects. Furthermore, implications of inadequate

numbers of Black organ donors are life threatening,

resulting in fewer Black potential recipients receiving

transplants.

The current sample was compared to the normative sample

in the 1973 study by Spielberger categorizing the current

sample according to respondent, race, location, and health










status. The normative sample from the 1973 study by

Spielberger was obtained through public schools and was

assessed in the classroom setting. The finding that the

current sample of male and female children generally

experienced significantly less anxiety than the normative

sample was unexpected. However, it is important to note

that the normative sample was obtained in 1973 and much

could have changed since that time. The norms were obtained

in Florida counties (i.e., Tallahassee, Bradenton, Leon

County, and Manatee County), as compared with the current

sample, which was obtained in Alachua County.

The current sample of children's and mothers' responses

on the social desirability questionnaires were compared with

the normative samples' responses on these questionnaires.

Both Black and White boys and Black and White mothers scored

significantly higher on the CSD and the Marlowe-Crowne,

respectively, as compared to the normative samples,

indicating that they were more concerned with appearing

socially desirable than the normative samples. While this

could be due to above average concern with appearing

socially desirable in these populations, it also could be

due to generational changes; the norms for the CSD were

obtained in 1965, while the norms for the Marlowe-Crowne

were obtained in 1964. The norms for the CSD were obtained

in small city and country schools in Southern Ohio. The

norms for the Marlowe-Crowne were obtained through









introductory psychology students at Ohio State University.

Geography also may contribute to differences between the

current sample and normative samples, as well as population

differences on the Marlowe-Crowne.

The current study included children with various

diagnoses to represent the group of chronically ill

children. The literature supports the use of various

chronic illnesses in psychological studies, rather than

using a single chronic illness, due to findings that

psychosocial effects of chronic illnesses vary more within

chronic illnesses than between them (Jessop & Stein, 1985;

Kellerman, Zeltzer, Ellengerg, Dash, & Rigler, 1980;

Mattsson, 1972; Wallander et al., 1987). The present study

confirmed this, finding that mother and child reports of

state and trait anxiety did not vary among the illnesses

when assessed within race. There was one exception to this

finding; mothers of White children with immuno-deficiency

disorders reported their children to experience more state

anxiety than White children with other chronic illnesses.

Nevertheless, the race-related findings do not seem to be

due to the type of illness; the immuno-deficiency disorders

finding is odd and necessitates replication/further

exploration.

Conclusions and Recommendations

Overall, this study confirmed previous findings of a

Respondent X Race interaction when assessing children's