Paternal Psychological Control Research Articles

Confirmatory factor analysis and gender invariance of the Persian version of psychological control scale: association with internalizing and externalizing behavior problems.

The current cross-sectional study aimed to examine the reliability, construct validity, gender invariance and concurrent validity of the psychological control scale-youth self-report (PCS-YSR) among Iranian adolescents. A total of 1,453 high school students (49.2% boys; Mage = 15.48, SD = 0.97), who aged between 14 and 18 years old completed the PCS-YSR and the youth self-report (YSR) scale of behavior problems. Reliability was established using Cronbach's alpha and ordinal alpha for maternal and paternal psychological control. The confirmatory factor analysis (CFA) results supported the original unidimensional model of the PCS-YSR scale for both mother and father forms. Results also revealed that mother and father forms of PCS-YSR were invariant across adolescents' gender. When comparing the mean differences, mothers were more psychologically controlling toward their sons, compared to their daughters. The mother and father forms of PCS-YSR were found to have acceptable concurrent validity through their relationship to internalizing and externalizing behavioral problems. Overall, our findings supported the psychometric properties of the Persian version of the Psychological Control Scale-Youth Self-Report among Iranian adolescents. This scale can be used as an efficient tool for parental psychological control among adolescents in Iran. The negative effect of the intrusive parenting behavior on child' negative outcomes in Iran, irrespective of culture, was shown.

Factors associated with severe depressive symptoms among Chinese secondary school students in Hong Kong: a large cross-sectional survey.

Many adolescents were reported to have severe depressive symptoms, and a careful assessment of its correlates is essential for prevention and intervention programs. This study aimed to gain insight into the prevalence of severe depressive symptoms and its association with factors at four levels (individual, relationship, school and society) in a large sample of Hong Kong Chinese secondary school students. Secondary school students from Secondary 1 through 7 were selected as participants using a cluster random sampling method. A questionnaire including inventories measuring 24 factors at the four levels (six individual factors, 11 relationship factors, three school factors, and four society factors) was completed by 8,963 participants (56.3% female) with a mean age of 15.1 (SD = 1.8) years. Students with a score of ≥15 on the Patient Health Questionnaire were defined as having severe depressive symptoms. The association between severe depressive symptoms and correlates were examined by t-test and χ2 test. Logistic regression models using a hierarchical approach then examined the individual contribution of these 24 factors to severe depressive symptoms with the control of other factors in the model. 7.4% of the students have severe depressive symptoms. Twenty-two of the 24 factors were significantly associated with severe depressive symptoms in bivariate analyses. In the logistic regression, 11 factors (three individual factors: age, self-esteem and self-mastery; six relationship factors: tobacco use, alcohol drinking, drug use, paternal psychological control, dinner with parents, and perceived social support from friends; one school factor: felt pressure from homework; and one society factor: number of sibling) were statistically significant. Felt pressure from homework, alcohol drinking, and perceived social support from friends were the strongest correlates of severe depressive symptoms. The prevalence of self-reported severe depressive symptoms in Hong Kong Chinese secondary school students was high, and the identification of multiple associated factors at the four levels simultaneously provides a knowledge basis for the development of a comprehensive, multivariate model of factors influencing severe depressive symptoms in Chinese secondary school students. The factors identified in the present study may be helpful when designing and implementing preventive intervention programs.

Parental control and adolescent internet addiction: the moderating effect of parent-child relationships.

The present study investigated how maternal and paternal controls, including behavioral and psychological controls, predict adolescent Internet addiction, as well as the potential moderating effects of adolescent gender and parent-child relationships on the predictions. Data were collected from 1,974 Chinese adolescents (age range = 14-22; mean = 16.47; SD = 0.87; 1,099 girls) in Guizhou Province, mainland China in November 2021. Internet addiction was measured using the ten-item Internet Addiction Test developed by Kimberly Young, and Parental control and parent-child relationships were measured by the respective subscales derived from the validated Chinese Parent-Child Subsystem Quality Scale. Hierarchical regression analyses revealed that after the covariates were statistically controlled, both parents' behavioral controls showed significant negative predictions on adolescent Internet addiction, while their psychological control tended to positively predict Internet addiction among adolescents, although the effect was only marginal. In addition, the impacts of maternal and paternal controls were equal, and such impacts did not vary between sons and daughters. While adolescent gender was not a significant moderator, the parent-child relationship quality significantly moderated the effects of paternal behavioral control, paternal psychological control, and maternal psychological control on adolescents' Internet addiction. Specifically, the prediction of paternal behavioral control was stronger while the effect of paternal and maternal psychological control was weaker among adolescents with a positive father-child relationship than those with a moderate or poor father-child relationship. These findings indicate the protective function of parents' behavioral control and the negative impact of psychological control on the development of adolescent Internet addiction. Further, a positive relationship between the father and the adolescent can strengthen the positive effect of paternal behavioral control and mitigate the negative effects of both parents' psychological controls.

Understanding the Relationship between Parental Psychological Control and Prosocial Behavior in Children in China: The Role of Self-Efficacy and Gender.

Objectives: Prosocial behavior is essential for individuals’ development, and the study aims to analyze the relationship between parental psychological control and prosocial behavior. Method: The current study investigated the relationships among Paternal Psychological Control (endogenous variable), General Self-Efficacy (mediator), and Prosocial Behaviors (exogenous endogenous variable) via a moderated mediation modeling approach (gender as the moderator). A total of 1822 Chinese students aged from 7- to 17-year-old (Mage = 12.4 years old, SDage = 1.89, 48.6% girls) were included in the current study. Results: After controlling participants’ age, the only child status, family income, and parent’s education level, results revealed that higher levels of parental control were associated with lower levels of students’ self-efficacy, which, in turn, reduced students’ prosocial behavior intention. Moreover, the relationship between self-efficacy and prosocial behavior intention was moderated by students’ gender, where the positive effects of self-efficacy on prosocial behavior intentions were reduced in girls. Conclusion: Findings highlight the importance of parental psychological control for supporting children’s self-efficacy to promote prosocial behaviors on different gender groups.

Negative messages from parents and sisters and Latina college students’ body image shame

Using the sociocultural model and risk and resilience theory, we examined the moderating role of Latinas’ family relationship quality on the associations between negative eating and weight messages from fathers, mothers, and sisters, and Latinas’ body image shame. Utilizing Amazon Mechanical Turk, we recruited a sample of 195 Latina young adults (Mage = 23.24, range = 18 −25; SD = 1.95; 67.4 % Mexican-origin) who reported retrospectively on negative appearance-related messages from each family member (i.e., fathers, mothers, and sisters), positive (e.g., parental warmth and sibling intimacy) and negative (i.e., parental psychological control and sibling negativity) relationship quality with parents and sisters, and current body image shame. Hierarchical linear regression analyses revealed that negative eating and weight messages from fathers, mothers, and sisters and sibling negativity were positively and significantly associated with Latinas’ body image shame. Further, we found that under conditions of high paternal psychological control but not low, the associations between fathers’ messages and Latinas’ body image shame were strengthened. For mothers, under conditions of low maternal psychological control but not high, the associations between mothers’ messages and Latinas’ body image shame were strengthened. Our findings reveal that family members’ negative comments are harmful for Latinas’ body image.

Marital dissatisfaction, psychological control and parent-child conflict in Chinese families - An actor–partner interdependence model analysis

Although family systems theories highlight the associations of marital quality with parenting practice and parent-child relationship, studies examining individual and inter-spousal linkages of marital dissatisfaction with psychological control and parent-child conflict among Chinese families are almost non-existent. Adopting the Actor-Partner Interdependence Model (APIM), dyadic interdependence in the associations of marital dissatisfaction with psychological control and parent-child conflict were examined in a sample of 386 Chinese families in Hong Kong. Fathers, mothers and adolescent children were involved in the data collection (Mfather’s age = 48.7; Mmother’s age = 44.7; Mchildren’s age = 14.6; 53.1% of adolescents were boys). Results showed that while father-perceived marital dissatisfaction was positively associated with paternal and maternal psychological control, mother-perceived marital dissatisfaction was not. Moreover, marital dissatisfaction perceived by each parent was linked to greater conflict between their children and the other parent, but it was not associated with his/her own conflict with children. The findings showed that Chinese fathers who perceived greater marital dissatisfaction might spill over their stress and hostility from marital dissatisfaction to practicing paternal psychological control and trigger their spouse to exercise maternal psychological control for their children. Besides, poorer marital satisfaction might be linked to conflictual relationship between their children and their spouse, hence increasing the risk of family triangulation. The present study suggests the importance of adopting a family-based intervention approach in helping Chinese parents facing marital dissatisfaction.

Maternal and Paternal Psychological Control Dimensions: Relations with Adolescent Outcomes

Maternal and Paternal Psychological Control Dimensions: Relations with Adolescent Outcomes

The Influence of Parental Psychological Control on the Tendency for Smartphone Addiction as Mediated by Relational Aggression in Adolescents

This study examines the influences of parental psychological control on the tendency for smartphone addiction and investigates whether adolescents’ relational aggression mediated the relation of parental psychological control on the tendency for smartphone addiction in adolescents. The sample for this study was 374 students (M 196, F 178) from four middle schools located in Seoul and Gyeonggi-do. Variables were measured with the Psychological Control Scale-Youth Self Report (PCS-YSR), the Peer Conflict Scale (PCS), and the Smartphone Addiction Diagnostic Scale (S-scale). The data were analyzed by means of descriptive statistics analysis, one-way ANOVA, correlation analysis, multiple regression analysis, and the Sobel test. Also, the Baron and Kenny’s model (1986) was used to verify mediating effects. The results are as follow. First, differences in the tendency for smartphone addiction according to gender, the period when participants started using their own smartphone, activities performed most by smartphone, hours of smartphone use per day on weekdays, and hours of smartphone use per day on weekends were significant. Second, parental psychological control, relational aggression, and all subvariables of the tendency for smartphone addiction showed a significant positive correlation. Third, relational aggression turned out to mediate partially between both maternal and paternal psychological control and all subvariables of the tendency for smartphone addiction. The results of this study show that parental psychological control has direct and indirect effects on the tendency for smartphone addiction and describe the mediating effects of relational aggression

An Examination of the Relationships Between Parenting Behaviors and Adolescents Well-being: A Cross-cultural Comparision

The current study aimed to explore in the adolescent sample the associations between parenting behaviors (maternal and paternal) and well-being in two countries: France and Turkey. A total of 607 undergraduate university students were recruited with a mean age of 20.85 ± 3.18 years: 283 French and 324 Turkish. The data were administrated by the means of the self-report questionnaires for perceived parenting behaviors (Behavioral control, psychological control, autonomy, and responsiveness) and for well-being by using two indicators: positive and negative affect, and psychological flourishing. Correlation and regression analyses revealed significant associations between parenting behaviors and well-being indicators. First, maternal and paternal psychological control in the Turkish and French groups was associated with negative-affect and this association is higher in the Turkish group than the French group. Moreover, psychological control was associated with a decrease in psychological flourishing only in the Turkish group. Second, maternal and paternal behavioral control was associated with lower negative-affect and higher psychological flourishing in the Turkish group than the French group. In addition, Turkish maternal/paternal responsiveness, as well as autonomy-support, was associated with low negative-affect and paternal autonomy-support was associated with high positive-affect. The implications of the findings for future research are discussed.

Medical responsibility growth in youth with spina bifida: Neuropsychological and parenting predictors.

For youth with spina bifida (SB) there is a growing need to understand how responsibilities for health care are transferred from family- to self-management over time. The current study examined trajectories of responsibility for medical tasks in youth with SB across adolescence, as well as executive functioning/attention and parenting behaviors as predictors of growth. As part of a larger, longitudinal study, 140 youth with SB (ages 8-15 at time 1; Mage = 11.43) reported on their responsibility for relevant medical tasks across five time points. Attention and executive functioning were assessed via performance-based and parent/teacher-report methods. Parenting behaviors consisted of acceptance, behavioral control, and psychological control and were assessed via observational and parent-report. Growth curve analyses revealed significant increases in youth medical responsibility across all SB tasks over time. Attention, executive functioning, maternal behavioral control, and paternal psychological control emerged as predictors of growth parameters in responsibility for communicating about SB and managing health care appointments. Results indicated that youth with SB obtain increasing responsibility for their health care over time. The transfer of responsibility for SB management may differ based on individual (i.e., the child's neuropsychological abilities) and family level (i.e., parenting behaviors) factors. Further research is needed to understand how growth in medical responsibility relates to changes in other aspects of SB self-management across development, such as medical adherence. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Bidirectional relationship between parental psychological control and adolescent maladjustment

IntroductionThis study explores the longitudinal and bidirectional relations between paternal/maternal psychological control and adolescent maladjustment (i.e., internalizing symptoms, aggression, and association with deviant peers). MethodsThis longitudinal investigation was conducted at two time points over a one-year interval with participants comprising 543 Chinese adolescents aged 10 to 13 (mean age at Time 1 = 11.29; 51.93% girls). The performed measurements encompassed paternal/maternal psychological control, adolescent internalizing symptoms, aggression, association with deviant peers, and demographic information. ResultsThe findings of a cross-lagged model analysis revealed that paternal psychological control was longitudinally and positively related to adolescent internalizing symptoms and aggression. Maternal psychological control was not significantly related to any domain of adolescent maladjustment. In turn, adolescent association with deviant peers was longitudinally and positively associated with both parents’ psychological control. ConclusionsParental psychological control was bidirectionally associated with adolescent maladjustment in general, and paternal psychological control played a crucial role on adolescent maladjustment in the Chinese cultural context. The study's findings supported the reciprocal model of parent–child interaction, and extended it by highlighting the apprehension of the characteristics of parental impact from a cultural perspective. The study results add to the current scholarly understanding of parental psychological control in the non-western cultural context.

Daily-Life Social Experiences as a Potential Mediator of the Relationship Between Parenting and Psychopathology in Adolescence.

Adolescence is a vulnerable period for psychopathology development, and certain parenting styles are consistent and robust predictors of a broad range of mental health outcomes. The mechanisms through which maladaptive parenting styles affect the development of psychopathology are assumed to be largely social in nature. Yet, the social mechanisms linking parenting to psychopathology are unexplored at arguably the most important level of functioning: daily life. This study aims to identify the associations between three parenting styles, and the experience of daily-life social interactions. Furthermore, we aim to explore the extent to which these parenting styles and altered daily-life social experiences are associated with psychopathology. In this study, we recruited a sample of N = 1,913 adolescents (63.3% girls; mean age = 13.7, age range = 11 to 20) as part of the first wave of the longitudinal cohort study “SIGMA”. Parenting styles (psychological control, responsiveness, and autonomy support) and psychopathology symptoms were assessed using a retrospective questionnaire battery. The experienced quality of social interactions in different types of company was assessed using the experience sampling method, ten times per day for 6 days. Direct associations between parenting styles and general quality of daily-life social experiences were tested using a three-level linear model, revealing significant associations between social experiences and different parenting styles. When interaction effects were added to this model, we found that maternal responsiveness and paternal psychological control mainly related to altered qualities of social interactions with parents, while paternal autonomy support was associated with better experiences of non-family social interactions. Finally, an exploratory path analysis highlighted how both paternal autonomy support and altered quality of non-family interactions are uniquely associated with psychopathology levels. These findings demonstrate the general and pervasive effects of maladaptive parenting styles, as parenting seems to broadly affect adolescents' interactions with different types of social partners in everyday life. Moreover, they illustrate a potential mediated relationship in which altered daily-life social interactions could drive the development of psychopathology. A stronger focus may be required on the role of altered day-to-day social experiences in the prevention and potentially, the treatment, of adolescent psychopathology.

Parenting and Adolescents\u2019 Academic Achievement: The Mediating Role of Goal Engagement and Disengagement

Prior research has investigated parental behavior and students’ motivation separately as predictors of adolescents’ academic achievement. The current study jointly examined the associations between parental behavior, adolescents’ motivation, and academic achievement. Using data collected from participants in youth programs (N = 220), we investigated whether students’ academic goal engagement and disengagement mediates the association between adolescents’ relationships with their parents and their academic achievement. Findings from regression-based mediation models indicated that adolescents’ perceived maternal support was positively associated with their academic achievement, and that this association was mediated by students’ engagement with academic goals. Perceived maternal psychological control was negatively associated with students’ academic success, mediated by students’ academic goal disengagement. Supplementary analyses examining components of perceived parental support and psychological control showed that maternal warmth may be most beneficial for adolescents’ academic success, whereas maternal devaluation may be most detrimental. Perceived paternal psychological control was only associated with lower academic achievement, but was not related to adolescents’ goal disengagement.

Maternal and paternal psychological control and adolescents' negative adjustment: A dyadic longitudinal study in three countries.

Psychological Control (PC) interferes with autonomy-related processes in adolescence and has a negative impact on adolescents’ development related to internalizing and externalizing problems. Several scholars suggested that PC can be used differently by mothers and fathers. However, these differences are still understudied and mainly grounded on maternal and/or adolescents’ perspectives, leading to potentially incomplete inferences on the effects of PC. The present study extends previous research on PC in two directions. First, we tested the dyadic and cumulative effects of maternal and paternal PC on adolescents’ antisocial behaviors and anxious-depressive symptoms. Secondly, we explored the cross-cultural generalizability of these associations in three countries: Italy, Colombia, and USA. Participants included 376 families with data from three consecutive years (T1, adolescents’ age = 13.70). Mothers’ and fathers’ reports of PC and youth’s reports of antisocial and internalizing behaviors were assessed. Using the Actor-Partner Interdependence Model (APIM) we found that maternal PC predicted adolescents’ reported antisocial behaviors whereas paternal PC predicted lower anxious-depressed symptoms. Comparisons across countries evidenced the cross-cultural invariance of the longitudinal APIM across Italy, Colombia, and USA. The practical implications of these results are discussed.

The Effects of Parenting Style on Emerging Adulthood Emotional Self-Regulation and Identity Development

The purpose of this research is to examine how parenting profiles, identity development, and emotional self-regulation may relate to one another in emerging adulthood utilizing a person-centered approach. The data being used for this study was from the Multi-Site University Study of Identity and Culture (MUSIC), which was collected using a cross-sectional online survey. The data consists of 3,775 students of which 61.9% were White and 69.9% were females ages 18-29. A hierarchical cluster analysis was performed for all participants using mother and father psychological control and nurturance to identify the parenting profiles. A four-cluster solution was most parsimonious and consistent after evaluating the agglomeration table and plots. Clusters were finalized using k-means cluster analysis; differences were tested through an analysis of variance (ANOVA) with Games-Howell post hoc testing. Parental Nurturance has high nurturance and low levels of psychological control from both parents. Parental Repression has high levels of psychological control and low levels of nurturance from both parents. Parental Equivocation has high levels of both parental nurturance and psychological control. Maternal Mitigation has high levels of maternal nurturance and paternal psychological control, and low levels of maternal psychological control and paternal nurturance. Parental Nurturance had the highest levels of depth and breadth of exploration, identification with commitment and commitment making, and use of reappraisal. The Maternal Mitigation profile was similar in outcomes. The Parental Equivocation and Parental Repression profiles were significantly lower on identity commitment and reappraisal and significantly higher on ruminative exploration and suppression.

Relationship between parental psychological control and children’s academic achievement in China: The role of children’s failure mindsets

Abstract The research on the relationship between parental psychological control and children’s academic achievement in East Asia is limited and has yielded inconsistent results. Based on family system theory, the current study examined the unique and interactive association between children’s academic achievement with maternal and paternal psychological control. The moderating role of children’s failure mindsets was also examined. The sample included 2583 Chinese primary children (1287 girls, 49.8%, mean age = 10.33) and their parents (the mean ages were 35.97 for the mothers and 36.82 for the fathers). The results indicated that maternal and paternal psychological control were interactively linked to children’s achievement. Specifically, the negative association between one parent’s psychological control and the child’s achievement was significant only when the other parent exerted a higher level of psychological control. The positions of fathers and mothers were similar. Moreover, the children’s failure mindset was not only directly linked to achievement but also moderated the association with paternal psychological control. Children with higher debilitating failure mindsets (scored 1 SD above the mean) suffered more from paternal psychological control than those with lower debilitating failure mindsets (scored 1 SD below the mean.). The findings suggested that both the parenting and children’s characteristics were associated with the children’s academic performance. Future interventions might be more efficient from a family system perspective.

The impact of children’s socioemotional development on parenting styles: the moderating effect of social withdrawal

ABSTRACT This study focused on associations between children’s socioemotional development (prosocial behaviour, internalizing and externalizing problems) and parenting styles (affection, behavioural control, and psychological control), and the moderating role of children’s social withdrawal (as a temperamental characteristic) in these associations. Children’s socioemotional development (n = 314) were rated by teachers at three-time points (grades 1–3). Parents completed questionnaires measuring their parenting styles at the same three-time points. The level of social withdrawal was obtained at the end of kindergarten from teachers’ reports. Panel analysis showed that prosocial behaviour was associated with a higher level of affection, while externalizing problems were associated with a higher level of behavioural control. Among children with a high level of social withdrawal, prosocial behaviour predicted high maternal psychological control, while internalizing problems predicted high paternal psychological control. However, among children with a low level of social withdrawal, socioemotional development had no impact on parenting styles.

Adolescents' somatic complaints in eight countries: what influence do parental rearing styles have?

Medically unexplained physical symptoms are frequently named by adolescents in both clinical and normative samples. This study analyzed the associations between parental rearing styles and adolescents' body complaints in diverse cultural contexts. In a cross-cultural study of 2415 adolescents from eight countries (Argentina, France, Germany, Greece, Pakistan, Peru, Poland, and Turkey), the associations of maternal and paternal support, psychological control, and an anxious parental monitoring style with youth body complaints were tested. Girls reported more somatic complaints than boys, the level of complaints differed between countries, and gender differences varied significantly between countries. Hierarchic multilevel models revealed that the expression of distress via body complaints, after controlling for country, gender, and sociodemographic status, was significantly associated with parental rearing styles. The negative impact of mothers' psychological control on body complaints generalize across countries. In addition, mothers' anxious monitoring had a negative impact on the offspring's health, whereas higher levels of paternal support and lower levels of paternal psychological control contributed to lower levels of somatic complaints. Sociodemographic variables such as family structure, standard of living, and employment status of the parents, did not turn out as significant in the final model. The findings point to the different roles of fathers and mothers play in adolescents' health and their complex interplay.

Associations between Parental Psychological Control and Externalizing Problems: The Roles of Need Frustration and Self-control

Our study aimed to develop our understanding of the relationship between parental psychological control and externalizing behaviors among adolescents. We investigated the fit of a theoretical model in which need frustration and self-control were specified as sequential mediators between parental psychological control and externalizing behaviors. A sample of Chinese adolescents and their parents participated in the research. These seventh and ninth graders (n = 1118, mean age = 14.52 years, SD = 1.65) reported perceived maternal and paternal psychological control, and reported their own experience of need frustration and self-rated levels of self-control. Externalizing problems were rated by both parents. The results of structural equation modeling revealed analogous structural associations between perceived maternal and paternal psychological control and externalizing problems. Overall, psychological control was directly associated with externalizing behaviors in the maternal model (β = 0.24, p < 0.01) and paternal model (β = 0.26, p < 0.01). Parental psychological control was associated exclusively and sequentially with externalizing behaviors via need frustration and self-control (for the maternal model: β = 0.13, p < 0.05, 95% CI = [0.02, 0.24]; for the paternal model: β = 0.13, p < 0.05, 95% CI = [0.02, 0.24]). By introducing need frustration and self-control as intervening factors and by demonstrating their sequential effects, our study helps to clarify the mechanisms underlying the links between parental psychological control and externalizing problems.

Longitudinal associations between neuropsychological functioning and medical responsibility in youth with spina bifida: The moderational role of parenting behaviors

ABSTRACT For youth with spina bifida (SB), the transfer of medical responsibilities from parent- to self-management is an important component of autonomy development. Youth with SB are at risk for neurocognitive impairments with inattention and executive dysfunction, which may impact their ability to take responsibility for medical tasks. However, adaptive parenting may buffer against the negative impact of executive/attentional dysfunction on levels of medical responsibility. Thus, this study examined the moderating roles of parenting behaviors and child age on the longitudinal associations between neuropsychological functioning and medical responsibility in youth with SB. Participants were recruited as part of a larger, longitudinal study. Youth with SB (N = 89, M age = 11.10 years) completed a neuropsychological battery of executive functioning and attention measures at Time 1 (T1). Parents reported on youth’s executive functioning/attention skills at T1, and child medical responsibility two years later at Time 2 (T2). Observational methods were used to assess parenting behaviors (warmth, behavioral and psychological control) at T1. Attention and cognitive shifting skills at T1 were positively related to child medical responsibility at T2. Two-way interactions between planning/organizing skills and paternal acceptance, and planning/organizing skills and paternal psychological control, were found. A three-way interaction between cognitive shifting skills, maternal acceptance, and child age was found. When conceptualizing risk factors for low medical responsibility in youth with SB, it is important to consider the family context beyond individual, cognitive factors. The results are discussed within the wider context of social-ecological models of medical responsibility.